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Belderbos RA, Corneth OBJ, Dumoulin D, Hendriks RW, Aerts JGJV, Willemsen M. Atypical B cells (CD21-CD27-IgD-) correlate with lack of response to checkpoint inhibitor therapy in NSCLC. Eur J Cancer 2024; 196:113428. [PMID: 38039777 DOI: 10.1016/j.ejca.2023.113428] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Checkpoint inhibitor (CI) therapy has revolutionized treatment for non-small cell lung cancer (NSCLC). However, a proportion of patients do not respond to CI therapy for unknown reasons. Although the current paradigm in anti-tumor immunity evolves around T cells, the presence of tertiary lymphoid structures and memory B cells has been positively correlated with response to CI therapy in NSCLC. In addition, double negative (DN) (CD27- IgD-) B cells have been shown to be abundant in NSCLC compared to healthy lung tissue and inversely correlate with the intratumoral presence of memory B cells. Nonetheless, no study has correlated DN B cells to survival in NSCLC. METHODS In this study, we evaluated the presence and phenotype of B cells in peripheral blood with flow cytometry of patients with NSCLC and mesothelioma before receiving CI therapy and correlated these with clinical outcome. RESULTS Non-responding patients showed decreased frequencies of B cells, yet increased frequencies of antigen-experienced CD21- DN (Atypical) B cells compared to responding patients and HC, which was confirmed in patients with mesothelioma treated with CI therapy. CONCLUSIONS These data show that the frequency of CD21- DN B cells correlates with lack of response to CI therapy in thoracic malignancies. The mechanism by which CD21- DN B cells hamper CI therapy remains unknown. Our findings support the hypothesis that CD21- DN B cells resemble phenotypically identical exhausted B cells that are seen in chronic infection or function as antigen presenting cells that induce regulatory T cells.
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Affiliation(s)
- R A Belderbos
- Department of Pulmonary Medicine, the Netherlands; Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, the Netherlands.
| | | | - D Dumoulin
- Department of Pulmonary Medicine, the Netherlands; Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, the Netherlands
| | - R W Hendriks
- Department of Pulmonary Medicine, the Netherlands
| | - J G J V Aerts
- Department of Pulmonary Medicine, the Netherlands; Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, the Netherlands.
| | - M Willemsen
- Department of Pulmonary Medicine, the Netherlands; Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, the Netherlands
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Dumoulin DW, Douma LH, Hofman MM, van der Noort V, Cornelissen R, de Gooijer CJ, Burgers JA, Aerts JGJV. Nivolumab and ipilimumab in the real-world setting in patients with mesothelioma. Lung Cancer 2024; 187:107440. [PMID: 38104353 DOI: 10.1016/j.lungcan.2023.107440] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Nivolumab (anti-PD-1) plus ipilimumab (anti-CTLA-4) is a new first-line treatment combination for patients with pleural mesothelioma. Nivolumab-ipilimumab improved the survival, however, 30.3% of the patients suffered from grade 3-4 treatment related adverse events (TRAE's) and TRAE's led to discontinuation in 23.0% of all patients. Here, we present the first real-world data of nivolumab plus ipilimumab in patients with malignant mesothelioma treated in two mesothelioma expert centers. METHODS Clinical data of patients with mesothelioma treated with nivolumab and ipilimumab were prospectively collected. Clinical parameters were obtained every visit, CT scans were evaluated every 12 weeks and adverse events were assessed continuously during the treatment. Data on grade 2-5 TRAE's and activity (overall response rate (ORR), duration of response (DOR), disease control rate (DCR), median progression-free survival (mPFS) and median overall survival (mOS) were reported. RESULTS Between January 2021 and August 2022, 184 patients were treated with nivolumab plus ipilimumab. The median follow-up was 12.1 months (95 %CI 11.1 - 13.1). Grade 3-4 TRAEs were seen in 27.7 % of the patients and 25.0 % discontinued immunotherapy treatment early because of TRAE's. ORR was 21.7 % (95 % CI 15.7-27.7), median DOR was 5.7 months (IQR 3.2-8.7) and DCR at 12 weeks 56.0 % (95 % CI 48.8-63.2). The mPFS was 5.5 months (95 %CI 4.1-6.9), mOS was 14.1 months (95 % CI 11.1-18.2). CONCLUSIONS Nivolumab plus ipilimumab had an equal efficacy in a real-world comparable population but also a high risk of TRAE's, leading to discontinuation of treatment in 25% of the patients.
