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Hattu D, van der Salm A, van Loon J, Taasti V, Peeters S, Ven LI, De Ruysscher D. 194P Motion of lymph nodes and the effect on the dose coverage in proton therapy of lung cancer. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00447-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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2
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Aldenhoven L, Ramaekers B, Degens J, Oberije C, van Loon J, Dingemans AC, De Ruysscher D, Joore M. Cost-effectiveness of proton radiotherapy versus photon radiotherapy for non-small cell lung cancer patients: Exploring the model-based approach. Radiother Oncol 2022; 183:109417. [PMID: 36375562 DOI: 10.1016/j.radonc.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Proton radiotherapy (PT) is a promising but more expensive strategy than photon radiotherapy (XRT) for the treatment of non-small cell lung cancer (NSCLC). PT is probably not cost-effective for all patients. Therefore, patients can be selected using normal tissue complication probability (NTCP) models with predefined criteria. This study aimed to explore the cost-effectiveness of three treatment strategies for patients with stage III NSCLC: 1. photon radiotherapy for all patients (XRTAll); 2. PT for all patients (PTAll); 3. PT for selected patients (PTIndividualized). METHODS A decision-analytical model was constructed to estimate and compare costs and QALYs of all strategies. Three radiation-related toxicities were included: dyspnea, dysphagia and cardiotoxicity. Costs and QALY's were incorporated for grade 2 and ≥ 3 toxicities separately. Incremental Cost-Effectiven Ratios (ICERs) were calculated and compared to a threshold value of €80,000. Additionally, scenario, sensitivity and value of information analyses were performed. RESULTS PTAll yielded most QALYs, but was also most expensive. XRTAll was the least effective and least expensive strategy, and the most cost-effective strategy. For thresholds higher than €163,467 per QALY gained, PTIndividualized was cost-effective. When assuming equal minutes per fraction (15 minutes) for PT and XRT, PTIndividualized was considered the most cost-effective strategy (ICER: €76,299). CONCLUSION Currently, PT is not cost-effective for all patients, nor for patient selected on the current NTCP models used in the Dutch indication protocol. However, with improved clinical experience, personnel and treatment costs of PT can decrease over time, which potentially leads to PTIndividualized, with optimal patient selection, will becoming a cost-effective strategy.
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Affiliation(s)
- Loeki Aldenhoven
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
| | - B Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - J Degens
- Department of Respiratory Medicine, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - C Oberije
- The D-Lab: Decision Support for Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J van Loon
- Department of Radiation Oncology (MAASTRO clinic), GROW School for Developmental Biology and Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A C Dingemans
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - D De Ruysscher
- Department of Radiation Oncology (MAASTRO clinic), GROW School for Developmental Biology and Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands
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Zeng H, Zheng D, Witlox W, Levy A, Traverso A, Kong FM, Houben R, De Ruysscher D, Hendriks L. EP14.01-014 Risk Factors for Brain Metastasis in Patients with Small Cell Lung Cancer: A Systematic Review and Meta-analysis. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Traverso A, Tohidinezhad F, Bontempi D, Dekker A, Hendriks L, De Ruysscher D. P1.15-01 Differential Diagnosis of Pneumonitis in Metastatic NSCLC (Non-Small Cell Lung Cancer) Patients Receiving Immunotherapy With Radiomics. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cortiula F, Hendriks L, Wijsman R, Debakker S, Steens M, Peeters S, Michelotti A, Sijtsema N, Urban S, Niezink A, Dursun S, Bootsma G, Canters R, Tohidinezhad F, Fasola G, Rinaldi I, Taasti V, Houben R, De Ruysscher D. 957P Proton-therapy and concurrent chemotherapy in stage III NSCLC: Effects on toxicity and immune therapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Eberhardt W, Poettgen C, Gauler T, Schulte C, Friedel G, Kopp HG, Fischer B, Schmidberger H, Kimmich M, Budach W, Cordes S, Metzenmacher M, de Los Rios RH, Spengler W, De Ruysscher D, Belka C, Welter S, Brintrup DL, Guberina M, Oezkan F, Darwiche K, Schuler M, Jöckel KH, Aigner C, Stamatis G, Stuschke M. MA06.08 Long-term Survival and Competing Risks of Death in the ESPATUE Randomized Phase-III Trial in Stage III NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Cortiula F, Reymen B, Peters S, Van Mol P, Wauters E, Vansteenkiste J, De Ruysscher D, Hendriks LEL. Immunotherapy in unresectable stage III non-small-cell lung cancer: state of the art and novel therapeutic approaches. Ann Oncol 2022; 33:893-908. [PMID: 35777706 DOI: 10.1016/j.annonc.2022.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022] Open
Abstract
The standard of care for patients with stage III non-small-cell lung cancer (NSCLC) is concurrent chemoradiotherapy (CCRT) followed by 1 year of adjuvant durvalumab. Despite the survival benefit granted by immunotherapy in this setting, only 1/3 of patients are alive and disease free at 5 years. Novel treatment strategies are under development to improve patient outcomes in this setting: different anti-programmed cell death protein 1/programmed death-ligand 1 [anti-PD-(L)1] antibodies after CCRT, consolidation immunotherapy after sequential chemoradiotherapy, induction immunotherapy before CCRT and immunotherapy concurrent with CCRT and/or sequential chemoradiotherapy. Cross-trial comparison is particularly challenging in this setting due to the different timing of immunotherapy delivery and different patients' inclusion and exclusion criteria. In this review, we present the results of clinical trials investigating immune therapy in unresectable stage III NSCLC and discuss in-depth their biological rationale, their pitfalls and potential benefits. Particular emphasis is placed on the potential mechanisms of synergism between chemotherapy, radiation therapy and different monoclonal antibodies, and how this affects the tumor immune microenvironment. The designs and questions tackled by ongoing clinical trials are also discussed. Last, we address open questions and unmet clinical needs, such as the necessity for predictive biomarkers (e.g. radiomics and circulating tumor DNA). Identifying distinct subsets of patients to tailor anticancer treatment is a priority, especially in a heterogeneous disease such as stage III NSCLC.
