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Panakkal N, Lekshmi A, Saraswathy VV, Sujathan K. Effective lung cancer control: An unaccomplished challenge in cancer research. Cytojournal 2023; 20:16. [PMID: 37681073 PMCID: PMC10481856 DOI: 10.25259/cytojournal_36_2022] [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: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 09/09/2023] Open
Abstract
Lung cancer has always been a burden to the society since its non-effective early detection and poor survival status. Different imaging modalities such as computed tomography scan have been practiced for lung cancer detection. This review focuses on the importance of sputum cytology for early lung cancer detection and biomarkers effective in sputum samples. Published articles were discussed in light of the potential of sputum cytology for lung cancer early detection and risk assessment across high-risk groups. Recent developments in sample processing techniques have documented a clear potential to improve or refine diagnosis beyond that achieved with conventional sputum cytology examination. The diagnostic potential of sputum cytology may be exploited better through the standardization and automation of sputum preparation and analysis for application in routine laboratory practices and clinical trials. The challenging aspects in sputum cytology as well as sputum-based molecular markers are to ensure appropriate standardization and validation of the processing techniques.
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Affiliation(s)
- Neeraja Panakkal
- Division of Cancer Research, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Asha Lekshmi
- Division of Cancer Research, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | - Kunjuraman Sujathan
- Division of Cancer Research, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Mohapatra MM, Rajaram M, Gochhait D, Kumar SV, Chakkalakkoombil SV. Can combined non-invasive methods improve diagnosis of lung cancer? J Cancer Res Ther 2023; 19:1142-1147. [PMID: 37787276 DOI: 10.4103/jcrt.jcrt_906_21] [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] [Indexed: 10/04/2023]
Abstract
Background Lung cancer is the most common malignancy in both gender. Early diagnosis is needed to reduce morbidity and mortality. There is a debate about the most accurate investigating modality for the diagnosis of lung cancer. Methods It is a retrospective cohort analysis to determine whether an approach of combined contrast-enhanced computed tomography (CECT) thorax with bronchoscopy method has higher sensitivity and specificity than combined CECT thorax with sputum cytology method. Records of patients with lung cancer who had visited the hospital within the last 6 months were retrospectively analyzed for their diagnostic modality. SPSS version 19 software was used for statistical analysis of the data. CECT scan thorax, bronchoscopy, and sputum cytology for lung cancer patients were analyzed. The CECT thorax plus bronchoscopy method was compared with the CECT thorax plus sputum cytology method. Their sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in diagnosing lung cancer were analyzed. Results Sixty-two patients were considered, including 62.9% males with a mean age of 55.5 years. In patients diagnosed with lung cancer, CECT thorax combined with bronchoscopy method was found to have a sensitivity of 96.67% than CECT thorax combined with sputum cytology method with a sensitivity of 90% and the difference in sensitivity between all individual approaches as well as the combined method was statistically significant with a P = 0.00001 and Chi-square value of 86.5909 owing to the low sensitivity of sputum cytology. CECT thorax combined with sputum cytology approach had a better specificity than CECT thorax combined with bronchoscopy. Conclusion Combined CECT thorax with sputum cytology method has a better specificity in diagnosing lung cancer than combined CECT thorax with bronchoscopy method.
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Affiliation(s)
| | - Manju Rajaram
- Department of Pulmonary Medicine, JIPMER, Puducherry, India
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Pandey N, Chongtham J, Pal S, Ali A, Lalwani S, Jain D, Mohan A, Srivastava T. When "No-Smoking" is not enough: Hypoxia and nicotine acetylcholine receptor signaling may drive lung adenocarcinoma progression in never-smokers. BIOCHIMICA ET BIOPHYSICA ACTA. MOLECULAR CELL RESEARCH 2023; 1870:119302. [PMID: 35649481 DOI: 10.1016/j.bbamcr.2022.119302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 01/03/2023]
Abstract
The question of how lung cancer progresses in never-smokers remains largely unanswered. In our analysis of data from 1727 lung cancer patients, we observed a difference of only 47 days in the overall survival between lung adenocarcinoma patients who were smokers vis-a-vis never-smokers - the disease has a poor prognosis irrespective of the smoking status, or gender. We have investigated the possible collaboration between the nAChR and hypoxia signaling pathway to explicate a mechanism of disease progression in never-smokers using patient-derived tumor cells. We found a previously unidentified increase in both acetylcholine and nAChR-α7 levels in non-small cell lung cancer cells in hypoxia. A similar increase in ubiquitously expressed nAChR-α7 transcripts was also observed in other cancer lines and primary tumor tissues. A direct binding of HIF-1α with the hypoxia-response element (HRE) present at -48 position preceding the transcriptional start site in nAChR-α7 promoter region was established. Crucially, the increased acetylcholine levels in hypoxia drove a feedback loop via modulation of PI3K/AKT pathway to stabilize HIF-1α in hypoxia. Further, hypoxia-mediated metastasis and induction of HIF-1α in these cells was significantly reversed by bungarotoxin, an antagonist of nAChR-α7. The nAChR-AKT-HIF network needs to be further investigated to conclusively prove its mechanism and to explore its therapeutic potential. Our study gives a plausible explanation for the equally worse prognosis of lung adenocarcinoma in never-smokers wherein the nAChR signaling is enhanced in hypoxia by acetylcholine in the absence of nicotine.
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Affiliation(s)
- Namita Pandey
- Department of Genetics, University of Delhi South Campus, New Delhi, India; Clinical Genomic Knowledgebase, PierianDx, Pune, Maharashtra, India
| | - Jonita Chongtham
- Department of Genetics, University of Delhi South Campus, New Delhi, India.
| | | | - Ashraf Ali
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Lalwani
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tapasya Srivastava
- Department of Genetics, University of Delhi South Campus, New Delhi, India.
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Muacevic A, Adler JR, Mehfooz N, Sofi MA, Syed NA, Dar NA, Choh NA, Qadri SK, Bhat GM. Clinicopathological Profile of Non-small Cell Lung Cancer and the Changing Trends in Its Histopathology: Experience From a Tertiary Care Cancer Center in Kashmir, India. Cureus 2023; 15:e34120. [PMID: 36843703 PMCID: PMC9949994 DOI: 10.7759/cureus.34120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Background The overall frequency and incidence of different cancers across the globe, including lung cancer, are marked by ethnic and geographical variations. Lung cancer is the most commonly diagnosed cancer worldwide that inflicts most of the cancer deaths. Non-small cell lung cancer (NSCLC) constitutes most lung cancer cases. The aim of this study was to find the frequency and clinicopathological characteristics of NSCLC in high incidence zone of Kashmir, an ethnically and geographically distinct area in Northern India. Material and methods The study was conducted to evaluate the clinicopathological profile of NSCLC at a tertiary care cancer center, Sher-I-Kashmir Institute of Medical Sciences (SKIMS). The patients and case records were analyzed for clinical presentation and demographic features, smoking status, radiological features, histopathological type, and stage of their disease at presentation. Results The study included 1557 NSCLC patients registered over a period of seven years, i.e., 2008-2014. Most of the patients belonged to rural areas (70%). The median age of the whole cohort was 58.0 years (ranges 22-95 years), and the male-to-female ratio was 3.7:1 (male = 1231 and female = 326). Smokers comprised 77.39% of cases, and Hookah was the most common form of smoking (65.06%). The ratio of squamous cell carcinoma and adenocarcinoma was 3.7:1 (67.5% vs. 24.9%). Stage III and IV disease accounted for 93% of cases (30.6% and 62.7%, respectively). Squamous cell carcinoma histopathology was dominant in smokers (74.3%) compared to adenocarcinoma (19%), while squamous cell carcinoma and adenocarcinoma histopathology ran parallel in nonsmokers (45.1% and 44%, respectively). Most of the patients had an Eastern Cooperative Oncology Group (ECOG) performance status between 1 and 2 (79%). Conclusion We conclude Kashmir region is a very high-risk area for lung cancer, with NSCLC showing a high incidence. Most of our patients present in advanced stages, and the frequency of adenocarcinoma is showing an increasing trend over the years from 2008-2014.
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Chandrasekharan A. Driver Mutations in Lung Cancer-Mapping the Way Forward. South Asian J Cancer 2022; 11:181-182. [PMID: 36588608 PMCID: PMC9803547 DOI: 10.1055/s-0042-1758549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Arun Chandrasekharan
- Aster Malabar Institute of Medical Sciences, Govindapuram, Kozhikode, Kerala, India,Address for correspondence Arun Chandrasekharan, MD, DM Aster Malabar Institute of Medical SciencesGovindapuram, Kozhikode 673016, KeralaIndia
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Muacevic A, Adler JR, Mehta A. Lung Cancer in Non-Smokers: Clinicopathological and Survival Differences from Smokers. Cureus 2022; 14:e32417. [PMID: 36644085 PMCID: PMC9833623 DOI: 10.7759/cureus.32417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background Lung cancer in non-smokers is a clinically distinct entity based on unique epidemiology, clinicopathology, genetics, treatment response, and outcome. Data from Indian centres are scarce. The objective of this study was to compare the frequency, clinical characteristics, driver mutations, and survival of non-smoking and smoking lung cancer patients treated at a tertiary cancer centre in North India. Methodology Two years of data on 724 consecutive lung cancer patients were assessed. Clinical, demographics, smoking history, and EGFR and ALK mutation test results were collected. Descriptive and inferential statistics were applied. Survival analysis was performed using the Kaplan-Meier method. Results Non-smokers comprised 40.9% of the study sample. Non-smokers were more likely than smokers to experience disease onset at a younger age (P = 0.004) and metastasis (P < 0.001). The tumor histology showed significant differences (P < 0.001), with non-smokers more likely to be diagnosed with adenocarcinoma (77.4%), while squamous and small cell histologies were commonly found among smokers (37.6% and 13.8%, respectively). The EGFR mutation and ALK rearrangement rates in the cohort were 23.3% and 10.1%, respectively, and were more frequent in non-smoking patients. Overall, 10-year survival was 7%, with a significantly better survival rate of non-smokers than smokers (median survival time of 15.13 vs 10.17 months; P = 0.012). Conclusions About four out of 10 patients diagnosed with lung cancer at our centre were non-smokers. They were more often young, diagnosed at an advanced stage, with predominantly adenocarcinoma histology, and had a threefold higher frequency of EGFR mutations than smokers. In our cohort, non-smokers appear to be a targetable group with better survival than smokers.