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Affiliation(s)
- D W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - L H Douma
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M M Hofman
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - V van der Noort
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - C J de Gooijer
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
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Bek LM, Berentschot JC, Hellemons ME, Remerie SC, van Bommel J, Aerts JGJV, Ribbers GM, van den Berg-Emons HJG, Heijenbrok-Kal MH. Return to work and health-related quality of life up to 1 year in patients hospitalized for COVID-19: the CO-FLOW study. BMC Med 2023; 21:380. [PMID: 37784149 PMCID: PMC10546751 DOI: 10.1186/s12916-023-03083-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Currently, evidence about the long-term consequences of COVID-19 on return to work and health-related quality of life (HRQoL) is limited. We evaluated return to work and its associations with baseline characteristics and physical and mental recovery over time in patients up to 1 year after hospitalization for COVID-19. Secondly, we aimed to evaluate the association between return to work and health-related quality of life (HRQoL). METHODS CO-FLOW, a multicenter prospective cohort study, enrolled adult participants hospitalized for COVID-19, aged ≥ 18 years within 6 months after hospital discharge. Return to work and HRQoL were collected at 3, 6, and 12 months after hospital discharge using the iMTA Productivity Cost Questionnaire and the 36-Item Short Form Health Survey, respectively. Data were collected between July 1, 2020, and September 1, 2022. Generalized estimating equations with repeated measurements were used to assess outcomes over time. RESULTS In the CO-FLOW study, 371 participants were employed pre-hospitalization. At 3, 6, and 12 months post-discharge, 50% (170/342), 29% (92/317), and 15% (44/295) of participants had not returned to work, and 21% (71/342), 21% (65/317), and 16% (48/295) only partially, respectively. ICU admission (adjusted odds ratio (95% confidence interval): 0.17 (0.10 to 0.30), p < 0.001), persistent fatigue (0.93 (0.90 to 0.97), p < 0.001), female sex (0.57 (0.36 to 0.90), p = 0.017), and older age (0.96 (0.93 to 0.98), p < 0.001) were independently associated with no return to work. ICU patients required a longer time to return to work than non-ICU patients. Patients who did not return or partially returned to work reported lower scores on all domains of HRQoL than those who fully returned. CONCLUSIONS One year after hospitalization for COVID-19, only 69% of patients fully returned to work, whereas 15% did not return and 16% partially returned to work. No or partial return to work was associated with reduced HRQoL. This study suggests that long-term vocational support might be needed to facilitate return to work. TRIAL REGISTRATION World Health Organization International Clinical Trials Registry Platform NL8710.
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Affiliation(s)
- L M Bek
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J C Berentschot
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M E Hellemons
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S C Remerie
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - J van Bommel
- Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J G J V Aerts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - H J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H Heijenbrok-Kal
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
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van der Sar IG, Wijbenga N, Nakshbandi G, Aerts JGJV, Manintveld OC, Wijsenbeek MS, Hellemons ME, Moor CC. The smell of lung disease: a review of the current status of electronic nose technology. Respir Res 2021; 22:246. [PMID: 34535144 PMCID: PMC8448171 DOI: 10.1186/s12931-021-01835-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
There is a need for timely, accurate diagnosis, and personalised management in lung diseases. Exhaled breath reflects inflammatory and metabolic processes in the human body, especially in the lungs. The analysis of exhaled breath using electronic nose (eNose) technology has gained increasing attention in the past years. This technique has great potential to be used in clinical practice as a real-time non-invasive diagnostic tool, and for monitoring disease course and therapeutic effects. To date, multiple eNoses have been developed and evaluated in clinical studies across a wide spectrum of lung diseases, mainly for diagnostic purposes. Heterogeneity in study design, analysis techniques, and differences between eNose devices currently hamper generalization and comparison of study results. Moreover, many pilot studies have been performed, while validation and implementation studies are scarce. These studies are needed before implementation in clinical practice can be realised. This review summarises the technical aspects of available eNose devices and the available evidence for clinical application of eNose technology in different lung diseases. Furthermore, recommendations for future research to pave the way for clinical implementation of eNose technology are provided.
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Affiliation(s)
- I G van der Sar
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - N Wijbenga
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Nakshbandi
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J G J V Aerts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - O C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M S Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M E Hellemons
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C C Moor
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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von der Thüsen JH, Dumoulin DW, Maat APWM, Wolf J, Sadeghi AH, Aerts JGJV, Cornelissen R. ETV6-NTRK3 translocation-associated low-grade mucinous bronchial adenocarcinoma: A novel bronchial salivary gland-type non-small cell lung cancer subtype. Lung Cancer 2021; 156:72-75. [PMID: 33895680 DOI: 10.1016/j.lungcan.2021.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/20/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION NTRK fusion genes have been found in several solid tumors, among which NSCLC and sarcoma. Novel NTRK translocation-related tumors are still being discovered. METHODS We report a 49-year-old patient with a mass in the left lower lung lobe that was resected. This specimen was analyzed and sequenced using targeted DNA next generation sequencing (NGS) and anchored-multiplex-PCR (AMP) targeted RNA NGS. RESULTS On pathological evaluation, a peribronchial mucinous neoplasm with a unique morphology was found. RNA NGS analysis showed anETV6-NTRK3 translocation in a low-grade mucinous bronchial adenocarcinoma. CONCLUSIONS This entity represents a novel subtype of non-small cell lung cancer, which we would like to term 'ETV6-NTRK3 translocation-associated low-grade mucinous bronchial adenocarcinoma'.