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Affiliation(s)
- F Cortiula
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Medical Oncology, Udine University Hospital, Udine, Italy
| | - B Reymen
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - S Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - P Van Mol
- Department of Respiratory Diseases KU Leuven, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - E Wauters
- Department of Respiratory Diseases KU Leuven, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - J Vansteenkiste
- Department of Respiratory Diseases KU Leuven, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium.
| | - D De Ruysscher
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - L E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Centre(+), GROW School for Oncology and Reproduction, Maastricht, the Netherlands
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Balgobind B, Visser J, Grehn M, Knap M, De Ruysscher D, Levis M, Pruvot E, Verhoeff J, Blanck O. STereotactic Arrhythmia Radioablation in Europe: critical structure contouring benchmark results of the STOPSTORM Consortium. Europace 2022. [DOI: 10.1093/europace/euac053.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EU Horizon
Background/Introduction
In patients with refractory ventricular tachycardia (VT), STereotactic Arrhythmia Radioablation (STAR) showed promising results for otherwise untreatable patients [1]. The STOPSTORM.eu project coordinates European efforts to clinically validate STAR.
Purpose
The primary goal of the critical structures benchmark study was to harmonize contouring of organs at risk (OAR) for STAR within the STOPSTORM.eu consortium. The results enable to refine protocols and guidelines to ensure treatment harmonization.
Methods
Three well-selected STAR cases [2] were provided for this benchmark and sent to all radiation oncology centres within the consortium. Every case had a contrast-enhanced cardiac-CT which was already deformed to the primary planning-CT to contour the OAR in detail. Every centre was asked to contour 31 OAR’s according to literature-based guidelines. The resulting structure sets were evaluated within VelocityTM 4.1.
Results
Twenty centres participated in the critical structure contouring benchmark.
Contouring of the structures was performed with high accuracy according to the provided guidelines. The contours of common OAR’s in radiotherapy, such as the heart, lungs, stomach, oesophagus, bronchus, great vessels, and spinal canal were correctly contoured by all centres. In the substructures of the heart (chambers, valves, arteries, and nodes), deviations in the contours occurred more frequently, but no large systematic errors were found (see figure 1-2). The centres that already performed STAR treatments had markedly less difficulties with the contouring of the substructures. However, these structures do not have a consensus for treatment planning purposes and late toxicity but need to be contoured correctly for future analysis within the STOPSTORM project.
Conclusion
This large STOPSTORM.eu multi-centre critical structure benchmark study showed a high accuracy regarding standard critical structures. In the case of heart substructures some deviations occurred, which lead to new definitions for contouring these structures within the consortium. In addition, a close collaboration between radiation oncologist and cardiac electrophysiologist is recommended.
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Affiliation(s)
- B Balgobind
- Amsterdam University Medical Center, Radiation Oncology, Amsterdam, Netherlands (The)
| | - J Visser
- Amsterdam University Medical Center, Radiation Oncology, Amsterdam, Netherlands (The)
| | - M Grehn
- University Medical Center of Schleswig-Holstein, Radiotherapy, Kiel, Germany
| | - M Knap
- Aarhus University Hospital, Oncology, Aarhus, Denmark
| | - D De Ruysscher
- Maastricht University, Radiation Oncology (MAASTRO), Maastricht, Netherlands (The)
| | - M Levis
- University of Turin, Oncology, Turin, Italy
| | - E Pruvot
- University Hospital of Lausanne, Heart and Vessel, Cardiology, Lausanne, Switzerland
| | - J Verhoeff
- University Medical Center Utrecht, Radiotherapy, Utrecht, Netherlands (The)
| | - O Blanck
- University Medical Center of Schleswig-Holstein, Radiotherapy, Kiel, Germany