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Boukansa S, Benbrahim Z, Gamrani S, Bardai S, Bouguenouch L, Mazti A, Boutahiri N, Serraj M, Amara B, Ouadnouni Y, Smahi M, Alami B, Mellas N, El Fatemi H. Correlation of Epidermal Growth Factor Receptor Mutation With Major Histologic Subtype of Lung Adenocarcinoma According to IASLC/ATS/ERS Classification. Cancer Control 2022; 29:10732748221084930. [PMID: 35348028 PMCID: PMC8969502 DOI: 10.1177/10732748221084930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Our prospective study aims to define the correlation of EGFR(epidermal growth factor receptor) mutations with major histological subtypes of lung adenocarcinoma from resected and non-resected specimens, according to the WHO 2015 classification, in Moroccan North East Population. METHODS Epidermal growth factor receptor mutations of 150 primary lung adenocarcinoma were performed using Real-Time PCR or SANGER sequencing. SPSS 21 was used to assess the relationship between histological subtypes of lung adenocarcinoma and EGFR mutation status. RESULTS 25 mutations were detected in the series of 150 lung adenocarcinomas, most of which were found in cases with papillary, acinar, patterns than without these patterns and more frequently occurred in the cases without solid pattern than with this pattern. A significant correlation was observed between EGFR mutation and acinar (P = 0,024), papillary pattern (P = 0,003) and, negative association with a solid pattern (P < 0,001). In females, EGFR mutations were significantly correlated with the acinar pattern (P = 0,02), whereas in males with the papillary pattern (P = 0,01). Association between the histologic component and exon 19 deletions and exon 21 mutations were also evaluated and, we found a significant correlation between the papillary major pattern with exon 19 mutations (P = 0,004) and, ex21 with the acinar component (P = 0,03). CONCLUSION An analysis of resected and non-resected lung ADC specimens in 150 Moroccan Northeast patients, revealed that acinar and papillary patterns may predict the presence of a mutation in the EGFR gene. While the solid major pattern may indicate a low mutation rate of the EGFR gene.
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Affiliation(s)
- Sara Boukansa
- Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Zineb Benbrahim
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Sanaa Gamrani
- Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Sanae Bardai
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Laila Bouguenouch
- Unit of Medical Genetics and Oncogenetics, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Asmae Mazti
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Nadia Boutahiri
- Department of Pneumology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mounia Serraj
- Department of Pneumology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Bouchra Amara
- Department of Pneumology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of Radiology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Nawfel Mellas
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hinde El Fatemi
- Faculty of Medicine and Pharmacy, Laboratory of Biomedical and Translational Research, Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Anatomic Pathology and Molecular Pathology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Ramani VK, Ganesha DV, Naik R. A Narrative Review of the Risk Factors for Cancer and the Preventive Opportunities: Current Status, Future Perspectives, and Implications for India. ASIAN JOURNAL OF ONCOLOGY 2021. [DOI: 10.1055/s-0041-1731092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Clinical cancer can arise from heterogenous pathways through various genetic mutations. Although we cannot predict the timeline by which an individual will develop cancer, certain risk assessment tools can be used among high-risk groups for focusing the preventive activities. As primary level of cancer prevention, healthy lifestyle approach is being promoted. The etiological factors for lung cancer include by-products of industrialization and air pollution. We need to factor the increase in household air pollution as well.
Methods “PubMed” database and Google search engines were used for searching the relevant articles. Search terms with Boolean operators used include “Cancer prevention,” “Missed opportunities in cancer causation,” and “incidence of risk factors.” This review includes 20 studies and other relevant literature that address the opportunities for cancer prevention.
Body The narrative describes the association between many of the risk factors and development of cancer. This includes tobacco, alcohol, infections, air pollution, physical inactivity, diet, obesity, screening and preventive strategies, chemoprevention, biomarkers of carcinogenesis, and factors that prolong the diagnosis of cancer.
Discussion Reports from basic science research provide evidence on the potential of biologically active food components and pharmacological agents for mitigating the risk of cancer and its progression. However, some reports from observational studies and randomized trials have been inconsistent. We need to recognize the impact of sociodemographic factors such as age, sex, ethnicity, culture, and comorbid illness on preventive interventions. Spiral computed tomographic scan is a robust tool for early detection of lung cancer.
Conclusion Infectious etiology for specific cancers provides opportunities for prevention and treatment. The complex interplay between man and microbial flora needs to be dissected, for understanding the pathogenesis of relevant malignancies. For reducing the morbidity of cancer, we need to focus on prevention as a priority strategy and intervene early during the carcinogenic process.
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Affiliation(s)
- Vinod K. Ramani
- Department of Preventive Oncology, Healthcare Global Enterprise Ltd., Bangalore, Karnataka, India
- Department of Public health, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
| | - D. V. Ganesha
- Department of Medical Oncology, St. John’s Medical College and Hospital, Bangalore, Karnataka, India
| | - Radheshyam Naik
- Department of Medical Oncology, Healthcare Global Enterprise Ltd., Bangalore, India
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Khanna VK, Ghosh S, MacMahon H, Mehta AC. Criteria for Low-Dose CT Lung Cancer Screening in the Setting of Air Pollution: A Discussion That Is Long Overdue. Chest 2021; 159:42-45. [PMID: 33422207 DOI: 10.1016/j.chest.2020.08.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Vineet K Khanna
- Veterans Affairs Medical Center, Department of Radiology, Columbus, OH.
| | - Subha Ghosh
- Cleveland Clinic Foundation, Radiology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Heber MacMahon
- Department of Radiology, University of Chicago Medical Center, Chicago, IL
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic Foundation, Respiratory Institute, Cleveland, OH
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Agarwal JP, Tibdewal A, Mohanty S, Mummudi N. Radiotherapy of brain metastasis from lung cancer in limited resource settings. J Thorac Dis 2021; 13:3308-3314. [PMID: 34164223 PMCID: PMC8182549 DOI: 10.21037/jtd-2019-rbmlc-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiotherapy is one of the most commonly used treatment modality for brain metastases from lung cancer. Its use has evolved from conventional whole brain radiation therapy (WBRT) to more sophisticated stereotactic radiosurgery (SRS) and hippocampal sparing radiotherapy. Indications of cranial radiotherapy are also evolving with the advent of targeted therapies directed against molecular markers like epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). Prognostic criteria such as recursive partitioning analyses and graded prognostic score helps in prognostication of brain metastases patients. Majority of the prospective and randomized studies of brain metastases from lung cancer have come from the developed countries with adequate resources. Efforts have been made to replicate or validate the data in developing countries. In this overview, we intend to discuss the role of radiotherapy for brain metastases in limited resource settings of developing countries. The aim should be to generate a good quality data which is applicable for routine clinical practice in a resource friendly manner. SRS is indicated in guidelines for limited brain metastases, however, it requires a more sophisticated treatment delivery and quality assurance machines which are not available at many centres in majority of the developing countries. Similarly, clinical research should be undertaken considering the demographic, clinical and genetic differences among different populations. Currently, tyrosine kinase inhibitors have dramatically changed the outcomes of metastatic non-small cell lung cancer including brain metastases. The role of WBRT is being questioned in driver mutated patients in developed countries. However, the applicability of this approach should be examined in resource constrained settings as availability of these drugs is limited, its higher cost and frequent use of surveillance brain imaging are the practical challenges.
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Affiliation(s)
- Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial centre, Homi Bhabha National Institute, Mumbai, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial centre, Homi Bhabha National Institute, Mumbai, India
| | - Sulagna Mohanty
- Department of Radiation Oncology, Tata Memorial centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial centre, Homi Bhabha National Institute, Mumbai, India
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Noronha V, Ravind R, Patil VM, Mokal S, Joshi A, Menon N, Kapoor A, Mahajan A, Janu A, Nakti D, Shah L, Shah S, Prabhash K. The role of chemotherapy in patients with small cell lung cancer and poor performance status. Acta Oncol 2020; 59:1520-1527. [PMID: 32924733 DOI: 10.1080/0284186x.2020.1819562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There are limited data on the role of chemotherapy in patients with small cell lung cancer (SCLC) and poor performance status (PS). METHODS This was a retrospective analysis of a prospective observational study in patients with SCLC and PS 3 or 4. We recorded the initial therapy, symptom improvement, response rate, overall survival (OS), and the impact of various factors on OS. RESULTS From June 2010 to August 2019, we enrolled 234 patients; 185 (79%) with PS 3 and 49 (21%) PS 4. Initial therapy was best supportive care (BSC) in 49 patients (21%), standard full dose chemotherapy in 31 (13%), and attenuated chemotherapy in 154 (66%). In 89% patients treated with attenuated chemotherapy, symptom-relief occurred at a median of 3 days (IQR, 1-7). Grade 3 and higher toxicities developed in 60% patients treated with initial attenuated chemotherapy, commonly hyponatremia in 39%, neutropenia in 16%, anemia in 11%, and infection in 10%. Grade 3 and higher toxicities as a result of standard chemotherapy occurred in 89% patients treated with upfront standard full dose chemotherapy compared to 69% of patients who received initial attenuated chemotherapy with subsequent treatment escalation. Overall, there were 6 (2.6%) toxic deaths. The response rate to chemotherapy was 77%. The median OS of the patients who received any chemotherapy was significantly longer at 6 months (95% CI, 4.8-7.2) compared to 1 month (95% CI, 0.4-1.6 months) in patients who were managed with BSC, p < 0.001; hazard ratio, 0.39 (95% CI, 0.27-0.56). The disease stage, lactate dehydrogenase level, and receipt of chemotherapy significantly impacted survival. CONCLUSION Chemotherapy prolongs survival in patients with SCLC and poor PS. Administering an initial attenuated chemotherapy regimen followed by standard full-dose chemotherapy when the PS improves may lower toxicity and improve tolerance.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rahul Ravind
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijay M. Patil
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Smruti Mokal
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Clinical Research Secretariat, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Amit Janu
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
| | - Dipti Nakti
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Leena Shah
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srushti Shah
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
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Meena DS, Kumar D, Bohra GK, Midha N. Gefitinib induced severe hyponatremia: A case report. J Oncol Pharm Pract 2020; 27:711-715. [PMID: 32686614 DOI: 10.1177/1078155220942302] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Evolution of targeted molecular therapies has greatly improved patient survival in cancer. Gefitinib is an oral, reversible, epidermal growth factor receptor inhibitor used in advance non-small cell lung cancer. Skin rashes and diarrhea are common adverse effects associated with gefitinib. However, electrolytes disorders are rarely reported with gefitinib, particularly hyponatremia. CASE REPORT We describe a 65-year-old male with metastatic non-small cell lung cancer treated with gefitinib for the last three weeks. He presented to our hospital with complaints of acute onset drowsiness. On evaluation of drowsiness, patient was diagnosed with severe hyponatremia.Management and outcome: After ruling out other common causes of hyponatremia, gefitinib was attributed as a cause of hyponatremia. Gefitinib was immediately stopped and IV hypertonic saline (3% sodium chloride) was started due to severe symptomatic hyponatremia. After seven days of cessation of gefitinib, he became asymptomatic with normalisation of serum sodium levels. DISCUSSION Hyponatremia in cancer patients is associated with poor prognosis and prolonged hospital stay. Possibility of gefitinib-induced hyponatremia should be considered in order to achieve early diagnosis and prevent significant mortality in cancer patients.