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Affiliation(s)
- J H von der Thüsen
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - D W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A P W M Maat
- Department of Thoracic Surgery Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J Wolf
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A H Sadeghi
- Department of Thoracic Surgery Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - R Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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6
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Banna GL, Cortellini A, Cortinovis DL, Tiseo M, Aerts JGJV, Barbieri F, Giusti R, Bria E, Grossi F, Pizzutilo P, Berardi R, Morabito A, Genova C, Mazzoni F, Di Noia V, Signorelli D, Gelibter A, Macerelli M, Rastelli F, Chiari R, Rocco D, Gori S, De Tursi M, Di Marino P, Mansueto G, Zoratto F, Filetti M, Montrone M, Citarella F, Marco R, Cantini L, Nigro O, D'Argento E, Buti S, Minuti G, Landi L, Guaitoli G, Lo Russo G, De Toma A, Donisi C, Friedlaender A, De Giglio A, Metro G, Porzio G, Ficorella C, Addeo A. The lung immuno-oncology prognostic score (LIPS-3): a prognostic classification of patients receiving first-line pembrolizumab for PD-L1 ≥ 50% advanced non-small-cell lung cancer. ESMO Open 2021; 6:100078. [PMID: 33735802 PMCID: PMC7988288 DOI: 10.1016/j.esmoop.2021.100078] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background To stratify the prognosis of patients with programmed cell death-ligand 1 (PD-L1) ≥ 50% advanced non-small-cell lung cancer (aNSCLC) treated with first-line immunotherapy. Methods Baseline clinical prognostic factors, the neutrophil-to-lymphocyte ratio (NLR), PD-L1 tumour cell expression level, lactate dehydrogenase (LDH) and their combination were investigated by a retrospective analysis of 784 patients divided between statistically powered training (n = 201) and validation (n = 583) cohorts. Cut-offs were explored by receiver operating characteristic (ROC) curves and a risk model built with validated independent factors by multivariate analysis. Results NLR < 4 was a significant prognostic factor in both cohorts (P < 0.001). It represented 53% of patients in the validation cohort, with 1-year overall survival (OS) of 76.6% versus 44.8% with NLR > 4, in the validation series. The addition of PD-L1 ≥ 80% (21% of patients) or LDH < 252 U/l (25%) to NLR < 4 did not result in better 1-year OS (of 72.6% and 74.1%, respectively, in the validation cohort). Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 [P < 0.001, hazard ratio (HR) 2.04], pretreatment steroids (P < 0.001, HR 1.67) and NLR < 4 (P < 0.001, HR 2.29) resulted in independent prognostic factors. A risk model with these three factors, namely, the lung immuno-oncology prognostic score (LIPS)-3, accurately stratified three OS risk-validated categories of patients: favourable (0 risk factors, 40%, 1-year OS of 78.2% in the whole series), intermediate (1 or 2 risk factors, 54%, 1-year OS 53.8%) and poor (>2 risk factors, 5%, 1-year OS 10.7%) prognosis. Conclusions We advocate the use of LIPS-3 as an easy-to-assess and inexpensive adjuvant prognostic tool for patients with PD-L1 ≥ 50% aNSCLC. Immunotherapy/chemoimmunotherapy combinations are currently not superior to immunotherapy alone for high PD-L1 aNSCLC. NLR with a cut-off of 4 was validated as an independent prognostic factor for immunotherapy in high PD-L1 aNSCLC. The addition of either PD-L1 ≥ 80% or LDH < 252 U/l to NLR < 4 did not result in better prognostic stratification. The LIPS-3 is a validated 3-class prognostic classification based on the NLR, ECOG PS and pretreatment steroids. The LIPS-3 is a routinely assessable adjuvant prognostic tool for high PD-L1 aNSCLC patients.