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De Ruysscher D. SP-0522 Radiomics and radiotherapy: State of the art and future challenges. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Traverso A, Rao C, Briassouli A, Dekker A, De Ruysscher D, van Elmpt W. PO-1609 Generating synthetic hypoxia images from FDG-PET using Generative Adversarial Networks (GANs). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Angrisani A, Houben R, Marcuse F, Hochstenbag M, Maessen J, De Ruysscher D, Peeters S. PO-1240 “Radiotherapy for Thymic Epithelial Tumors: What Is The Optimal Dose? A Systematic Review.”. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Rosas C, Rattay T, Azria D, Elliott R, Gutiérrez-Enríquez S, Rancati T, Rosenstein B, De Ruysscher D, Sperk E, Stobart H, Symonds R, Talbot C, De Santis M, Vega A, Veldeman L, Webb A, West C, Chang-Claude J, Seibold P. MO-0804 Determinants of fatigue and longitudinal changes up to 2 years post-radiotherapy for breast cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02440-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rancati T, Gioscio E, Cicchetti A, Rosenstein B, Seibold P, Avuzzi B, Azria D, Choudhury A, De Ruysscher D, Dunning A, Elliott R, Kerns S, Lambrecht M, Sperk E, Symonds P, Talbot C, Vega A, Veldeman L, Valdagni R, Webb A, Chang-Claude J, West C. MO-0557 Estimates of α/β ratios for individual late urinary toxicity endpoints: analysis of a cohort trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Cicchetti A, La Rocca E, De Santis M, Seibold P, Azria D, De Ruysscher D, Valdagni R, Dunning A, Elliot R, Gutiérrez-Enríquez S, Lambrecht M, Sperk E, Rancati T, Rattay T, Rosenstein B, Talbot C, Vega A, Veldeman L, Webb A, Chang-Claude J, West C. MO-0801 Machine learning based models of radiotherapy-induced skin induration for breast cancer patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hendriks L, Keek S, Chatterjee A, Belderbos J, Bootsma G, van den Borne B, Dingemans AM, Gietema H, Groen H, Herder G, Pitz C, Praag J, De Ruysscher D, Schoenmaekers J, Smit H, Stigt J, Westenend M, Zeng H, Woodruff H, Lambin P. 127P Does radiomics have added value in predicting the development of brain metastases in patients with radically treated stage III non-small cell lung cancer (NSCLC)? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cortiula F, De Ruysscher D, Dursun S, Steens M, Bootsma G, Canters R, Rinaldi I, Taasti V, Houben R, Reynders K, Peeters S, Angrisani A, Hattu D, Hendriks L. 113P Proton-therapy and concurrent chemotherapy in stage III NSCLC: Effects on durvalumab eligibility and safety profile. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Angrisani A, Houben R, Marcuse F, Hochstenbag M, Maessen J, De Ruysscher D, Peeters S. “Radiotherapy for Thymic Epithelial Tumors: What Is The Optimal Dose? A Systematic Review.”. Clin Transl Radiat Oncol 2022; 34:67-74. [PMID: 35360004 PMCID: PMC8960904 DOI: 10.1016/j.ctro.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/13/2022] [Indexed: 11/21/2022] Open
Abstract
Thymic epithelial tumors(TETs) often require a multimodal approach, including RT. RT dose recommendations largely derive from old data, where 2D RT was widely used. This systematic review focused on the optimal dose for TETs with modern RT. 5 eligible studies reporting dose response were analyzed and synthesized. Current guidelines remain valid, this work might be an eye-opener fostering new data.
Thymic epithelial tumors (TETs) are rare thoracic tumors, often requiring multimodal approaches. Surgery represents the first step of the treatment, possibly followed by adjuvant radiotherapy (RT) and, less frequently, chemotherapy. For unresectable tumors, a combination of chemotherapy and RT is often used. Currently, the optimal dose for patients undergoing radiation is not clearly defined. Current guidelines on RT are based on studies with a low level of evidence, where 2D RT was widely used. We aim to shed light on the optimal radiation dose for patients with TETs undergoing RT through a systematic review of the recent literature, including reports using modern RT techniques such as 3D-CRT, IMRT/VMAT, or proton-therapy. A comprehensive literature search of four databases was conducted following the PRISMA guidelines. Two investigators independently screened and reviewed the retrieved references. Reports with < 20 patients, 2D-RT use only, median follow-up time < 5 years, and reviews were excluded. Two studies fulfilled all the criteria and therefore were included. Loosening the follow-up time criteria to > 3 years, three additional studies could be evaluated. A total of 193 patients were analyzed, stratified for prognostic factors (histology, stage, and completeness of resection), and synthesized according to the synthesis without meta-analysis (SWIM) method. The paucity and heterogeneity of eligible studies led to controversial results. The optimal RT dose neither for postoperative, nor primary RT in the era of modern RT univocally emerged. Conversely, this overview can spark new evidence to define the optimal RT dose for each TETs category.