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Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Gopal Krishana Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
| | - Naresh Midha
- Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, India
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Non-small cell lung cancer in never- and ever-smokers: Is it the same disease? J Thorac Cardiovasc Surg 2020; 161:1903-1917.e9. [PMID: 32893009 DOI: 10.1016/j.jtcvs.2020.03.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To investigate differences in presentation, pathology, and outcomes after resection of non-small cell lung cancer (NSCLC) in never-smokers versus ever-smokers. METHODS From January 2006 to July 2016, 172 never-smokers and 1376 ever-smokers with NSCLC underwent pulmonary resection. The 2 cohorts were matched on patient characteristics, histopathological cancer cell type, and pathological stage group using a weighted balancing score, and overall survival and cancer recurrence were compared by pathological stage. Random forests for survival was used to identify granular cancer characteristics with different survival and cancer recurrence importance between groups. RESULTS In never-smokers, the prevalence of NSCLC was more frequent in women than in men (63% [n = 109] vs 45% [n = 63]). Compared with ever-smokers, never-smokers had less upper-lobe disease (53% [n = 91] vs 62% [n = 855]) and more adenocarcinoma (88% [n = 151] vs 62% [n = 845]). Postoperative complications were similar. Never-smokers had a lower prevalence of non-lung cancer deaths than ever-smokers (13% vs 23% at 5 years; P = .006). Among matched pairs, never-smokers had better overall survival at 5 years in pathological stage I (96% vs 78%), but worse survival in stage II (54% vs 78%). Tumor size, N category, and histopathological cell type were more important drivers of mortality and cancer recurrence in never-smokers than in ever-smokers. CONCLUSIONS NSCLC in never-smokers affects women more than men and presents with different anatomic and histopathological distributions. Matched never-smokers have better or equivalent outcomes than ever-smokers in pathological stage I cancer, but are less likely to survive and to be cured of cancer as tumor burden increases. These findings suggest that there might be unique tumor or host behaviors differentially impacting survival of never- and ever-smoking patients with NSCLC.
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Domvri K, Porpodis K, Zisi P, Apostolopoulos A, Cheva A, Papamitsou T, Papakosta D, Kontakiotis T. Epidemiology of lung cancer in Northern Greece: An 18-year hospital-based cohort study focused on the differences between smokers and non-smokers. Tob Induc Dis 2020; 18:22. [PMID: 32265616 PMCID: PMC7132575 DOI: 10.18332/tid/118718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/24/2020] [Accepted: 03/03/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Lung cancer remains a leading cause of cancer incidence, yet, in Greece, country-level registry-based data are limited. We have thus investigated the epidemiology of lung cancer and its trends in the George Papanikolaou Hospital, Northern Greece over 18 years (2000–2018). METHODS We analyzed all the cases reported in the Bronchoscopy Unit of the Hospital for the period 2000–2018. In total, 15131 subjects (12300 males and 2831 females) that presented with a mass in the imaging, were submitted to bronchoscopy. Characteristics of patients such as age, sex, smoking history and occupation were collected. Statistical analysis was performed with SPSS 21.0 software package. RESULTS Among all subjects, a total of 5628 (37.2%; mean age: 65.85 ± 9.6 years) cases of primary lung cancer were identified with a male to female ratio of 2:1 (41.1% to 20.4%) (p<0.001). Squamous cell lung cancer was the most common type of lung cancer identified in this population (44%) with a higher proportion in males compared to females (p<0.001). Furthermore, adenocarcinoma was mostly observed in female non-smokers compared to males (p<0.001). The majority of lung cancer cases were identified in patients occupied with agriculture and livestock breeding (41.1%). The mean age at lung cancer diagnosis was 66.13 ± 9.19 years for the whole study population. Lung cancer cases observed with a higher mean of 43.93 ± 10.84 years of smoking compared to cancer-free patients with 39.64 ± 13.23 years of smoking (p<0.001). CONCLUSIONS Apart from smoking, demographic characteristics including age, sex and occupation appear to have an impact on lung cancer development in this population. Smoking history alone could not predict the development of lung cancer in the studied northern Greek population.
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Affiliation(s)
- Kalliopi Domvri
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Konstantinos Porpodis
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Panagiota Zisi
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Apostolos Apostolopoulos
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Angeliki Cheva
- Laboratory of Pathology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Papamitsou
- Laboratory of Histology-Embryology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, George Papanikolaou Hospital, Thessaloniki, Greece
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Pandey A, Singh A, Singh S, Shahi H, Kumar A, Kumari A, Das A. Smoking Pattern among Rural Indian Cancer Patients: A Prospective Survey. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_56_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Smoking predisposes to cancer. Prevalence and pattern of smoking among rural Indian cancer patients is unknown. Aim: The aim of the study was to estimate the prevalence of smoking in cancer patients. Objective: The objective of the study was to estimate the type of smoking and pattern in cancer patients and correlate with clinical and demographic variables through a prospective survey. Materials and Methods: All consecutive individual adult (age >18 years) patients diagnosed with any cancer and registered in the medical oncology outpatient department were enrolled for questionnaire-based survey on smoking between July 2017 and October 2017. Demographic variables were also recorded including income, education, and occupation. Frequency distribution and cross tabulation were used for the statistical analysis using SPSS version 17. Results: Of 517 cancer patients enrolled, 456 (88%) were rural. The prevalence of smoking was 125/517 (0.24, 95% confidence interval – 0.20–0.27). Among them, 67 (54%) were bidi smokers, while 58 (46%) smoked cigarette. Majority had smoking history of more than 20 years (40%), while 20% were recent smokers, <5 years. Hundred out of one hundred twenty-five (80%) patients were male, while 24/25 (96%) women smoked bidi. More than 56% of the bidi smokers were illiterate, while the majority of cigarette smokers (50%) had completed high secondary schooling. The majority of bidi (63%) and cigarette smokers (62%) had monthly income <Rs. 10,000. Almost 98% of bidi smokers and 77% of cigarette smoking population were rural. Farmers and laborers had higher prevalence of smoking, 35/96 (53%) and 28/70 (40%), respectively, while 11% of housewives were bidi smokers. Nearly 40% of head-and-neck cancer and 48% of lung cancer patients had a smoking history, with 65% and 76% being bidi smokers among them, respectively. Conclusion: One in four cancer patients smoke. Most of the smokers are illiterate with low socioeconomic profile and predominantly laborers and farmers. Bidi is the predominant type of smoking.
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Affiliation(s)
- Avinash Pandey
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anjana Singh
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Shivkant Singh
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Heena Shahi
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Amit Kumar
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Aishwarya Kumari
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anshuman Das
- Department of Medical Oncology, State Cancer Institute, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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Noronha V, Patil VM, Joshi A, Menon N, Chougule A, Mahajan A, Janu A, Purandare N, Kumar R, More S, Goud S, Kadam N, Daware N, Bhattacharjee A, Shah S, Yadav A, Trivedi V, Behel V, Dutt A, Banavali SD, Prabhash K. Gefitinib Versus Gefitinib Plus Pemetrexed and Carboplatin Chemotherapy in EGFR-Mutated Lung Cancer. J Clin Oncol 2020; 38:124-136. [PMID: 31411950 DOI: 10.1200/jco.19.01154] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Standard first-line therapy for EGFR-mutant advanced non-small-cell lung cancer (NSCLC) is an epidermal growth factor receptor (EGFR)-directed oral tyrosine kinase inhibitor. Adding pemetrexed and carboplatin chemotherapy to an oral tyrosine kinase inhibitor may improve outcomes. PATIENTS AND METHODS This was a phase III randomized trial in patients with advanced NSCLC harboring an EGFR-sensitizing mutation and a performance status of 0 to 2 who were planned to receive first-line palliative therapy. Random assignment was 1:1 to gefitinib 250 mg orally per day (Gef) or gefitinib 250 mg orally per day plus pemetrexed 500 mg/m2 and carboplatin area under curve 5 intravenously every 3 weeks for four cycles, followed by maintenance pemetrexed (gefitinib plus chemotherapy [Gef+C]). The primary end point was progression-free survival (PFS); secondary end points included overall survival (OS), response rate, and toxicity. RESULTS Between 2016 and 2018, 350 patients were randomly assigned to Gef (n = 176) and Gef+C (n = 174). Twenty-one percent of patients had a performance status of 2, and 18% of patients had brain metastases. Median follow-up time was 17 months (range, 7 to 30 months). Radiologic response rates were 75% and 63% in the Gef+C and Gef arms, respectively (P = .01). Estimated median PFS was significantly longer with Gef+C than Gef (16 months [95% CI, 13.5 to 18.5 months] v 8 months [95% CI, 7.0 to 9.0 months], respectively; hazard ratio for disease progression or death, 0.51 [95% CI, 0.39 to 0.66]; P < .001). Estimated median OS was significantly longer with Gef+C than Gef (not reached v 17 months [95% CI, 13.5 to 20.5 months]; hazard ratio for death, 0.45 [95% CI, 0.31 to 0.65]; P < .001). Clinically relevant grade 3 or greater toxicities occurred in 51% and 25% of patients in the Gef+C and Gef arms, respectively (P < .001). CONCLUSION Adding pemetrexed and carboplatin chemotherapy to gefitinib significantly prolonged PFS and OS but increased toxicity in patients with NSCLC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Nandkumar Kadam
- Gunvati J. Kapoor Medical Relief Charitable Foundation, Mumbai, India
| | - Nilesh Daware
- Gunvati J. Kapoor Medical Relief Charitable Foundation, Mumbai, India
| | | | | | | | | | | | - Amit Dutt
- Advanced Centre for Treatment, Research and Education in Cancer, Navi Mumbai, India
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Mohan A, Garg A, Gupta A, Sahu S, Choudhari C, Vashistha V, Ansari A, Pandey R, Bhalla AS, Madan K, Hadda V, Iyer H, Jain D, Kumar R, Mittal S, Tiwari P, Pandey RM, Guleria R. Clinical profile of lung cancer in North India: A 10-year analysis of 1862 patients from a tertiary care center. Lung India 2020; 37:190-197. [PMID: 32367839 PMCID: PMC7353932 DOI: 10.4103/lungindia.lungindia_333_19] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: Over the past few years, the demographic profile of lung cancer has changed. However, most reports are limited by small numbers, short follow-up period, and show an inconsistent pattern. A comprehensive evaluation of changing trends over a long period has not been done. Materials and Methods: Consecutive lung cancer patients were studied over a 10-year period from January 2008 to March 2018 at the All India Institute of Medical Sciences, New Delhi, and relevant clinical information, and survival outcomes were analyzed. Results: A total of 1862 patients were evaluated, with mean (SD) age of 59 (11.1) years, and comprising 82.9% males. Majority were smokers (76.2%) with median smoking index of 500 (interquartile range [IQR]: 300–800). Adenocarcinoma (ADC) was the most common type (34%), followed by squamous cell carcinoma (SCC – 28.6%) and small cell lung cancer (SCLC) (16.1%). Over the 10-year period, ADC increased from 9.5% to 35.9%, SCC from 25.4% to 30.6%, and non-small cell lung cancer -not otherwise specified (NSCLC-NOS) decreased from 49.2% to 21.4%. The proportion of females with lung cancer increased although smoking rates remained similar. Majority of NSCLC (95%) continued to be diagnosed at an advanced stage (3 or 4). Epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) rearrangements were present in 25.3% and 11.5% ADC patients, respectively. The median overall survival was 8.8 months (IQR 3.7–19) for all patients and 12.57 (IQR 6.2–28.7) months among the 1013 patients who were initiated on specific treatment (chemotherapy, targeted therapy, radiotherapy, or surgery). Never-smokers were younger, more likely to be female and educated, had a higher prevalence of ADC and EGFR/ALK mutations, and had better survival. Conclusion: Among this large cohort, our center seems to follow the global trend with increasing incidence of ADC. EGFR mutation positivity was similar to existing reports, while higher ALK positivity was detected. A characteristic phenotype of never-smokers with lung cancer was elucidated which demonstrated better survival.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avneet Garg
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Gupta
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Satyaranjan Sahu
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrashekhar Choudhari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Vashistha
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Ashraf Ansari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Hariharan Iyer
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
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18
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Govind KB, Koppaka D, Dasappa L, Jacob LA, C. Babu SM, Lokesh NK, Haleshappa RA, Rajeev LK, Saldanha SC, Abhishek A, Asati V, Chethan R, Ramprasad VL. Detection of clinically relevant epidermal growth factor receptor pathway mutations in circulating cell-free tumor DNA using next generation sequencing in squamous cell carcinoma lung. South Asian J Cancer 2019; 8:247-249. [PMID: 31807490 PMCID: PMC6852636 DOI: 10.4103/sajc.sajc_281_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Limited repertoires of targets are available in the management of squamous cell carcinoma lung. In this study, we analyzed epidermal growth factor receptor (EGFR), RAS, BRAF mutations in lung cancer patients of squamous cell histology using next-generation sequencing (NGS) on the circulating cell-free DNA (cf-DNA). MATERIALS AND METHODS In this prospective observational study, patients with squamous cell carcinoma lung, either newly diagnosed or having a progressive disease on prior therapy were eligible. Cf-DNA was extracted from peripheral blood and analyzed for EGFR, KRAS, NRAS, and BRAF mutations using NGS. RESULTS Sixteen patients were enrolled over a period of 1 month. The mean cf-DNA quantity extracted from the plasma was 96.5 ng (range, 15-200 ng). Eight clinically relevant mutations in the EGFR pathway were identified. These include Exon 21 mutations in 4 patients, Exon 20 mutation in onepatient, complex mutations with coexisting Exon 21 and Exon18 in one patient and KRAS Exon 2 mutations in two patients. CONCLUSION cf-DNA is a minimally invasive technique for detection of clinically relevant mutations in lung cancer patients. The use of novel advanced techniques such as NGS may help in detecting EGFR pathway mutations in patients with squamous cell carcinoma lung.