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Affiliation(s)
- G L Banna
- Oncology Department, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - A Cortellini
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | | | - M Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - J G J V Aerts
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - F Barbieri
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - R Giusti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - E Bria
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P Pizzutilo
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - R Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori 'Fondazione G Pascale', IRCCS, Napoli, Italy
| | - C Genova
- Lung Cancer Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - F Mazzoni
- Department of Oncology, Careggi University Hospital, Florence, Italy
| | - V Di Noia
- Medical Oncology, University Hospital of Foggia, Foggia, Italy
| | - D Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Gelibter
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - M Macerelli
- Department of Oncology, University Hospital Santa Maria Della Misericordia, Udine, Italy
| | - F Rastelli
- Medical Oncology, Fermo Area Vasta 4, Fermo, Italy
| | - R Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud 'Madre Teresa Di Calcutta', Monselice, Italy
| | - D Rocco
- Pneumo-Oncology Unit, Monaldi Hospital, Naples, Italy
| | - S Gori
- Oncology Unit, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella VR, Italy
| | - M De Tursi
- Department of Medical, Oral & Biotechnological Sciences University G. D'Annunzio, Chieti-Pescara, Chieti, Italy
| | - P Di Marino
- Clinical Oncology Unit, S.S. Annunziata Hospital, Chieti, Italy
| | - G Mansueto
- Medical Oncology, F. Spaziani Hospital, Frosinone, Italy
| | - F Zoratto
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - M Filetti
- Medical Oncology, St. Andrea Hospital, Rome, Italy
| | - M Montrone
- Thoracic Oncology Unit, Clinical Cancer Center IRCCS Istituto Temorid 'Giovanni Paolo II', Bari, Italy
| | - F Citarella
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - R Marco
- Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - L Cantini
- Department of Pulmonary Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - O Nigro
- Medical Oncology, ASST-Sette Laghi, Varese, Italy
| | - E D'Argento
- Comprehensive Cancer Center, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - S Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - G Minuti
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - L Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | - G Guaitoli
- Department of Oncology and Hematology, Modena University Hospital, Modena, Italy
| | - G Lo Russo
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - A De Toma
- Medical Oncology (B), Policlinico Umberto I, 'Sapienza' University of Rome, Rome, Italy
| | - C Donisi
- Medical Oncology Unit, University Hospital and University of Cagliari, Cagliari, Italy
| | - A Friedlaender
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - A De Giglio
- Division of Medical Oncology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - G Porzio
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - C Ficorella
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - A Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
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Raniszewska A, Vroman H, Dumoulin D, Cornelissen R, Aerts JGJV, Domagała-Kulawik J. PD-L1 + lung cancer stem cells modify the metastatic lymph-node immunomicroenvironment in nsclc patients. Cancer Immunol Immunother 2020; 70:453-461. [PMID: 32808188 PMCID: PMC7889682 DOI: 10.1007/s00262-020-02648-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Cancer stem cells (CSCs) are implicated in tumor initiation and development of metastasis. However, whether CSCs also affect the immune system is not fully understood. We investigated correlations between the PD-L1+ CSCs, changes in T-cell phenotype in metastatic and non-metastatic lymph nodes (LNs) and response to treatment. METHODS LNs' aspirates were obtained during the EBUS/TBNA procedure of 20 NSCLC patients at different stages of the disease. CSCs and T-cell characteristics were determined by flow cytometry. RESULTS PD-L1+ CSCs positively correlated with the percentage of Tregs, PD-1+ CD4 T cells and Tim3+ CD4+ T cells, whereas PD-L1+ CSCs were negatively correlated with CD4+ T cells and CD28+ CD4+ T cells. The percentage of PD-L1+ CSCs was higher in patients with progressive disease (PD) as compared to patients with stable disease (SD) or partial response (PR). Among T cells, only PD-1+ CD4+ T cells and Tim3+ CD4+ T-cell frequencies were higher in patients with PD as compared to patients with SD or PR. CONCLUSION The frequency of PD-L1+ CSCs associates with an altered T-cell frequency and phenotype indicating that CSCs can affect the immune system. The higher percentage of PD-L1+ CSCs in patients with PD may confirm their resistance to conventional therapy, suggesting that CSCs may be an interesting target for immunotherapy.
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Affiliation(s)
- A Raniszewska
- Department of Pathology, Medical University of Warsaw, Pawinskiego 7 Street, 02-106, Warsaw, Poland
| | - H Vroman
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - D Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - R Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J Domagała-Kulawik
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Banacha 1a Street, 02-097, Warsaw, Poland
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Moor CC, Mostard RLM, Grutters JC, Bresser P, Aerts JGJV, Dirksen CD, Kimman ML, Wijsenbeek MS. Patient expectations, experiences and satisfaction with nintedanib and pirfenidone in idiopathic pulmonary fibrosis: a quantitative study. Respir Res 2020; 21:196. [PMID: 32703201 PMCID: PMC7376884 DOI: 10.1186/s12931-020-01458-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
Background Two antifibrotic drugs, nintedanib and pirfenidone, are available for treatment of idiopathic pulmonary fibrosis (IPF). Although efficacy and adverse events have been well studied, little is known about patient experiences with these drugs. We aimed to systematically and quantitatively evaluate patient expectations, experiences, and satisfaction with nintedanib and pirfenidone. Furthermore, we assessed which factors were associated with overall patient satisfaction with medication. Methods Outpatients with IPF prospectively completed the Patient Experiences and Satisfaction with Medication (PESaM) questionnaire before start, and after three and 6 months of antifibrotic treatment, as part of a randomized eHealth trial (NCT03420235). The PESaM questionnaire consists of an expectation module, a validated generic module evaluating patient experiences and satisfaction concerning the effectiveness, side-effects, and ease of use of a medication, and a disease-specific module about IPF. Satisfaction was scored on a scale from − 5 (very dissatisfied) to + 5 (very satisfied). Results In total, 90 patients were included, of whom 43% used nintedanib and 57% pirfenidone. After 6 months, the mean overall score for satisfaction with medication was 2.1 (SD 1.9). No differences were found in experiences and satisfaction with medication, and the number and severity of side-effects between nintedanib and pirfenidone. Perceived effectiveness of medication was rated as significantly more important than side-effects and ease of use (p = 0.001). Expectations of patients regarding effectiveness were higher than experiences after 6 months. Self-reported experience with effectiveness was the main factor associated with overall medication satisfaction. Conclusions Patient experiences and satisfaction with antifibrotic treatment were fairly positive, and similar for nintedanib and pirfenidone. Systematic evaluation of patient expectations, experiences, and satisfaction with medication could enhance shared-decision making and guide drug treatment decisions in the future. Trial registration NCT03420235.