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Romita A, Tohidinezhad F, Traverso A, Dekker A, De Ruysscher D. 18P A radiomic approach to differentiate the immunotherapy-induced pneumonitis in patients with stage IV NSCLC. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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De Ruysscher D. JIES01.02 Radiomics and Radiotherapy: State of the Art and Future Challenges. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zeng H, De Ruysscher D, Hu X, Zheng D, Yang L, Kong F, Hendriks L. P63.12 Radiotherapy for Small Cell Lung Cancer in Current Clinical Practice Guidelines. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Peters S, Pujol JL, Dafni U, Dómine M, Popat S, Reck M, Andrade J, Becker A, Moro-Sibilot D, Curioni-Fontecedro A, Molinier O, Nackaerts K, Insa Mollá A, Gervais R, López Vivanco G, Madelaine J, Mazieres J, Faehling M, Griesinger F, Majem M, González Larriba JL, Provencio Pulla M, Vervita K, Roschitzki-Voser H, Ruepp B, Mitchell P, Stahel RA, Le Pechoux C, De Ruysscher D. Consolidation nivolumab and ipilimumab versus observation in limited-disease small-cell lung cancer after chemo-radiotherapy - results from the randomised phase II ETOP/IFCT 4-12 STIMULI trial. Ann Oncol 2021; 33:67-79. [PMID: 34562610 DOI: 10.1016/j.annonc.2021.09.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/13/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Concurrent chemotherapy and thoracic radiotherapy followed by prophylactic cranial irradiation (PCI) is the standard treatment in limited-disease small-cell lung cancer (LD-SCLC), with 5-year overall survival (OS) of only 25% to 33%. PATIENTS AND METHODS STIMULI is a 1:1 randomised phase II trial aiming to demonstrate superiority of consolidation combination immunotherapy versus observation after chemo-radiotherapy plus PCI (protocol amendment-1). Consolidation immunotherapy consisted of four cycles of nivolumab [1 mg/kg, every three weeks (Q3W)] plus ipilimumab (3 mg/kg, Q3W), followed by nivolumab monotherapy (240 mg, Q2W) for up to 12 months. Patient recruitment closed prematurely due to slow accrual and the statistical analyses plan was updated to address progression-free survival (PFS) as the only primary endpoint. RESULTS Of the 222 patients enrolled, 153 were randomised (78: experimental; 75: observation). Among the randomised patients, median age was 62 years, 60% males, 34%/65% current/former smokers, 31%/66% performance status (PS) 0/1. Up to 25 May 2020 (median follow-up 22.4 months), 40 PFS events were observed in the experimental arm, with median PFS 10.7 months [95% confidence interval (CI) 7.0-not estimable (NE)] versus 42 events and median 14.5 months (8.2-NE) in the observation, hazard ratio (HR) = 1.02 (0.66-1.58), two-sided P = 0.93. With updated follow-up (03 June 2021; median: 35 months), median OS was not reached in the experimental arm, while it was 32.1 months (26.1-NE) in observation, with HR = 0.95 (0.59-1.52), P = 0.82. In the experimental arm, median time-to-treatment-discontinuation was only 1.7 months. CTCAE v4 grade ≥3 adverse events were experienced by 62% of patients in the experimental and 25% in the observation arm, with 4 and 1 fatal, respectively. CONCLUSIONS The STIMULI trial did not meet its primary endpoint of improving PFS with nivolumab-ipilimumab consolidation after chemo-radiotherapy in LD-SCLC. A short period on active treatment related to toxicity and treatment discontinuation likely affected the efficacy results.
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Affiliation(s)
- S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Lausanne University, Lausanne, Switzerland
| | - J-L Pujol
- Thoracic Oncology Unit, Hopital Arnaud de Villeneuve, Montpellier, France
| | - U Dafni
- National and Kapodistrian University of Athens, Athens, Greece; Frontier Science Foundation-Hellas, Athens, Greece
| | - M Dómine
- Hospital Universitario Fundacion Jimenez Díaz (IIS-FJD), Madrid, Spain
| | - S Popat
- Medicine, Royal Marsden Hospital, London, UK
| | - M Reck
- Thoracic Oncology, Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - J Andrade
- Medical Oncology, Hospital Virgen De La Salud, Toledo, Spain
| | - A Becker
- Department of Pulmonology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - D Moro-Sibilot
- Thoracic Oncology Unit, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - A Curioni-Fontecedro
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - O Molinier
- Department of Respiratory Disease, Centre Hospitalier - Le Mans, Le Mans, France
| | - K Nackaerts
- Department of Pulmonology, Respiratory Oncology Unit, KU Leuven, Leuven, Belgium
| | - A Insa Mollá
- Medical Oncology, Hospital Clínico Universitario De Valencia, Valencia, Spain
| | - R Gervais
- Medical Oncology, Centre François Baclesse, Caen, France
| | - G López Vivanco
- Medical Oncology, Hospital Universitario Cruces, Barakaldo, Spain
| | - J Madelaine
- Thoracic Oncology Unit, Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - J Mazieres
- Thoracic Oncology, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | | | | | - M Majem
- Hospital De La Santa Creu I Sant Pau, Barcelona, Spain
| | | | | | - K Vervita
- Frontier Science Foundation-Hellas, Athens, Greece
| | - H Roschitzki-Voser
- Coordinating Office, European Thoracic Oncology Platform, Bern, Switzerland
| | - B Ruepp
- Coordinating Office, European Thoracic Oncology Platform, Bern, Switzerland
| | - P Mitchell
- Olivia Newton-John Cancer Centre, Austin Hospital (VIC), Melbourne, Australia
| | - R A Stahel
- Coordinating Office, European Thoracic Oncology Platform, Bern, Switzerland.