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Affiliation(s)
- Kanakasetty Babu Govind
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Deepak Koppaka
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Lokanatha Dasappa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Suresh M. C. Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - N. Kadabur Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | | | - L. K. Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Smitha Carol Saldanha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Anand Abhishek
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Vikas Asati
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - R. Chethan
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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Vinoth Kumar NM, Khijmatgar S, Chowdhury A, Gootveld M, Lynch E, Chowdhury C. The interrelationship between urinary cotinine and nicotine dependence among tobacco users in an Indian de-addiction centre: A cohort pilot study. J Oral Biol Craniofac Res 2019; 9:326-330. [PMID: 31360631 PMCID: PMC6642268 DOI: 10.1016/j.jobcr.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/27/2019] [Accepted: 07/14/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nalini M. Vinoth Kumar
- Department of Psychiatric Nursing, Nitte Usha Institute of Nursing Sciences, Nitte- Deemed to be University, Deralakatte, Mangalore, Karnataka, India
| | - Shahnawaz Khijmatgar
- Department of Oral Biology, AB Shetty Memorial Institute of Dental Sciences, Nitte- Deemed to be University, Deralakatte, Mangalore, Karnataka, India
| | | | - Martin Gootveld
- Health and Life Science, De Montfort University, Gateway, Leicester, LE1 9BH, UK
| | - Edward Lynch
- School of Dental Medicine, University of Nevada, Las Vegas, United States
| | - Chitta Chowdhury
- Department of Oral Biology and Genomic Studies, A.B. Shetty Memorial Institute of Dental Sciences, Nitte- Deemed to be University, Deralakatte, Mangalore, Karnataka, India Mangalore, 575 018, Karnataka, India
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Bhatti V, Kwatra KS, Puri S, Calton N. Histopathological Spectrum and Immunohistochemical Profile of Lung Carcinomas: A 9-Year Study from a Tertiary Hospital in North India. Int J Appl Basic Med Res 2019; 9:169-175. [PMID: 31392181 PMCID: PMC6652278 DOI: 10.4103/ijabmr.ijabmr_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Lung cancer is the most common cancer worldwide and the leading cause of cancer-related death. Diagnostic bronchoscopic or percutaneous biopsies are usually small. However, judicious use of immunohistochemistry (IHC) helps in accurate subtyping, which forms the basis for molecular tests and treatment. Aim: The aim was to study the role of IHC in the diagnosis of various histological subtypes of lung cancer. Methods: This 9-year study from 2009 to 2017 included all cases diagnosed as lung carcinoma on tissue biopsies. IHC markers were selected based on histopathology, from a panel comprising CK7, CK20, CK5/6, p63, thyroid transcription factor 1 (TTF-1), napsin A, synaptophysin, chromogranin A, neuron-specific enolase, CD56, and CDX2. Metastatic cancers to the lung were excluded from the study. Results: There were 199 cases of lung carcinoma comprising squamous cell carcinoma (37.7% [n = 75]), adenocarcinoma (26.1% [n = 52]), small cell carcinoma (20.6% [n = 41]), non-small cell lung carcinoma-unclassified (10.1% [n = 20]), adenosquamous carcinoma (2.5% [n = 5]), and others (3% [n = 6]). IHC was done on 47.7% (95/199) of cases. Squamous cell carcinomas showed CK5/6 and p63 positivity in 13/13 (100%) and 12/13 (92.3%) cases, respectively. Adenocarcinomas were positive for napsin A in 12/13 (92.3%) and TTF-1 in 35/41 (85.4%) cases. Neuroendocrine markers were positive in all small cell carcinomas. Conclusion: Squamous cell carcinoma was the most common primary lung malignancy in the North Indian population, followed by adenocarcinoma and small cell carcinoma. IHC panel of TTF-1, napsin A, CK5/6, and p63 is very helpful to classify most non-small cell lung carcinomas.
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Affiliation(s)
- Vandana Bhatti
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | | | - Shivani Puri
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Nalini Calton
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Thomas P, Vincent B, George C, Joshua JM, Pavithran K, Vijayan M. A comparative study on erlotinib & gefitinib therapy in non-small cell lung carcinoma patients. Indian J Med Res 2019; 150:67-72. [PMID: 31571631 PMCID: PMC6798608 DOI: 10.4103/ijmr.ijmr_1896_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 11/24/2022] Open
Abstract
Background & objectives Tyrosine kinase inhibitors (TKIs) targeting the epidermal growth factor receptor (EGFR) have been evaluated in patients with advanced non-small cell lung cancer (NSCLC). Erlotinib and gefitinib are the first-generation EGFR-TKIs for patients with NSCLC. However, there is a paucity of studies comparing the effectiveness of these two drugs. Hence, this study was aimed to compare the effectiveness and safety of erlotinib and gefitinib in NSCLC patients. Methods This study included 71 NSCLC patients who received EGFR-TKIs between 2013 and 2016. Adverse drug reaction of both erlotinib (n=37) and gefitinib (n=34) was determined and graded according to Common Terminology Criteria for Adverse Events grading system. Effectiveness was measured using response evaluation criteria in solid tumours and progression-free survival (PFS). Pharmacoeconomic analysis was performed by cost-effective analysis. Results When comparing safety profile, both the drugs had similar adverse events except for dermal side effects such as acneiform eruption (51.4%), rash (54.05%) and mucositis (59.5%) for erlotinib and 20.6, 26.5 and 29.4 per cent for gefitinib, respectively. The PFS of the two drugs was compared to differentiate the effectiveness of erlotinib and gefitinib. There was no significant difference between the effectiveness of the two drugs. The pharmacoeconomic analysis showed that gefitinib was more cost-effective than erlotinib. Interpretation & conclusions This study showed that erlotinib and gefitinib had similar effectiveness but gefitinib had a better safety profile compared to erlotinib. Therefore, gefitinib could be considered a better option for NSCLC patients compared to erlotinib. However, further studies need to be done with a large sample to confirm these findings.
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Affiliation(s)
- Preenumol Thomas
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Bini Vincent
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Christeena George
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Julie Mariam Joshua
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - K. Pavithran
- Department of Medical Oncology & Haematology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Meenu Vijayan
- Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
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22
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Walia HK, Verma U, Singh N, Sharma S. Polymorphisms in GSTM1 and GSTT1 influence the response and treatment outcome in lung cancer patients treated with platinum-based chemotherapy. Br J Biomed Sci 2019; 76:198-200. [PMID: 31218944 DOI: 10.1080/09674845.2019.1634784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- H K Walia
- Department of Biotechnology, Thapar University, Patiala, India
| | - U Verma
- Department of Biotechnology, Thapar University, Patiala, India
| | - N Singh
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - S Sharma
- Department of Biotechnology, Thapar University, Patiala, India
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Translatable gene therapy for lung cancer using Crispr CAS9-an exploratory review. Cancer Gene Ther 2019; 27:116-124. [PMID: 31222183 DOI: 10.1038/s41417-019-0116-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/29/2019] [Accepted: 05/19/2019] [Indexed: 12/12/2022]
Abstract
Gene therapy using CRISPR Cas9 technique is rapidly gaining popularity among the scientific community primarily because of its versatility, cost-effectiveness, and high efficacy. While the laboratory-based experiments and findings making use of CRISPR as a gene editing tool are available in ample amounts, the question arises that how much of these findings are actually translatable into measures helping in combating particular disease conditions. In this review, we highlight the important studies and findings done till now in the perspective of lung cancer with an in-depth analysis of various clinical trials associated with the use of CRISPR Cas9 technology in the field of cancer research.
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Shankar A, Saini D, Dubey A, Roy S, Bharati SJ, Singh N, Khanna M, Prasad CP, Singh M, Kumar S, Sirohi B, Seth T, Rinki M, Mohan A, Guleria R, Rath GK. Feasibility of lung cancer screening in developing countries: challenges, opportunities and way forward. Transl Lung Cancer Res 2019; 8:S106-S121. [PMID: 31211111 DOI: 10.21037/tlcr.2019.03.03] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is the leading cause of all cancer deaths worldwide, comprising 18.4% of all cancer deaths. Low-dose computed tomography (LDCT) has shown mortality benefit in various trials and now a standard tool for lung cancer screening. Most researches have been carried out in developed countries where lung cancer incidence and mortality is very high. There is an increasing trend in lung cancer incidence in developing countries attributed to tobacco smoking and various environmental and occupational risk factors. Implementation of lung cancer screening is challenging, so organised lung cancer screening is practically non-existent. There are numerous challenges in implementing such programs ranging from infrastructure, trained human resources, referral algorithm to cost and psychological trauma due to over-diagnosis. Pulmonary tuberculosis and other chest infections are important issues to be addressed while planning for lung cancer screening in developing countries. Burden of these diseases is very high and can lead to over-diagnosis in view of cut off of lung nodule size in various studies. Assessment of high risk cases for lung cancer is difficult as various forms of smoking make quantification non-uniform and difficult. Lung cancer screening targets only high risk population unlike screening programs for other cancers where entire population is targeted. There is a need of lung cancer screening for high risk cases as it saves life. Tobacco control and smoking cessation remain the most important long term intervention to decrease morbidity and mortality from lung cancer in developing countries. There is no sufficient evidence supporting the introduction of population-based screening for lung cancer in public health services.