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Affiliation(s)
- C C Moor
- Department of Respiratory Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - R L M Mostard
- Department of Respiratory Medicine, Zuyderland Medical, Heerlen, the Netherlands
| | - J C Grutters
- Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, the Netherlands.,Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P Bresser
- Department of Respiratory Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - J G J V Aerts
- Department of Respiratory Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - C D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M S Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands.
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Pruis M, Geurts WRR, Thüsen JHVD, Meijssen IC, Dinjens WNM, Aerts JGJV, Lolkema MP, Dubbink HJ, Paats MS. Abstract B136: Highly accurate DNA-based detection of MET exon 14 skipping mutations in non-small cell lung cancer and clinical response upon targeted treatment. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-b136] [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: 11/16/2022]
Abstract
Abstract
Background: Approximately 1.6%-5.7% of non-small cell lung cancers (NSCLC) are described to be driven by oncogenic MET exon 14 skipping mutations (METex14del). Although currently no therapy is registered specifically against METex14del, Phase I/II clinical trials and named patient based programs with cMET inhibitors show promising results. RNA-based analysis seems most optimal for METex14del detection, because theoretically, it would capture all MET exon 13-exon 15 fusions, regardless of the underlying DNA changes. However, acquiring sufficient RNA is often problematic. An alternative is DNA-based analysis, but commercially available DNA-based panels only detect up to 63% of known METex14del alterations. The goal of this study is to describe an optimized DNA-based diagnostic test for METex14del, and to report the histologic and clinical features of a real world METex14del non-squamous NSCLC patient cohort, including follow-up of patients treated with cMET-targeted therapy and consequent resistance mechanisms to cMET inhibition. Methods: Routine diagnostic pathology NSCLC FFPE specimens were investigated by a custom-made DNA-based targeted amplicon-based next generation sequencing (NGS) panel which includes 4 amplicons for METex14del detection. Retrospectively, histopathological characteristics and clinical follow up were investigated for advanced NSCLC with METex14del. We only present data of patients receiving crizotinib in a named patient based program (Pfizer Oncology). Results: In silico analysis showed that our custom-made NGS panel can detect 96% of reported METex14 alterations. From Jan 2016 - May 2018, METex14del was found in 2% of patients with NSCLC tested for therapeutic purposes (31/1496). Outside above mentioned timeframe and tested for other purposes, an additional 15 patients were detected, making a total of 46 NSCLC patients with METex14del, since introduction of our panel in May 2015. Adenocarcinoma was the most common histological type (31/46, 68.9%), followed by sarcomatoid carcinoma (8/46, 17.8%). Thirty-six patients had advanced NSCLC, they were predominantly male (69% vs 31%) and mostly (ex) smokers (64% vs 31%), with a median age of 76.5 years at disease onset [range 53-90]. Eleven patients were treated with targeted therapy, either with crizotinib in named patient based program or in clinical trials. With crizotinib, disease control was achieved for 4 out of 5 patients (3 PR [PFS 4 -12 mo], 1 SD [14 mo]). Biopsy at progression revealed a resistance mechanism (MET c.3682G>A; p.D1228N) to crizotinib in two patients, respectively, 6 and 12 months after start of crizotinib treatment. Conclusions: In this study, we show that we can detect 96% of the known MET exon 14 skipping mutations using our custom-made DNA based NGS approach for DNA isolated from FFPE tissue. In this large consecutive series, METex14del was found in 2% of NSCLC, mostly elderly patients, in a good condition and with a smoking history. Although a small cohort, patients responded well to targeted treatment, underlining the need for routine testing of METex14del in advanced non-squamous NSCLC to guarantee optimal personalized treatment.