| | - C Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - D De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht, Netherlands
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Tohidinezhad F, Pennetta F, Van Loon J, De Ruysscher D, Traverso A. PH-0270 Prediction models for cardiotoxicity in patients with non-small-cell lung cancer: systematic review. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Angrisani A, Hattu D, Hendriks L, Peeters S, Reymen B, Van Loon J, Verhoeven K, In ‘t Ven L, Dhont J, De Ruysscher D. PD-0844 Sarcopenia evolution in stage III lung cancer treated with photon or proton chemo-radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dingemans AMC, Früh M, Ardizzoni A, Besse B, Faivre-Finn C, Hendriks LE, Lantuejoul S, Peters S, Reguart N, Rudin CM, De Ruysscher D, Van Schil PE, Vansteenkiste J, Reck M. Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up ☆. Ann Oncol 2021; 32:839-853. [PMID: 33864941 PMCID: PMC9464246 DOI: 10.1016/j.annonc.2021.03.207] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- A.-M. C. Dingemans
- Department of Pulmonology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Respiratory Medicine, Rotterdam
- Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M. Früh
- Department of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen
- Department of Medical Oncology, University of Bern, Bern, Switzerland
| | - A. Ardizzoni
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B. Besse
- Gustave Roussy, Villejuif
- Paris-Saclay University, Orsay, France
| | - C. Faivre-Finn
- Division of Cancer Sciences, University of Manchester & The Christie, NHS Foundation Trust, Manchester, UK
| | - L. E. Hendriks
- Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S. Lantuejoul
- Department of Biopathology, Centre Léon Bérard, Grenoble Alpes University, Lyon, France
| | - S. Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - N. Reguart
- Department of Medical Oncology, Hospital Clínic and Translational Genomics and Targeted Therapeutics in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - C. M. Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D. De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - P. E. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - J. Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - M. Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, Lung Clinic, Grosshansdorf, Germany
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Evers J, De Jaeger K, Hendriks L, Van der Sangen M, Terhaard C, Siesling S, De Ruysscher D, Struikmans H, Aarts M. 30P Trends and variations in treatment of stage I-III non-small cell lung cancer from 2008–2018: A nationwide population-based study from the Netherlands. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Candiff O, Belderbos J, Damen E, Van Haaren P, Crijns W, Hol S, Paelinck L, Jaspers J, Van Kesteren Z, De Kerf G, Van Elmpt W, Ubbels J, Schagen S, De Ruysscher D, De Ruiter M. P49.01 Treatment Planning QA of Hippocampal Avoidance Prophylactic Cranial Irradiation in the Multicenter Randomized Phase III Trial (NCT01780675). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cooke S, De Ruysscher D, Reymen B, Lambrecht M, Fredberg Persson G, Faivre-Finn C, Dieleman E, Van Diessen J, Sikorska K, Lalezari F, Sonke J, Belderbos J. OA02.05 Local, Regional and Pulmonary Failures in the Randomised PET-Boost Trial for NSCLC Patients. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vilches Freixas G, Vaniqui A, Vaassen F, Hazelaar C, Öllers M, Canisius S, Tissen D, Van Enckevort E, Rousch E, Verhoeven K, Van Loon J, De Ruysscher D, Bosmans G, Van Elmpt W, Rinaldi I, Peeters S. PO-1614: Breath hold characteristics and intra-fraction motion during nasal high flow therapy assisted RT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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LeenderS M, Robeers R, Hendriks L, Van Loon J, Bootsma G, Wanders R, Pitz C, Reymen B, Houben R, Van Baardwijk A, Verhoeven K, Peeters S, De Ruysscher D. PO-1025: Prognostic factors for PFS and OS in radically treated patients with oligometastatic NSCLC. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Offermann-Wulms C, Roumen C, Ankolekar A, Van Engelen A, Fijten R, De Ruysscher D. PO-1930: Factors influencing clinical trial participation: an assessment for a trial decision aid. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peeters S, Canisius S, Tissen D, Van Enckevort E, Rousch E, Öllers M, Bosmans G, Verhoeven K, Overhof C, Van Loon J, De Ruysscher D, Vilches-Freixas G. PO-1014: Mitigating breathing motion with nasal high flow therapy (NHFT) in lung cancer: A prospective study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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32
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Degens J, De Ruysscher D, Houben R, Kietselaer B, Bootsma G, Hendriks L, Huijbers E, Schols A, Dingemans AMC. Are patients with stage III non-small cell lung cancer treated with chemoradiotherapy at risk for cardiac events? Results from a retrospective cohort study. BMJ Open 2020; 10:e036492. [PMID: 32988942 PMCID: PMC7523207 DOI: 10.1136/bmjopen-2019-036492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Dyspnoea is one of the symptoms frequently encountered after treatment with chemoradiotherapy (CRT) in stage III non-small cell lung cancer (NSCLC). Long-term data on mild to moderately severe cardiac events as underlying cause of dyspnoea in patients with stage III NSCLC are lacking. Therefore, the incidence of new cardiac events, with a common terminology criteria for adverse events (CTCAE) score of ≥2 within 5 years after diagnosis, were analysed. DESIGN Retrospective multicentre cohort study of patients with stage III NSCLC treated with CRT from 2006 to 2013. The medical files of the treated patients were reviewed. OUTCOME MEASURES The primary endpoint of the study was the incidence of new cardiac events with a CTCAE score of ≥2 within 5 years after diagnosis. Secondary endpoint was to identify risk factors associated with the development of a cardiac event. RESULTS Four hundred and sixty patients were included in the study. Of all patients, 150 (32.6%) developed a new cardiac event. In patients with a known cardiac history (n=138), 44.2% developed an event. The most common cardiac events were arrhythmia (14.6%), heart failure (7.6%) and symptomatic coronary artery disease (6.8%). Pre-existent cardiac comorbidity (HR 1.96; p<0.01) and WHO-performance score ≥2 (HR 2.71; p<0.01) were significantly associated with developing a cardiac event. The majority of patients did not have pre-existent cardiac comorbidity (n=322). Elevated WHO/International Society of Hypertension score was not identified as a significant predictor for cardiac events. CONCLUSION One-third of patients with stage III NSCLC treated in daily clinical practice develop a new cardiac event within 5 years after CRT. All physicians confronted with patients with NSCLC should take cardiac comorbidity as a serious possible explanation for dyspnoea after treatment with CRT.