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Affiliation(s)
- Abhishek Shankar
- Preventive Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Deepak Saini
- Indian Society of Clinical Oncology, Delhi, India
| | - Anusha Dubey
- Indian Society of Clinical Oncology, Delhi, India
| | - Shubham Roy
- Indian Society of Clinical Oncology, Delhi, India
| | - Sachidanand Jee Bharati
- Oncoanaesthesia and Palliative Medicine, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Navneet Singh
- Pulmonary Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Chandra Prakash Prasad
- Medical Oncology (Lab), Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Mayank Singh
- Medical Oncology (Lab), Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Sunil Kumar
- Surgical Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | - Bhawna Sirohi
- Medical Oncology, Max Institute of Cancer Care, Delhi, India
| | - Tulika Seth
- Clinical Hematology, All India Institute of Medical Sciences, Delhi, India
| | - Minakshi Rinki
- Biotechnology, Swami Shraddhanand College, Delhi University, Delhi, India
| | - Anant Mohan
- Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, Delhi, India
| | - Randeep Guleria
- Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, Delhi, India
| | - Goura Kishor Rath
- Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
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Srinivasan M, Chaturvedula A, Fossler MJ, Patil A, Gota V, Prabhash K. Population Pharmacokinetics of Pemetrexed in Adult Non-Small Cell Lung Cancer in Indian Patients. J Clin Pharmacol 2019; 59:1216-1224. [PMID: 30973978 DOI: 10.1002/jcph.1417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/25/2019] [Indexed: 01/04/2023]
Abstract
The objective of the study was to develop a population pharmacokinetic model of pemetrexed and identify factors contributing to variability in exposure in Indian patients. Plasma samples were obtained from a cohort of 85 patients following 500 mg/m2 intravenous infusion and population pharmacokinetic analysis was performed using NONMEM (version 7.3.0). The stochastic approximation expectation maximization method was used to estimate parameters. The full covariate model approach was used by specifying clinically meaningful covariates a priori. Credible intervals obtained using Markov chain Monte Carlo Bayesian analysis were used to reduce the full covariate model by eliminating the covariates whose CI included the null. Model qualification was performed using visual predictive check and bootstrap. The final population parameter estimates and relative standard error for clearance (CL) was 3.3 L/h (10.8), central volume of distribution (V1) was 5.2 L (7.8), peripheral volume of distribution (V2) was 5.9 L (14.5) and intercompartmental clearance (Q) was 6.8 L/h (14.3). A large between-subject variability (50%-108% coefficient of variation) was observed in pharmacokinetic parameters. The percent coefficient of variation for the area under the plasma concentration-time curve from time zero to infinity was 72% and for maximum concentration was 68.25%. Diagnostic plots showed no major bias in the model. The final model included V1, V2, and Q scaled to body surface area raised to a fixed exponent of 1. Creatinine clearance and sex on clearance and albumin on V1 were statistically significant covariates based on Bayesian credible interval. However, traditional bootstrap resulted in a 95% confidence interval of the sex effect parameter including null. Given the size and nonsignificant sex effect in traditional bootstrap, it is considered clinically not significant.
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Shukla S, Husain N, Gupta A, Anand N. Cytomorphological Features of Lung Adenocarcinoma with Anaplastic Lymphoma Kinase Gene Rearrangement. J Cytol 2019; 36:8-12. [PMID: 30745732 PMCID: PMC6343393 DOI: 10.4103/joc.joc_127_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The anaplastic lymphoma kinase (ALK) gene rearrangement is a predictive and prognostic marker in pulmonary adenocarcinoma. A series of clinical and pathological features have been documented in patients who harbor this translocation. Aims: The objectives of this study were to analyze the specific cytomorphological features of lung adenocarcinoma that harbored the ALK gene rearrangement and to compare the morphological features with the mutation-negative cases. Materials and Methods: The study sample of 40 cases included 15 ALK-positive cases and 25 ALK-negative cases. After the diagnosis was established, testing for ALK rearrangement was on the histopathology sample. The corresponding fine-needle aspiration cytology slides were retrieved from the records and cytomorphological features were analyzed. Results: A comparison of pattern between the ALK-positive and ALK-negative group revealed that the sheet-like pattern and singly scattered cells were more common in the ALK-positive group. Moderate-to-severe nuclear pleomorphism was identified in 80% of ALK-positive cases and 72% of ALK-negative cases. The presence of mucinous features and/or signet ring morphology was the most striking feature of ALK-positive cases with P value of 0.002. The presence of necrosis in the background was identified in 80% of ALK-positive cases and was statistically significant (P = 0.001). Conclusion: This is among the few studies from India, where a detailed analysis of the cytomorphological features of cases with ALK phenotype versus the mutation negative cases has been performed.
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Affiliation(s)
- Saumya Shukla
- Department of Pathology, Dr. Ram Manohar Lohia, Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr. Ram Manohar Lohia, Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anurag Gupta
- Department of Pathology, Dr. Ram Manohar Lohia, Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nidhi Anand
- Department of Pathology, Dr. Ram Manohar Lohia, Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Shrimali RK, Chakraborty S, Prasath S, Arun B, Chatterjee S. Impact of modern radiotherapy techniques on survival outcomes for unselected patients with large volume non-small cell lung cancer. Br J Radiol 2018; 92:20180928. [PMID: 30457882 DOI: 10.1259/bjr.20180928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE: Intensity modulated radiotherapy (IMRT) is used, where necessary, for bulky or complex-shaped, locally advanced, non-small cell lung cancer (NSCLC). We evaluate our real-world experience with radical radiotherapy including concurrent chemoradiation (CCRT), and analyse the impact of IMRT on survival outcomes in patients with larger volume disease. METHODS: All patients treated between May 2011 and December 2017 were included. Analyses were conducted for factors affecting survival, including large volume disease that was defined as planning target volume (PTV) > 500 cc. RESULTS: In 184 patients with large volume disease, the median overall survival was 19.2 months, compared to 22 months seen with the overall cohort of 251 patients who received radical radiotherapy. PTV and using CCRT were significant predictors for survival. IMRT was used in 93 (50.5%) of 184 patients with large PTV. The patients treated using IMRT had significantly larger disease volume (median PTV = 859 vs 716 cc; p-value = 0.009) and more advanced stage (proportion of Stage IIIB: 56 vs 29%; p-value = 0.003) compared to patients treated with three-dimensional conformal radiotherapy. Yet, the outcomes with IMRT were non-inferior to those treated with 3DCRT. CCRT was used in 103 (56%) patients with large volume disease and resulted in a significantly better median survival of 24.9 months. The proportional benefit from CCRT was also greater than in the overall cohort. CONCLUSION: Despite being used for larger volume and more advanced NSCLC, inverse-planned IMRT resulted in non-inferior survival. ADVANCES IN KNOWLEDGE: IMRT enables the safe use of curative CCRT for large-volume, locally-advanced NSCLC.
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Affiliation(s)
- Raj Kumar Shrimali
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
| | - Santam Chakraborty
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
| | - Sriram Prasath
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
| | - B Arun
- 1 Department of Radiation Oncology, Tata Medical Center, Kolkata , India
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Malhotra RK, Manoharan N, Nair O, Deo S, Rath GK. Trends in Lung Cancer Incidence in Delhi, India 1988-2012: Age-Period-Cohort and Joinpoint Analyses. Asian Pac J Cancer Prev 2018; 19:1647-1654. [PMID: 29937537 PMCID: PMC6103588 DOI: 10.22034/apjcp.2018.19.6.1647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Lung cancer (LC) has been one of the most commonly diagnosed cancers worldwide, both in terms
of new cases and mortality. Exponential growth of economic and industrial activities in recent decades in the Delhi
urban area may have increased the incidence of LC. The primary objective of this study was to evaluate the time trend
according to gender. Method: LC incidence data over 25 years were obtained from the population based urban Delhi
cancer registry. Joinpoint regression analysis was applied for evaluating the time trend of age-standardized incidence
rates. The age-period-cohort (APC) model was employed using Poisson distribution with a log link function and the
intrinsic estimator method. Results: During the 25 years, 13,489 male and 3,259 female LC cases were registered,
accounting for 9.78% of male and 2.53% of female total cancer cases. Joinpoint regression analysis revealed that LC
incidence in males continued to increase during the entire period, a sharp acceleration being observed starting from
2009. In females the LC incidence rate remained a plateau during 1988-2002 and thereafter increased. The cumulative
risks for 1988-2012 were 1.79% and 0.45%. The full APC (IE) model showed best fit for an age-period-cohort effect
on LC incidence, with significant increase with age peaking at 70-74 years in males and 65-69 years in females. A
rising period effect was observed after adjusting for age and cohort effects in both genders and a declining cohort effect
was identified after controlling for age and period effects. Conclusion: The incidence of LC in urban Delhi showed
increasing trend from 1988-2012. Known factors such as environmental conservation, tobacco control, physical activity
awareness and medical security should be implemented more vigorously over the long term in our population.
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Korpanty GJ, Kamel-Reid S, Pintilie M, Hwang DM, Zer A, Liu G, Leighl NB, Feld R, Siu LL, Bedard PL, Tsao MS, Shepherd FA. Lung cancer in never smokers from the Princess Margaret Cancer Centre. Oncotarget 2018; 9:22559-22570. [PMID: 29854298 PMCID: PMC5978248 DOI: 10.18632/oncotarget.25176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/23/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Lung cancer in never smokers represents a distinct epidemiological, clinical, and molecular entity. Results Most 712 never smoking lung cancer patients were female (72%) with a median age at diagnosis of 62.2 years (18–94). Caucasians (46%), East Asians (42%), adenocarcinoma histology (87%) and presentation with metastatic disease at diagnosis (59%) were common. Of 515 patients with available archival tissue, the most common identified single mutations were EGFR (52.2%), followed by ALK (7.5%), KRAS (2.3%), TP53 (1.3%), ERBB2 (1%), BRAF (0.4%), PIK3CA (0.4%), SMAD4 (0.4%), CTNNB1 (0.2%), AKT1 (0.2%), and NRAS (0.2%); 8% tumors had multiple mutations, while 25.8% had none identified. Median overall survival (mOS) was 42.2 months (mo) for the entire cohort. Patients with mutations in their tumors had significantly better mOS (69.5 mo) when compared to those without (31.0 mo) (HR = 0.59; 95% CI: 0.44–0.79; p < 0.001). Earlier stage (p < 0.001), adenocarcinoma histology (p = 0.012), good performance status (p < 0.001) and use of targeted therapy (p < 0.001) were each independently associated with longer survival. Patients with ALK-translocation-positive tumours have significantly longer OS compared to those without any mutations (p = 0.0029) and to those with other and null mutations (p = 0.022). Conclusions Lung cancer in never smokers represents a distinct clinical and molecular entity characterized by a high incidence of targetable mutations and long survival. Methods We analyzed retrospectively the data from electronic patient records of never smokers diagnosed with lung cancer treated at the Princess Margaret Cancer Centre (Toronto) between 1988–2015 to characterize demographic and clinical features, pathology, molecular profile (using hotspot or targeted sequencing panels), treatment and survival.