Citation Format: Melinda Pruis, WRR Geurts, JH von der Thüsen, IC Meijssen, WNM Dinjens, JGJV Aerts, MP Lolkema, HJ Dubbink, MS Paats. Highly accurate DNA-based detection of MET exon 14 skipping mutations in non-small cell lung cancer and clinical response upon targeted treatment [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B136. doi:10.1158/1535-7163.TARG-19-B136
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10
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Pruis MA, Geurts-Giele WRR, von der TJH, Meijssen IC, Dinjens WNM, Aerts JGJV, Dingemans AMC, Lolkema MP, Paats MS, Dubbink HJ. Highly accurate DNA-based detection and treatment results of MET exon 14 skipping mutations in lung cancer. Lung Cancer 2019; 140:46-54. [PMID: 31862577 DOI: 10.1016/j.lungcan.2019.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 08/20/2019] [Revised: 11/01/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The oncogenic MET exon 14 skipping mutation (METex14del) is described to drive 1.3 %-5.7 % of non-small-cell lung cancer (NSCLC) and multiple studies with cMET inhibitors show promising clinical responses. RNA-based analysis seems most optimal for METex14del detection, however, acquiring sufficient RNA material is often problematic. An alternative is DNA-based analysis, but commercially available DNA-based panels only detect up to 63 % of known METex14del alterations. The goal of this study is to describe an optimized DNA-based diagnostic test for METex14del in NSCLC, including clinical features and follow-up of patients treated with cMET-targeted therapy and consequent resistance mechanisms. MATERIAL AND METHODS Routinely processed diagnostic pathology non-squamous NSCLC specimens were investigated by a custom-made DNA-based targeted amplicon-based next generation sequencing (NGS) panel, which includes 4 amplicons for METex14del detection. Retrospectively, histopathological characteristics and clinical follow up were investigated for advanced non-squamous NSCLC with METex14del. RESULTS In silico analysis showed that our NGS panel is able to detect 96 % of reported METex14 alterations. METex14del was found in 2 % of patients with non-squamous NSCLC tested for therapeutic purposes. In total, from May 2015 - Sep 2018, METex14del was found in 46 patients. Thirty-six of these patients had advanced non-squamous NSCLC, they were predominantly elderly (76.5 years [53-90]), male (25/36) and (ex)-smokers (23/36). Five patients received treatment with crizotinib (Pfizer Oncology), in a named patient based program, disease control was achieved for 4/5 patients (3 partial responses, 1 stable disease) and one patient had a mixed response. Two patients developed a MET D1228N mutation during crizotinib treatment, inducing a resistance mechanism to crizotinib. CONCLUSIONS This study shows that METex14del can be reliably detected by routine DNA NGS analysis. Although a small cohort, patients responded well to targeted treatment, underlining the need for routine testing of METex14del in advanced non-squamous NSCLC to guarantee optimal personalized treatment.
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Affiliation(s)
- M A Pruis
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - W R R Geurts-Giele
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Thüsen J H von der
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - I C Meijssen
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - W N M Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J G J V Aerts
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A M C Dingemans
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Pulmonary Diseases, Maastricht UMC +, Maastricht, the Netherlands
| | - M P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M S Paats
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - H J Dubbink
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
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Van 'T Klooster CC, Ridker PM, Hjortnaes J, Van Der Graaf Y, Asselbergs FW, Westerink J, Aerts JGJV, Visseren FLJ. 2153The relation between systemic inflammation and incident cancer in patients with stable cardiovascular disease; a cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic systemic low-grade inflammation, measured by elevated plasma concentrations of high sensitive C-reactive Protein (CRP), is a risk factor for cardiovascular disease (CVD). There is evidence that systemic low-grade inflammation is also related to a higher risk of cancer.
Purpose
In the present prospective cohort study the relation between systemic low-grade inflammation and risk of cancer was evaluated in patients with clinically manifest vascular disease.
Methods
In total 7178 patients from the SMART cohort with manifest cardiovascular disease and plasma CRP levels ≤10 mg/L were included. Data of the cohort were linked to the Dutch national cancer registry. Cox regression models were fitted to study the relation between CRP and incident cardiovascular disease as well as incident cancer. Cancer types were classified according to anatomical location of origin, as well as histopathological subtype, irrespective of their anatomical location of origin. To adjust for potential confounding, age, sex, smoking status, packyears of smoking, and body mass index were added to the models, and additional cardiovascular risk factors, including diabetes mellitus, and systolic blood pressure.
Results
After a median follow-up time of 8.3 years (interquartile range 4.6–12.3) 1289 recurrent cardiovascular events (myocardial infarction, stroke, or vascular mortality) and 1072 incident cancer diagnoses were observed. CRP level was related to recurrent cardiovascular disease risk (HR 1.57; 95% CI 1.35–1.82) (Figure 1A), as well as risk of CVD and/or cancer (HR 1.45; 95% CI 1.29–1.62) (Figure 1B) comparing the third tertile of CRP to the first tertile. CRP concentration was related to total cancer risk (HR 1.33; 95% CI 1.13–1.55 for the third tertile of CRP compared to the first tertile) (Figure 1C). Especially incident lung cancer, independent of histopathological subtype, was related to CRP level (HR 2.64; 95% CI 1.77–3.93 for the third tertile of CRP compared to the first) (Figure 1D). No effect modification by smoking status or years of smoking cessation was observed of the relation between CRP and lung cancer (p-values for interaction >0.05). Incidence of epithelial neoplasms and especially squamous cell neoplasms were related to CRP concentration, irrespective of their anatomical location of origin (HR 1.17; 95% CI 1.08–1.27, and HR 1.11; 95% CI 1.02–1.20 for 1 mg/L higher CRP level respectively). Sensitivity analyses accounting for reverse causality by excluding patients with a cancer diagnosis within 1 and within 2 years of follow up showed similar results.