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Affiliation(s)
- Juliette Degens
- Departement of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | - D De Ruysscher
- Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, MAASTRO, Maastricht, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology, MAASTRO, Maastricht, the Netherlands
| | - Bastiaan Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, the Netherlands
| | - Gerben Bootsma
- Department of Respiratory Medicine, Zuyderland Medical Centre Heerlen, Heerlen, the Netherlands
| | - Lizza Hendriks
- Department of Respiratory Medicine, GROW School for Oncology and Developmental Biology, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | - Ellen Huijbers
- General Practitioner, focus on Cardio-Vascular Risk Management, DOH Zorggroep, Eindhoven, the Netherlands
| | - Annemie Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Anne-Marie C Dingemans
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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Peters S, Pujol JL, Dafni U, Dómine M, Becker A, Andrade J, Curioni-Fontecedro A, Molinier O, Moro-Sibilot D, Nackaerts K, Mollá AI, López Vivanco G, Madelaine J, Popat S, Reck M, Roschitzki-Voser H, Mitchell P, De Ruysscher D, Le Pechoux C, Stahel R. LBA84 Consolidation ipilimumab and nivolumab vs observation in limited stage SCLC after chemo-radiotherapy: Results from the ETOP/IFCT 4-12 STIMULI trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2326] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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De Ruysscher D, Ramalingam S, Urbanic J, Gerber D, Tan D, Cai J, Li A, Peters S. 1255TiP CheckMate 73L: A phase III study comparing nivolumab (NIVO) plus concurrent chemoradiotherapy (CCRT) followed by NIVO ± ipilimumab (IPI) versus CCRT followed by durvalumab (DURV) for previously untreated, locally advanced (LA) stage III non-small cell lung cancer (NSCLC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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35
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Vansteenkiste J, Wauters E, Reymen B, Ackermann CJ, Peters S, De Ruysscher D. Current status of immune checkpoint inhibition in early-stage NSCLC. Ann Oncol 2020; 30:1244-1253. [PMID: 31143921 DOI: 10.1093/annonc/mdz175] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Immune checkpoint inhibition (ICI) immunotherapy has revolutionized the approach to metastatic non-small-cell lung cancer (NSCLC). In particular, antibodies blocking the inhibitory immune checkpoints programmed death 1 (PD-1) and its ligand (PD-L1) are associated with higher response rates, improved overall survival and better tolerability as compared with conventional cytotoxic chemotherapy. Recently, ICI has moved from the second-line to the first-line setting for many patients with non-oncogene-addicted NSCLC, either alone or in combination with chemotherapy. The next logical step is to examine this therapy in patients with non-metastatic NSCLC to improve long-term overall survival and cure rates. For patients with unresectable stage III NSCLC, ICI with durvalumab after concurrent chemoradiotherapy has brought a major improvement in 2-year progression-free and overall survival, which holds promise for an improved cure rate. As the relapse pattern in patients with completely resected early-stage NSCLC is predominantly systemic, high expectations rest on the integration of ICI therapy in their treatment approach. A large number of studies with adjuvant or neo-adjuvant ICI are ongoing and will be discussed here. The advent of stereotactic ablative radiotherapy has brought a valid alternative treatment of patients unfit for or not willing to undergo surgery. Data on combining systemic therapy and stereotactic ablative radiotherapy are virtually non-existent, but there is a strong biological rationale to combine radiotherapy and ICI therapy. Early findings in small feasibility studies are promising and now need to be explored in well-designed phase III trials.
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Affiliation(s)
- J Vansteenkiste
- Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium.
| | - E Wauters
- Respiratory Oncology Unit, University Hospital KU Leuven, Leuven, Belgium
| | - B Reymen
- Radiation Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C J Ackermann
- Department of Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - S Peters
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - D De Ruysscher
- Radiation Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Früh M, Panje CM, Reck M, Blackhall F, Califano R, Cappuzzo F, Besse B, Novello S, Garrido P, Felip E, O'Brien M, Paz Ares L, de Marinis F, Westeel V, De Ruysscher D, Putora PM. Choice of second-line systemic therapy in stage IV small cell lung cancer (SCLC) - A decision-making analysis amongst European lung cancer experts. Lung Cancer 2020; 146:6-11. [PMID: 32485661 DOI: 10.1016/j.lungcan.2020.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Stage IV small cell lung cancer (SCLC) is associated with short survival and progression after first-line systemic therapy frequently occurs within months. Although topotecan is approved for second-line treatment, its efficacy is limited, and treatment heterogeneity exists. MATERIAL AND METHODS The decision-making patterns for second line treatment of 13 European medical oncologists with expertise in SCLC were analyzed. RESULTS The two criteria most relevant to decision-making were the performance status and the interval of recurrence since first-line treatment. With an interval of less than 3 months since the end of first-line chemotherapy, 62 % of the experts recommended cyclophosphamide, doxorubicin and vincristine (CAV) for fit patients and 54 % recommended topotecan for unfit patients. For an interval of more than 6 months, a clear consensus for a re-challenge with a platinum doublet was achieved (92 %). However, there was no consensus on the second-line therapy with an interval of 3-6 months since the end of first-line therapy. CONCLUSION Real world practice may differ from recommendations in general guidelines and cannot always be directly derived from trial results as other factor such as habits, patient's preference, convenience or costs have to be factored in.