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Affiliation(s)
- Grzegorz J Korpanty
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Melania Pintilie
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David M Hwang
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Alona Zer
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ronald Feld
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philippe L Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ming-Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Agarwal JP, Chakraborty S, Laskar SG, Mummudi N, Patil VM, Upasani M, Prabhash K, Noronha V, Joshi A, Purandare N, Tandon S, Arora J, Badhe R. Applying the QUARTZ Trial Results in Clinical Practice: Development of a Prognostic Model Predicting Poor Outcomes for Non-small Cell Lung Cancers with Brain Metastases. Clin Oncol (R Coll Radiol) 2018; 30:382-390. [PMID: 29499878 DOI: 10.1016/j.clon.2018.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/21/2017] [Accepted: 01/05/2018] [Indexed: 01/21/2023]
Abstract
AIMS The role of whole brain radiotherapy (WBRT) in patients with brain metastases from non-small cell lung cancers (NSCLC) has been questioned. However, no reliable criteria exist to identify patients who do not benefit from WBRT. The objective of the current study was to develop a prognostic model to identify such patients whose survival matches that of the Quality of Life after Treatment for Brain Metastases (QUARTZ) study. MATERIALS AND METHODS Outcome data of patients with NSCLC with brain metastases undergoing WBRT enrolled in a prospective observational study in a tertiary cancer centre were used to develop a prognostic model. Baseline clinico-radiological factors were used for development of the model. The model was internally validated and calibration accuracy was checked for prediction of 70 day mortality. The generated prognostic model was presented as a nomogram. RESULTS The median overall survival of 140 patients enrolled in the study was 166 days (95% confidence interval 108-242 days). The prognostic model identified gender, Karnofsky performance status and epidermal growth factor receptor activating mutation status as significant factors influencing overall survival. The model showed a modest discriminative ability with an optimism-corrected C-index of 0.64. However, model calibration error did reveal a moderate degree of calibration error. The high-risk subgroup identified by the model had a median overall survival of 67 days (95% confidence interval 56-101 days), which was similar to that observed in the QUARTZ trial. CONCLUSION This prognostic model derived from traditional clinico-radiological features had a modest ability to identify patients with poor prognosis who may not benefit from WBRT. However, the high-risk subgroup identified using this prognostic model had a survival similar to that observed for patients in the QUARTZ trial.
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Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Chakraborty
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - M Upasani
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - N Purandare
- Department of Radiology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Tandon
- Department of Pulmonary Medicine, Tata Memorial Hospital, Parel, Mumbai, India
| | - J Arora
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - R Badhe
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
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Apurva A, Tandon SP, Shetmahajan M, Jiwnani SS, Karimundackal G, Pramesh CS. Surgery for lung cancer—the Indian scenario. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0634-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Jambhekar N. Evolving concepts in lung cancer pathology and its impact on thoracic oncology practice. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Noronha V, Prabhash K. Evolving Management Strategies and Controversies in Early-Stage Lung Cancer. J Oncol Pract 2017; 13:79-81. [PMID: 28972829 DOI: 10.1200/jop.2016.020099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Verma S, Kumar M, Kumari M, Mehrotra R, Kushwaha RAS, Goel M, Kumar A, Kant S. An Immunohistochemical Study of Anaplastic Lymphoma Kinase and Epidermal Growth Factor Receptor Mutation in Non-Small Cell Lung Carcinoma. J Clin Diagn Res 2017; 11:EC22-EC25. [PMID: 28892905 DOI: 10.7860/jcdr/2017/27941.10279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/03/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lung cancer is one of the leading causes of cancer related death. Targeted treatment for specific markers may help in reducing the cancer related morbidity and mortality. AIM To study expression of Anaplastic Lymphoma Kinase (ALK)and Epidermal Growth Factor Receptor (EGFR) mutations in patients of Non-Small Cell Lung Cancer NSCLC, that are the targets for specific ALK inhibitors and EGFR tyrosine kinase inhibitors. MATERIALS AND METHODS Total 69 cases of histologically diagnosed NSCLC were examined retrospectively for immunohistochemical expression of EGFR and ALK, along with positive control of normal placental tissue and anaplastic large cell lymphoma respectively. RESULTS Of the NSCLC, Squamous Cell Carcinoma (SCC) accounted for 71.0% and adenocarcinoma was 26.1%. ALK expression was seen in single case of 60-year-old female, non-smoker with adenocarcinoma histology. EGFR expression was seen in both SCC (59.18%) and adenocarcinoma in (77.78%) accounting for 63.77% of all cases. Both ALK and EGFR mutation were mutually exclusive. CONCLUSION EGFR expression was seen in 63.77% of cases, highlighting the importance of its use in routine analysis, for targeted therapy and better treatment results. Although, ALK expression was seen in 1.45% of all cases, it is an important biomarker in targeted cancer therapy. Also, the mutually exclusive expression of these two markers need further studies to develop a diagnostic algorithm for NSCLC patients.
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Affiliation(s)
- Sonal Verma
- Senior Resident, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Madhu Kumar
- Associate Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Malti Kumari
- Associate Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Raj Mehrotra
- Ex Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R A S Kushwaha
- Professor, Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Madhumati Goel
- Professor, Department of Pathology, King George's, Medical University, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Professor, Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Surya Kant
- Professor, Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Jain D, Iqbal S, Walia R, Malik P, Cyriac S, Mathur SR, Sharma MC, Madan K, Mohan A, Bhalla A, Pathy S, Kumar L, Guleria R. Evaluation of epidermal growth factor receptor mutations based on mutation specific immunohistochemistry in non-small cell lung cancer: A preliminary study. Indian J Med Res 2017; 143:308-14. [PMID: 27241644 PMCID: PMC4892077 DOI: 10.4103/0971-5916.182621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND & OBJECTIVES Studies have shown that immunohistochemical (IHC) staining using epidermal growth factor receptor (EGFR) mutation specific antibodies, is an easy and cost-effective, screening method compared with molecular techniques. The purpose of present study was to assess the percentage positivity of IHC using EGFR mutation specific antibodies in lung biopsy samples from patients with primary lung adenocarcinoma (ADC). METHODS Two hundred and six biopsies of primary lung ADC were subjected to EGFR mutation specific antibodies against del E746-A750 and L858R. Detection of EGFR mutation done by high resolution melting analysis (HRM) was used as gold standard. A concordance was established between molecular and IHC results. Frequency of IHC positivity was assessed. RESULTS Of the 206 patients, 129 were male and 77 were female patients, with a mean age of 54.1 yr. Fifty five (26.6%) patients (36 men; 19 women) showed positivity for IHC of del E746-A750 (33) and L858R (22). HRM results were available in 14 patients which showed EGFR mutations in correspondence with del E746-750 or L858R in 64.2 per cent cases. Positive cases on HRM were further confirmed by DNA sequencing and fragment analysis. Three patients showed exon[20] variation. Two cases were negative for mutation. The genotype of del E746-750 mutation was more common than L858R. A concordance was established between molecular mutation and IHC in 85.7 per cent cases. INTERPRETATION & CONCLUSIONS In this preliminary study from India mutation specific IHC was used for assessment of mutation status of EGFR. Although the number tested was small, a good concordance was observed between molecular EGFR mutation and IHC expression. IHC methodology is a potentially useful tool to guide clinicians for personalized treatment in lung ADC, especially where facilities for molecular analysis are not readily available and for use in small biopsies where material is scant for molecular tests.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sobuhi Iqbal
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Walia
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunu Cyriac
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Sushmita Pathy
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
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Aggarwal J, Chakraborty S, Ghosh Laskar S, Patil VM, Prabhash K, Bhattacharya A, Noronha V, Purandare NC, Joshi A, Mummudi N, Arora J, Badhe R. Reference Data for Standardized Quality of Life Questionnaires in Indian Patients with Brain Metastases from Non-small Cell Lung Cancer: Results from a Prospective Study. Cureus 2017; 9:e1149. [PMID: 28497011 PMCID: PMC5425287 DOI: 10.7759/cureus.1149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Reference data for European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaires do not include studies from the Indian subcontinent. The objective of the current study was to establish a reference dataset for Indian patients of non-small cell lung cancer (NSCLC) presenting with brain metastases (BM). MATERIAL AND METHODS One hundred forty patients with NSCLC with BM treated between 2012-2015 were registered in a prospective cohort study (CTRI/2013/01/003299). The baseline quality of life was evaluated using the EORTC general quality of life questionnaire QLQ-C30 and lung cancer specific module LC13. Minimum important difference (MID) scores for individual domains of the EORTC QLQ-C30 and LC13 questionnaires were derived (MID = 0.2 x standard deviation) from the reference data for patients with recurrent/metastatic lung cancers. In addition, a systematic review was conducted to identify studies reporting baseline quality of life scores for recurrent/metastatic NSCLC. RESULTS Scores of several functional as well as symptom scales in the current NSCLC population differed by more than the MID from the baseline mean scores in the reference EORTC population as well as that reported from other studies. Differences in mean score from the EORTC reference data ranged from 6.2 and 9.4 points for the role functioning and cognitive functioning domains. In the symptom scales, the largest differences were observed for the financial difficulties (23.9) scores for the QLQ-C30 and peripheral neuropathy (21.7) for LC13 questionnaires. CONCLUSION The current study demonstrates that baseline reference scores need to be established for patients from the Indian subcontinent. The findings from the current study have important implications for studies employing quality of life (QOL) assessment in the Indian NSCLC patient population.
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Affiliation(s)
| | | | | | - Vijay M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Jitendra Arora
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rupali Badhe
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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Bala S, Gundeti S, Linga VG, Maddali LS, Digumarti RR, Uppin SG. Clinicopathological features and outcomes in advanced nonsmall cell lung cancer with tailored therapy. Indian J Med Paediatr Oncol 2017; 37:242-250. [PMID: 28144090 PMCID: PMC5234160 DOI: 10.4103/0971-5851.195735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Context: Lung cancer is an important cause of cancer-related deaths worldwide. There is an increasing incidence of lung cancer in never smokers and a shift of histology from squamous cell to adenocarcinoma globally in the recent past. Data on treatment outcomes with newer platinum doublets is scant from India. Aims: To study the clinicopathological features, response rates (RRs), progression-free survival (PFS), overall survival (OS), and the 1, 2, and 3 years survival, in patients with advanced nonsmall cell lung cancer (NSCLC). Materials and Methods: Data of all patients who received chemotherapy for Stage IIIB and IV NSCLC between January 2010 and June 2014 were retrospectively analyzed. Statistical Analysis Used: Univariate analysis for OS was done by plotting Kaplan–Meier curves and the log-rank test was used to calculate P values. Logistic regression analysis for OS was carried out using MedCalc statistical software. Results: A total of 353 patients received chemotherapy. Of these, 256 were evaluable for outcome parameters. The median age at presentation was 58 years with a male:female ratio of 2.53:1. The smoker:nonsmoker ratio was 1:1. Adenocarcinomatous histology was the most common both in smokers and nonsmokers reported in 70.8% patients. Epidermal growth factor receptor (EGFR) mutation and echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase translocation were seen in 35% and 3% of patients, respectively. The RR, median PFS, OS, 1, 2, and 3 years survival were 80%, 8 months, 12.1 months, 51.5%, 12.7%, and 4.2%, respectively. There was no significant survival difference among the treatment regimen used but the response to I line chemotherapy impacted survival. Female gender, performance status, and nonsquamous histology were significant predictors of OS (P = 0.0443, P = 0.0003, P = 0.048, respectively). Conclusions: There was an increase in the incidence of nonsmokers. Adenocarcinoma was the most common histology in both smokers and nonsmokers. Treatment outcomes in advanced lung cancer were better compared to the past with the advent of newer platinum doublets and EGFR tyrosine kinase inhibitors. The response to first-line chemotherapy significantly impacts outcomes in advanced NSCLC.