Kaplan Meier curves per CRP tertile
Conclusion
Chronic systemic low-grade inflammation, measured by plasma CRP levels ≤10mg/L, is a risk factor for incident cancer, markedly lung cancer, independent of smoking status, in patients with stable cardiovascular disease.
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Affiliation(s)
- C C Van 'T Klooster
- University Medical Center Utrecht, Vascular medicine, Utrecht, Netherlands (The)
| | - P M Ridker
- Brigham and Womens Hospital, Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiology, Boston, United States of America
| | - J Hjortnaes
- University Medical Center Utrecht, Thoracic surgery, Utrecht, Netherlands (The)
| | - Y Van Der Graaf
- Julius Health Center - Julius Gezondheidscentra, Utrecht, Netherlands (The)
| | - F W Asselbergs
- University Medical Center Utrecht, Cardiology, Division Heart and Lungs, Utrecht, Netherlands (The)
| | - J Westerink
- University Medical Center Utrecht, Vascular medicine, Utrecht, Netherlands (The)
| | - J G J V Aerts
- Erasmus Medical Center, Respiratory Medicine, Rotterdam, Netherlands (The)
| | - F L J Visseren
- University Medical Center Utrecht, Vascular medicine, Utrecht, Netherlands (The)
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Visser S, Koolen SLW, de Bruijn P, Belderbos HNA, Cornelissen R, Mathijssen RHJ, Stricker BH, Aerts JGJV. Pemetrexed exposure predicts toxicity in advanced non-small-cell lung cancer: A prospective cohort study. Eur J Cancer 2019; 121:64-73. [PMID: 31561135 DOI: 10.1016/j.ejca.2019.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/26/2019] [Revised: 07/21/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND We explored whether total exposure to pemetrexed predicts effectiveness and toxicity in advanced non-small-cell lung cancer (NSCLC). Furthermore, we investigated alternative dosing schedules. METHODS In this prospective cohort study, patients with advanced NSCLC receiving first- or second-line pemetrexed(/platinum) were enrolled. Plasma sampling was performed weekly (cyclePK) and within 24 h (24hPK) after pemetrexed administration. With population pharmacokinetic/pharmacodynamic modelling, total exposure to pemetrexed during cycle 1 (area under the curve during chemotherapy cycle 1 [AUC1]) was estimated and related to progression-free survival (PFS)/overall survival (OS). We compared mean AUC1 (mg·h/L) in patients with and without severe chemotherapy-related adverse events (AEs) during total treatment. Second, different dosing schedules were simulated to minimise the estimated variability (coefficient of variation [CV]) of AUC. RESULTS For 106 of 165 patients, concentrations of pemetrexed were quantified (24hPK, n = 15; cyclePK, n = 106). After adjusting for prognostic factors, sex, disease stage and World Health Organisation performance score, AUC1 did not predict PFS/OS in treatment-naive patients (n = 95) (OS, hazard ratio [HR] = 1.05, 95% confidence interval [CI]: 1.00-1.11; PFS, HR = 1.03, 95% CI: 0.98-1.08). Patients with severe chemotherapy-related AEs (n = 55) had significantly higher AUC1 values than patients without them (n = 51) (226 ± 53 vs 190 ± 31, p < 0.001). Compared with body surface area-based dosing (CV: 22.5%), simulation of estimated glomerular filtration rate (eGFR)-based dosing (CV 18.5%) and fixed dose of 900 mg with 25% dose reduction, if the eGFR<60 mL/min (CV: 19.1%), resulted in less interindividual variability of AUC. CONCLUSIONS Higher exposure to pemetrexed does not increase PFS/OS but is significantly associated with increased occurrence of severe toxicity. Our findings suggest that fixed dosing reduces interpatient pharmacokinetic variability and thereby might prevent toxicity, while preserving effectiveness.