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Affiliation(s)
- M Früh
- Department of Medical Oncology/Hematology, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland; University of Bern, Bern, Switzerland.
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - M Reck
- LungenClinic Airway Research Center North (ARCN), German Center for Lung Research, Grosshansdorf, Germany
| | - F Blackhall
- Division of Cancer Sciences, University of Manchester & The Christie NHS Foundation Trust Manchester, United Kingdom
| | - R Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Medical Oncology, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - F Cappuzzo
- Oncology and Hematology Department, AUSL Romagna, Viale Randi 5, Ravenna, Italy
| | - B Besse
- Institut Gustave Roussy, Villejuif, France; Université Paris Sud, Le Kremlin Bicetre, France
| | - S Novello
- Oncology Department, AOU San Luigi, University of Turin, Italy
| | - P Garrido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Felip
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - M O'Brien
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, United Kingdom
| | - L Paz Ares
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - D De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), School for Oncology and Developmental Biology (GROW), Maastricht, the Netherlands
| | - P M Putora
- University of Bern, Bern, Switzerland; Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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De Ruysscher D, Faivre-Finn C, Nackaerts K, Jordan K, Arends J, Douillard J, Ricardi U, Peters S. Recommendation for supportive care in patients receiving concurrent chemotherapy and radiotherapy for lung cancer. Ann Oncol 2020; 31:41-49. [DOI: 10.1016/j.annonc.2019.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/06/2019] [Accepted: 10/08/2019] [Indexed: 12/13/2022] Open
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De Ruysscher D, Nakaerts K. ES23.04 Optimal Supportive Care During and After Concurrent Chemoradiotherapy and I/O. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Witlox W, De Ruysscher D, Lacas B, Le Pechoux C, Pignon J, Guckenberger M, Sun A, Redman M, Wang S, Hu C, Van Der Noort V, Li N, Van Tinteren H, Groen H, Joore M, Ramaekers B. OA12.01 PCI for Radically Treated Non-Small Cell Lung Cancer: A Meta-Analysis Using Updated Individual Patient Data of Randomized Trials. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Peters S, Felip E, Dafni U, Tufman A, Guckenberger M, Irigoyen A, Nadal E, Becker A, Vees H, Pless M, Martinez-Marti A, Lambrecht M, Andratschke N, Tsourti Z, Piguet AC, Roschitzki-Voser H, Rabaglio-Poretti M, Stahel R, Vansteenkiste J, De Ruysscher D. Efficacy evaluation of concurrent nivolumab addition to a first-line, concurrent chemo-radiotherapy regimen in unresectable locally advanced NSCLC: Results from the European Thoracic Oncology Platform (ETOP 6-14) NICOLAS phase II trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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41
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Peters S, Felip E, Dafni U, Belka C, Guckenberger M, Irigoyen A, Nadal E, Becker A, Vees H, Pless M, Martinez-Marti A, Tufman A, Lambrecht M, Andratschke N, Piguet AC, Kassapian M, Roschitzki-Voser H, Rabaglio-Poretti M, Stahel RA, Vansteenkiste J, De Ruysscher D. Safety evaluation of nivolumab added concurrently to radiotherapy in a standard first line chemo-radiotherapy regimen in stage III non-small cell lung cancer-The ETOP NICOLAS trial. Lung Cancer 2019; 133:83-87. [PMID: 31200833 DOI: 10.1016/j.lungcan.2019.05.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/25/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Chemo-radiotherapy (CRT) and concurrent PD-1 inhibition has shown promising results in pre-clinical models. So far, the feasibility of delivering concurrent CRT and PD-1/PD-L1 inhibition has never been assessed in a clinical trial. MATERIAL AND METHODS NICOLAS is a phase-II trial evaluating the safety and efficacy of nivolumab combined with CRT in stage III NSCLC. Patients received 3 cycles of platinum-based chemotherapy and concurrent RT (66 Gy/33fractions). Nivolumab started concurrently with RT. The primary endpoint was 6-month post-RT rate of grade-≥3-pneumonitis. A formal interim safety analysis (IA) was scheduled when the first 21 patients reached 3 months follow-up post-RT. An early positive safety conclusion would be reached at IA if there were no grade ≥3-pneumonitis in those patients. Efficacy evaluation was planned provided the safety conclusion was reached. RESULTS AND CONCLUSION As of 13 December 2018, 82 patients were recruited with median follow-up of 13.4 months. The most frequent adverse events (AEs) were anaemia, fatigue and pneumonitis. No unexpected AEs or increased toxicities were observed. For the first 21 patients, no grade-≥3-pneumonitis was observed by the end of the 3-month post-RT follow-up period. The early safety IA provides evidence that the addition of nivolumab to concurrent CRT is safe and tolerable regarding the 6-month rate of pneumonitis grade ≥3 at the one-sided significance level of 5%. Following that, the 1-year progression-free survival will be evaluated in an expanded patient cohort. NICOLAS trial creates the opportunity for assessing the activity of the combination of checkpoint with concurrent CRT in larger prospective trials for locally advanced NSCLC.