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Affiliation(s)
- Stalin Bala
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vijay Gandhi Linga
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Lakshmi Srinivas Maddali
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Raghunadha Rao Digumarti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Synergistic Association of CYP1A1 Polymorphisms with Increased Susceptibility to Squamous Cell Lung Cancer in North Indian Smokers. Int J Biol Markers 2016; 31:e402-e412. [DOI: 10.5301/jbm.5000221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/20/2022]
Abstract
Objectives Studies in different populations have shown that polymorphisms within the CYP1A1 gene play an important role in determining individual susceptibility to lung cancer. However, the data obtained so far have been contradictory within the same or different populations. Few studies have focused on the synergistic effect of CYP1A1 polymorphisms on the susceptibility to lung cancer overall and to different histological subtypes along with the impact of smoking. Methods A total of 704 individuals (353 lung cancer patients and 351 controls) were evaluated for CYP1A1 polymorphisms. CYP1A1 genotyping was done by means of PCR-RFLP. Results A CYP1A1 mutant genotype was found to be significantly associated with lung cancer (OR = 3.15; 95% CI = 1.75-5.71; p = 0.0001) and this risk was 4-fold higher in case of squamous cell carcinoma (SCC). The CYP1A1 m2 allelic variant was found to be strongly associated with the risk of SCC and adenocarcinoma. The combined “at risk” genotypes of the CYP1A1 m1 and m2 allelic variants were associated with lung cancer risk and this risk was higher in case of SCC (OR = 2.0; 95% CI = 1.97-3.81; p = 0.028). Furthermore, the lung cancer risk was associated with smoking, especially in heavy smokers carrying CYP1A1 variant genotypes. We also observed that heavy smokers with the mutant m1 genotype were at increased risk of SCC (OR = 5.4; 95% CI = 2.4-11.9; p<0.0001). Furthermore, when stratified for smoking dose and histology, the effect was compounded in heavy smokers and SCC (OR = 7.5; 95% CI = 1.8-30.9; p = 0.004). Conclusions Polymorphism in the CYP1A1 gene is an important risk modifier for lung cancer.
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Habib OS, Al-Asadi JN, Hussein OG. Lung cancer in Basrah, Iraq during 2005-2012. Incidence and time trend. Saudi Med J 2016; 37:1214-1219. [PMID: 27761559 PMCID: PMC5303798 DOI: 10.15537/smj.2016.11.16269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: To study the incidence rate of lung cancer and its time trend in Basrah during 2005-2012. Methods: This was a cancer registry-based retrospective study including all Basrah inhabitant patients diagnosed with primary lung cancer during the period from January 2005 to December 2012. The crude incidence rate was calculated in addition to the age standardized incidence rate (ASIR)/100,000 using the world standard population. Results: Out of 746 registered cases of lung cancer in Basrah, 75.9% were males and 24.1% were females with a male: female gender ratio of 3.1:1. The crude incidence rate was 3.93/100,000 (5.89/100,000 for males and 1.93/100,000 for females). The ASIR was 8.25/100,000 (13.30/100,000 for males and 4.08/100,000 for females). The time trend showed a decrease in incidence rate in the last 2 years (2011 and 2012) compared with the preceding years. Conclusion: The incidence rate of lung cancer in Basrah did not differ greatly from that reported for some Arab and neighboring countries. No definite time trend could be identified apart from a tendency for the incidence rate to decline in 2011 and 2012.
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Affiliation(s)
- Omran S Habib
- Department of Community Medicine, College of Medicine, University of Basrah, Basrah, Iraq. E-mail.
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Abstract
India has the dubitable honor of being ranked first in the world with regards to lung disease burden. A good proportion of this disease burden is amenable to surgical treatment. However, patients have limited access to quality thoracic surgical care due to a number of obstacles. This review article summarizes these obstacles and the implied opportunities that exist in this nascent surgical discipline in the world's second most populous country.
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Affiliation(s)
- Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA;; Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Nair AG, Asnani HT, Mehta VC, Mehta SV, Pathak RS, Palkar AH, Gopinathan I. Tyrosine Kinase Inhibitors in the Treatment of Choroidal Metastases from Non-Small-Cell Lung Cancer: A Case Report and Review of Literature. Ocul Oncol Pathol 2016; 3:28-33. [PMID: 28275600 DOI: 10.1159/000448114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/30/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Choroidal metastases being the sole presenting feature of lung cancer is rare. Erlotinib, a tyrosine kinase inhibitor (TKI), is used in the treatment of lung adenocarcinoma where tumor cells exhibit epidermal growth factor receptor (EGFR) mutations. We report a case of metastatic non-small-cell lung cancer (NSCLC) with choroidal metastasis, which was the sole presenting feature and which responded to erlotinib. METHODS We performed a retrospective case review. CASE A 78-year-old man presented with a choroidal mass which was found to be the presenting feature of metastatic NSCLC. Our patient, a nonsmoker, had disseminated bony metastases, and therefore was advised to undergo palliative chemotherapy, which he refused. He was therefore instituted on oral erlotinib. RESULTS Tumor cells expressing EGFR mutations are known to be susceptible to TKIs. Even though the tumor in our case showed no mutation, i.e. was classified as 'wild-type', our patient showed a dramatic response to erlotinib. At 1 year, the choroidal lesion had regressed and visual acuity had recovered. CONCLUSIONS TKIs may be beneficial in patients with choroidal metastases from NSCLC, especially those in which an EGFR mutation is noted. Even in the absence of such mutations, choroidal metastases may show a favorable effect in response to TKIs, such as erlotinib.
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Affiliation(s)
- Akshay Gopinathan Nair
- Advanced Eye Hospital and Institute, Mumbai, India; Aditya Jyot Eye Hospital, Mumbai, India; Mehta Eye Clinic Pvt. Ltd, Mumbai, India; Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, India
| | - Haresh T Asnani
- Advanced Eye Hospital and Institute, Mumbai, India; Mehta Eye Clinic Pvt. Ltd, Mumbai, India
| | | | | | - Rima S Pathak
- Tata Memorial Cancer Hospital, Mumbai, India; British Columbia Cancer Agency, Abbotsford, B.C., Canada
| | - Amit H Palkar
- Lokmanya Tilak Municipal Medical College and Hospital, Mumbai, India
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Samanta S, Sharma A, Das B, Mallick AK, Kumar A. Significance of Total Protein, Albumin, Globulin, Serum Effusion Albumin Gradient and LDH in the Differential Diagnosis of Pleural Effusion Secondary to Tuberculosis and Cancer. J Clin Diagn Res 2016; 10:BC14-8. [PMID: 27656432 DOI: 10.7860/jcdr/2016/20652.8379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 06/28/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lung cancer and Pulmonary tuberculosis are two major public health problems associated with significant morbidity and mortality worldwide particularly in low and middle income countries like India. Wrong diagnosis of lung cancer cases as pulmonary tuberculosis in primary health care system delays the onset of anti-cancer chemotherapy as well as initiation of DOTS thus increasing complication and mortality rate in malignancy patients. In this context easy, cost effective diagnostic tool at primary level must be the priority and need of hour. AIM To study and evaluate any significance of biochemical parameters (total protein, albumin, globulin, serum effusion albumin gradient, LDH) in serum and pleural effusion secondary to tuberculosis and lung cancer. MATERIALS AND METHODS A case control study was carried out on patients attending OPD and IPD, Department of Pulmonary Medicine, RMCH. Hundred cases of Tuberculosis effusion, 50 cases of Malignant effusion and 100 age and sex matched apparently healthy controls were taken for correlation of biochemical parameters (total protein, albumin, globulin, serum effusion albumin gradient, LDH) and statistically evaluated to find any significance between tuberculosis, lung cancer and control group. Blood and pleural fluid samples were collected and then subjected to assessment of parameters (total protein, albumin, LDH) by using EM360 Autoanalyser and kits were supplied by Transasia diagnostics. Globulin and Serum Effusion Albumin Gradient (SEAG) was calculated mathematically. STATISTICAL ANALYSIS Data is presented as mean ± SD. Comparison of serum and pleural fluid levels (of taken parameters) were done in TB, Lung Cancer and Control groups by ANOVA and students t-test. The p-value <0.05 were considered as statistically significant. RESULTS We found serum-total protein, albumin, globulin to be significantly higher in TB group than lung cancer group but serum LDH was higher in lung cancer group (in all parameters p=<0.0001). Pleural Fluid-total protein, albumin, globulin was again significantly higher in TB group than lung cancer group and LDH was higher in lung cancer group (p=<0.0001). SEAG is also significantly higher in TB group than lung cancer group (p=<0.002). CONCLUSION The results suggests early quantization of these parameters can differentiate pulmonary tuberculosis from lung cancer and thus can decrease the mortality rate of lung cancer cases though more extensive study with increased sample size may provide more insights.
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Affiliation(s)
- Sumeru Samanta
- Assistant Professor and Research Fellow, Department of Biochemistry, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India
| | - Ashish Sharma
- Associate Professor and Guide, Department of Biochemistry, Geetanjali Medical College and Hospital, Geetanjali University , Udaipur, Uttar Pradesh, India
| | - Biswajit Das
- Professor and Head, Co-Guide, Department of Biochemistry, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India
| | - Ayaz K Mallick
- Associate Professor, Department of Biochemistry, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India
| | - Amit Kumar
- Associate Professor, Department of Pulmonary Medicine, Rohilkhand Medical College and Hospital , Bareilly, Uttar Pradesh, India
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Shih WMJ, Hsu HC, Jiang RS, Lin MH. Lived Experience among Patients Newly Diagnosed with Lung Adenocarcinoma Stage IV within One Year. Asian Pac J Cancer Prev 2016; 16:6633-8. [PMID: 26434887 DOI: 10.7314/apjcp.2015.16.15.6633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND lung cancer (LC) is the fifth of the 10 leading causes of death in the world. LC is in first place for cancer-related mortality for both males and females in Taiwan. It is one of the most difficult cancers to treat and is often diagnosed at a late stage. Patients with stage IV are often unprepared for the diagnosis. MATERIALS AND METHODS To explore lived experience among patients newly diagnosed with lung adenocarcinoma stage IV within one year. RESULTS Twelve participants were recruited in this study. Content analysis of the interviews revealed four themes: (1) emotional roller coaster, (2) trying to find out causes, (3) adjusting my lifestyle, and (4) cancer fighter. CONCLUSIONS This study provides new insight into the experiences of lung cancer patients y with newly diagnosed lung adenocarcinoma stage 4. These results will inform future supportive care service development and intervention research for patients with advanced stage cancer.