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Affiliation(s)
- S Peters
- Centre Hospitalier Universitaire Vaudois (CHUV), Département d'Oncologie, Lausanne, Switzerland
| | - E Felip
- Vall d'Hebron University Hospital, Institute of Oncology (VHIO), Barcelona, Spain
| | - U Dafni
- Frontier Science Foundation-Hellas & National and Kapodistrian University of Athens, Greece
| | - C Belka
- Department of Radiation Oncology and DZL Munich, University Hospital, LMU Munich, Germany
| | - M Guckenberger
- University Hospital Zurich, Department for Radiation Oncology, University of Zurich, Switzerland
| | - A Irigoyen
- Hospital Virgen De La Salud, Department of Medical Oncology, Toledo, Spain
| | - E Nadal
- Catalan Institute of Oncology, Department of Medical Oncology, IDIBELL L'Hospitalet, Barcelona, Spain
| | - A Becker
- Amsterdam University Medical Center, Department of Respiratory Diseases, Amsterdam, the Netherlands
| | - H Vees
- Clinic Hirslanden, Radiation Oncology, Zürich, Switzerland
| | - M Pless
- Cantonal Hospital Winterthur, Medical Oncology, Winterthur, Switzerland
| | - A Martinez-Marti
- Vall d'Hebron University Hospital, Institute of Oncology (VHIO), Barcelona, Spain
| | - A Tufman
- Ludwig Maximilian University of Munich (LMU), Medizinische Klinik and Poliklinik V, German Center for Lung Research, Munich, Germany
| | - M Lambrecht
- University Hospitals Gasthuisberg, Department of Radiotherapy-Oncology, Leuven, Belgium
| | - N Andratschke
- University Hospital Zurich, Department for Radiation Oncology, University of Zurich, Switzerland
| | - A C Piguet
- European Thoracic Oncology Platform (ETOP), Bern, Switzerland
| | - M Kassapian
- Frontier Science Foundation-Hellas, Athens, Greece
| | | | | | - R A Stahel
- University Hospital Zurich, Department of Haematology and Oncology, Switzerland
| | - J Vansteenkiste
- University Hospitals Gasthuisberg, Department of Respiratory Diseases, Leuven, Belgium
| | - D De Ruysscher
- Maastro Clinic, Department of Radiation Oncology Maastricht, the Netherlands.
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42
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Sanduleanu S, Jochems A, Upadhaya T, Even A, Leijenaar R, Dankers F, Klaassen R, Woodruff H, Hatt M, Kaanders H, Hamming-Vrieze O, Van Laarhoven H, Subramiam R, Huang S, O’Sullivan B, Bratman S, Dubois L, Miclea R, Di Perri D, Geets X, De Ruysscher D, Hoebers F, Lambin P. PO-0733 Non-invasive imaging for tumor hypoxia: a novel validated CT and FDG-PET-based Radiomic signature. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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43
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Offermann-Wulms C, Roumen C, Ankolekar A, Coenen J, Nijsten I, Fijten R, De Ruysscher D. EP-2103 Development of a personalized, interactive patient decision aid for participation in clinical trials. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32523-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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44
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Apolle R, Appold S, Bussink J, Faivre-Finn C, Khalifa J, Lievens Y, De Ruysscher D, Van Elmpt W, Troost E. EP-1367 Target volumes in adaptive treatment of NSCLC show large discrepancies among experts. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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45
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Rancati T, Seibold P, Webb A, Chang-Claude J, Cicchetti A, Azria D, De Ruysscher D, Elliott R, Gutiérrez-Enríquez S, Rosenstein B, Talbot C, Vega A, Veldeman L, Valdagni R, West C. OC-0161 Validation of clinical/dosimetric/genetic risk factor models for late RT-induced rectal bleeding. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Witlox W, Ramaekers B, Groen H, Dingemans AM, Praag J, Belderbos J, Van der Noort V, Van Tinteren H, Joore M, De Ruysscher D. The effect of prophylactic cranial irradiation (PCI) for young stage III NSCLC patients: Subgroup analyses of the NVALT-11/DLCRG-02 study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz067.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Adebahr S, Liu Y, Colette S, Faivre-Finn C, Ahmad S, Ahmed M, Belderbos J, Andratschke N, Franks K, Geets X, Guckenberger M, Konopa K, Lambrecht M, Lewitzki V, Lievens Y, Pourel N, De Ruysscher D, Dziadziuszko R, Fortpied C, McDonald F, Peulen H, Grosu A, Hurkmans C, Le Pechoux C, Nestle U. OC-0061 EORTC 22113-8113 Lungtech trial on SBRT of central lung tumors. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30481-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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48
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Talbot C, Azria D, Burr T, Chang-Claude J, Dunning A, Jacquet MF, Herskind C, De Ruysscher D, Elliott R, Gutiérrez-Enríquez S, Lambin P, Müller A, Rancati T, Rattay T, Rosenstein B, Seibold P, Valdagni R, Vega A, Veldeman L, Veldwijk M, Wenz F, Webb A, West C. OC-0647 Analysis of biomarkers for late radiotherapy toxicity in the REQUITE project. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31067-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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De Ruysscher D. SP-0325 Is fractionation history? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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West C, Azria D, Chang-Claude J, De Ruysscher D, Elliott R, Gutiérrez-Enríquez S, Rancati T, Rosenstein B, Seibold P, Talbot C, Vega A, Veldeman L, Webb A. EP-1663 REQUITE multicentre study of patients undergoing radiotherapy for breast, lung or prostate cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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