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Affiliation(s)
- Whei-Mei Jean Shih
- Graduate Institute of Health Care, Chang Gung University of Science and Technology , Tao-Yuan, Taiwan E-mail :
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Peddireddy V, Badabagni SP, Gundimeda SD, Mundluru HP. Association of eNOS
and ACE
gene polymorphisms and plasma nitric oxide with risk of non-small cell lung cancer in South India. CLINICAL RESPIRATORY JOURNAL 2016; 12:207-217. [DOI: 10.1111/crj.12517] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 06/14/2016] [Accepted: 06/17/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Vidyullatha Peddireddy
- Department of Environmental Toxicology, Institute of Genetics and Hospital for Genetic Diseases, Osmania University; Hyderabad India
- Present address: Department of Biotechnology; University of Hyderabad; Hyderabad Andhra Pradesh 500046 India
| | - Siva Prasad Badabagni
- Department of Environmental Toxicology, Institute of Genetics and Hospital for Genetic Diseases, Osmania University; Hyderabad India
| | - Sandhya Devi Gundimeda
- Department of Biotechnology, School of Life Sciences, University of Hyderabad, Indo-American Cancer Hospital; Hyderabad India
| | - Hema Prasad Mundluru
- Department of Environmental Toxicology, Institute of Genetics and Hospital for Genetic Diseases, Osmania University; Hyderabad India
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Raspanti GA, Hashibe M, Siwakoti B, Wei M, Thakur BK, Pun CB, Milrod C, Adhikari S, Lee YCA, Sapkota A. Ethnic Variation in Consumption of Traditional Tobacco Products and Lung Cancer Risk in Nepal. Asian Pac J Cancer Prev 2016; 16:5721-6. [PMID: 26320442 DOI: 10.7314/apjcp.2015.16.14.5721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Lung cancer is the leading contributor to cancer deaths in the developing world. Within countries, significant variability exists in the prevalence of lung cancer risk, yet limited information is available whether some of the observed variability is associated with differences in the consumption pattern of local tobacco products with differing potency. We recruited 606 lung cancer cases and 606 controls from the B.P. Koirala Memorial Cancer Hospital in Nepal from 2009-2012. We estimated odds ratios (ORs) and 95% confidence intervals (CI) for lung cancer risk associated with different tobacco products, using unconditional logistic regression. Unfiltered cigarettes tended to be the most frequently used products across ethnic subgroup with about 53.7% of Brahmins, 60.1% of Chettris, and 52.3% of Rai/Limbu/Magar/others. In contrast, about 39.9% of Madishe/Tharu smokers reported using bidi compared with only 27.7% who smoked unfiltered cigarettes. Among those who only smoked one type of product, choor/kankat smokers had the highest lung cancer risk (OR 10.2; 95% CI 6.2-16.6), followed by bidi smokers (OR 5.6; 95% CI 3.6-8.7), unfiltered cigarettes (OR 4.9; 95% CI 3.4-7.2), and filtered cigarettes (OR 3.4; 95% CI 2.2-5.3). A clear dose-response relationship was observed between increased frequency of smoking and lung cancer risk across all ethnic subgroups. These results highlight the important role of traditional tobacco products on lung cancer risk in the low income countries.
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Affiliation(s)
- Greg A Raspanti
- Maryland Institute for Applied Environmental Health, University of Maryland College Park School of Public Health, Maryland, USA E-mail :
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Gupta N, Sekar A, Rajwanshi A. Role of FNAC, fluid specimens, and cell blocks for cytological diagnosis of lung cancer in the present era. J Cytol 2016; 32:217-22. [PMID: 26811567 PMCID: PMC4707781 DOI: 10.4103/0970-9371.171219] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cytoblocks prepared from residual tissue fluids and fine-needle aspirations can be useful adjuncts to smears for establishing a more definitive cytopathologic diagnosis. These paraffin embedded cytoblocks have been popular since these can be handled like any other histologic specimen. Rapid on-site evaluation (ROSE) can help in attaining adequate material in the cytoblock, which is a major concern to the cytopathologists. Ancillary studies can be done using cytoblocks including IHC and various molecular techniques. The opportunities for cytopathologists to influence therapy, and uncover strategies in the complex field of lung cancer are exciting and limitless especially in the presence of an adequate cytoblock
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Affiliation(s)
- Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Aravind Sekar
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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Pandey AV, Phillip DS, Noronha V, Joshi A, Janu A, Jambekar N, Kaushal R, Mahajan A, Prabhash K. Maintenance pemetrexed in nonsmall cell lung carcinoma: Outcome analysis from a tertiary care center. Indian J Med Paediatr Oncol 2016; 36:238-42. [PMID: 26811593 PMCID: PMC4711222 DOI: 10.4103/0971-5851.171544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Maintenance pemetrexed is a standard treatment option for selected non squamous nonsmall cell lung carcinoma patients having a response to platin based doublet. We conducted a clinical audit of such selected patients and report the outcome among the Indian population. Aim: To evaluate the outcomes with maintenance pemetrexed in the patients with locally advanced and metastatic adenocarcinoma lung. Objectives: To calculate the progression free survival (PFS), overall survival (OS), and factors affecting the outcome. Materials and Methods: Data of patients with locally advanced and metastatic adenocarcinoma lung were retrieved from prospectively maintained lung cancer database registered between June 2011 and March 2014. The patients who achieved partial response (n = 87) or stable disease (n = 101) after 6 cycles of pemetrexed platin based doublet and received the maintenance pemetrexed were selected for final analysis (n = 188). Kaplan–Meir survival analysis was used for PFS and OS. Log rank test was used to evaluate the factors affecting the outcome. Results: Median follow-up is 14 months. The median number of maintenance pemetrexed cycles received is 6 (1–38). Common reason for the discontinuation are disease progression (n = 127), renal toxicity (n = 4), and social/financial (n = 7). Median PFS and OS are 8 months and 20 months, respectively. The patients with baseline pleural effusion had better PFS (9 months vs. 7 months, P = 0.02) and OS (26 months vs. 18 months, P = 0.05). The patients receiving more than 6 cycles of maintenance had improved PFS (12 vs. 7 months, P = 0.002) and OS (26 vs. 16 months, P = 0.05). Conclusion: Maintenance pemetrexed is feasible and well tolerated by the majority of Indian patients who achieved the response after platin based doublet. The patients with baseline pleural effusion benefit more with maintenance pemetrexed.
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Affiliation(s)
| | - Deepa Susan Phillip
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nirmala Jambekar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajesh Kaushal
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Shukla S, Malhotra KP, Husain N, Gupta A, Anand N. The utility of cytology in the diagnosis of adenocarcinoma lung: A tertiary care center study. J Cytol 2016; 32:159-64. [PMID: 26729975 PMCID: PMC4687205 DOI: 10.4103/0970-9371.168838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Pulmonary adenocarcinoma harbors various molecular abnormalities that include epidermal growth factor mutation, anaplastic lymphoma kinase gene re-arrangement, K-RAS mutations. The availability of targeted therapy against these molecular markers has revolutionized personalized medicine. Accurate cytological diagnosis of pulmonary adenocarcinoma will aid in utilising the cytology smears for molecular testing. Objective: The objective of this retrospective study was to evaluate the diagnostic efficacy of various cytology samples in the diagnosis of pulmonary adenocarcinoma. Materials and Methods: The study included a retrospective case series of 50 patients with biopsy proven non small cell lung carcinoma of adenocarcinoma subtype. The corresponding cytology reports of all the 50 cases were analyzed for different samples including broncho-alveolar lavage (BAL), bronchial washings, bronchial brush smears, pleural fluid, sputum and guided fine needle aspiration cytology (FNAC) of lung and metastatic lymph nodes. The overall cyto-diagnosis efficacy as well that of various cytological samples were analyzed. Results: Multiple cytology samples were received in 14 of 50 cases. The overall diagnostic efficacy of the various cytology samples in the diagnosis of malignancy was 78% and 66.6% cases were accurately typed as non small cell lung carcinoma-adenocarcinoma. The best cytological sample for the detection of pulmonary adenocarcinoma was bronchial brush smears which had a detection rate of 70%. In fine needle aspiration cytology samples and bronchial washings the detection rate was 65.5% and 25% respectively. Discussion and Conclusion: In cases where the cytological diagnosis is certain the tissue biopsies can be simultaneously tested for EGRF and ALK gene mutations. Repeat biopsies are often required due to small amount of tumor tissue or necrotic biopsies. Alternate use of cytological specimen for molecular testing can be done when a diagnosis of pulmonary adenocarcinoma is established.
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Affiliation(s)
- Saumya Shukla
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kiran Preet Malhotra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anurag Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nidhi Anand
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Kota R, Gundeti S, Gullipalli M, Linga VG, Maddali LS, Digumarti R. Prevalence and outcome of epidermal growth factor receptor mutations in non-squamous non-small cell lung cancer patients. Lung India 2015; 32:561-5. [PMID: 26664160 PMCID: PMC4663857 DOI: 10.4103/0970-2113.168099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) mutation analysis has become an important part of the initial workup of non-squamous non-small cell lung cancer (NS-NSCLC) patients as it is now recognized both as a prognostic and predictive marker to therapy with EGFR tyrosine kinase inhibitors (TKI). AIM In this retrospective study conducted at a University hospital, we evaluated the prevalence of EGFR mutations in patients with NS-NSCLC, clinico-pathological correlation and outcome to treatment with EGFR TKIs. MATERIALS AND METHODS Case records of 147 patients of NS-NSCLC in whom EGFR mutation status was tested were screened. EGFR mutation analysis was done using DNA sequencing by real time polymerase chain reaction method from tissue and cell blocks prepared from core biopsy, fine needle aspiration cytology and pleural fluid specimens. RESULTS EGFR mutations were seen in 30.6% of the 111 evaluable specimens, with a significantly higher rate in females (44% vs 19.6% P = 0.0072) as compared to men and non-smokers (41% vs 12% P = 0.0013) as against smokers. Most common mutations were observed in exons 19 (71%) and 21 (25%). The estimated median progression free survival for patients with and without mutations when treated with upfront TKIs was 12 months and 3 months respectively and the estimated median overall survival for patients with and without mutations was 20 and 9 months respectively. CONCLUSION This study from India, further establishes the importance of upfront EGFR mutation testing in all NS-NSCLC patients, not only to prognosticate, but also to identify that subset of patients who could benefit from EGFR TKI therapy, early in the course of their disease.
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Affiliation(s)
- Rajesh Kota
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Muralidhar Gullipalli
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Vijay Gandhi Linga
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Lakshmi Srinivas Maddali
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Raghunadharao Digumarti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
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