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Affiliation(s)
- S Visser
- Department of Pulmonary Medicine, Amphia Hospital, Breda, Netherlands; Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - S L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands; Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, Netherlands
| | - P de Bruijn
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - H N A Belderbos
- Department of Pulmonary Medicine, Amphia Hospital, Breda, Netherlands
| | - R Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - R H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands; Inspectorate of Health Care, Utrecht, Netherlands
| | - J G J V Aerts
- Department of Pulmonary Medicine, Amphia Hospital, Breda, Netherlands; Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
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Pieters A, Bakker M, Hoek RAS, Altenburg J, van Westreenen M, Aerts JGJV, van der Eerden MM. Predicting factors for chronic colonization of Pseudomonas aeruginosa in bronchiectasis. Eur J Clin Microbiol Infect Dis 2019; 38:2299-2304. [PMID: 31471703 PMCID: PMC6858402 DOI: 10.1007/s10096-019-03675-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/08/2019] [Indexed: 12/01/2022]
Abstract
About 25% of the patients with bronchiectasis are likely to develop a chronic colonization with Pseudomonas aeruginosa. A better understanding of predictors of acquiring Pseudomonas within the patient population may facilitate future focused research. The aim of this retrospective observational study was to investigate predicting factors for P. aeruginosa colonization in patients with bronchiectasis. This was a single-center retrospective cohort study using a bronchiectasis database which consisted of 211 patients with bronchiectasis. Data were collected for demographic details, etiology, spirometry, microbiology data, maintenance medication use, exacerbation frequency, hospital admission rate, and FACED and Bronchiectasis Severity Index (BSI) score. Two hundred eleven patients were identified from our bronchiectasis database. Overall, 25% of the patients (n = 53) had a chronic colonization with P. aeruginosa. Seventeen patients (8%) died in a 5-year follow-up period of whom 7 (41%) had a chronic P. aeruginosa colonization (p > 0.05). After multiple regression analysis, P. aeruginosa-positive patients were significantly associated with an older age (> 55 years) (p = 0.004), the use of hypertonic saline (0.042), and inhalation antibiotics (< 0.001). Furthermore, the presence of PCD (p < 0.001) and post-infectious etiology (p < 0.001) as underlying causes were significantly associated with P. aeruginosa colonization. We observed that independent predictors for P. aeruginosa colonization were age > 55 years, hypertonic saline, and PCD, and post-infectious etiology as underlying causes of bronchiectasis. Since prevention of P. aeruginosa colonization is an important aim in the treatment of bronchiectasis, more attention could be directed to these groups at risk for Pseudomonas colonization.
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Affiliation(s)
- A Pieters
- Erasmus Medical Center, Rotterdam, The Netherlands.
| | - M Bakker
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - R A S Hoek
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Altenburg
- Erasmus Medical Center, Rotterdam, The Netherlands
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Bugter O, van Brummelen SE, van der Leest KH, Aerts JGJV, Maat APWM, Baatenburg de Jong RJ, Amelink A, Robinson DJ. Towards the Optical Detection of Field Cancerization in the Buccal Mucosa of Patients with Lung Cancer. Transl Oncol 2019; 12:1533-1538. [PMID: 31473370 PMCID: PMC6743047 DOI: 10.1016/j.tranon.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION: An increase in detection of early-stage asymptomatic lung tumors could increase the overall survival rate of lung cancer patients. A new approach to cancer (pre-)screening focusses on detecting field cancerization instead of the tumor itself. The objective of this study was to investigate the use of optical spectroscopy to detect field cancerization in the buccal mucosa of lung cancer patients. METHODS: Optical buccal mucosa measurements were performed in lung cancer patients and controls using multidiameter single-fiber reflectance spectroscopy. We analyzed whether the measured optical parameters could distinguish lung cancer patients from controls. RESULTS: Twenty-three lung cancer patients, 24 chronic obstructive pulmonary disease (COPD) control patients, and 36 non-COPD controls were included. The majority of tumors were non-small-cell lung carcinomas (96%) and classified as stage I (48%). The tissue scattering properties μs' and γ at 800 nm and the tissue bilirubin concentration were all near-significantly different (P = .072, 0.058, and 0.060, respectively) between the lung cancer and COPD group. μs' at 800 nm had a sensitivity of 74% and a specificity of 63%. The microvascular blood oxygen saturation of the lung cancer patients was also higher than the COPD patients (78% vs. 62%, P = .002), this is probably a consequence of the systemic effect of COPD. CONCLUSIONS: We have demonstrated that μs' at 800 nm is increased in the buccal mucosa of patients with lung cancer compared to controls with COPD. This might be an indication of field cancerization in the oral cavity of patients with lung cancer.
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Affiliation(s)
- O Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands; Center for Optical Diagnostics and Therapy, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - S E van Brummelen
- Department of Pulmonology, Fransiscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - K H van der Leest
- Department of Pulmonology, Amphia, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - J G J V Aerts
- Department of Pulmonology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - A P W M Maat
- Department of Cardiothoracic Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - A Amelink
- Department of Optics, TNO, Stieltjesweg 1, 2628 CK Delft, The Netherlands
| | - D J Robinson
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands; Center for Optical Diagnostics and Therapy, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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15
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Visser S, Hou J, Bezemer K, de Vogel LL, Hegmans JPJJ, Stricker BH, Philipsen S, Aerts JGJV. Prediction of response to pemetrexed in non-small-cell lung cancer with immunohistochemical phenotyping based on gene expression profiles. BMC Cancer 2019; 19:440. [PMID: 31088547 PMCID: PMC6515672 DOI: 10.1186/s12885-019-5645-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background Palliative pemetrexed-based chemotherapy remains a standard of care treatment for the majority of patients with advanced non-squamous non-small-cell lung cancer (NSCLC). Currently, no predictive markers for pemetrexed treatment are available. Methods Resected tumour samples from pemetrexed-naïve NSCLC patients were collected. Gene expression profiling with respect to predicted sensitivity to pemetrexed classified predicted responders (60%) and non-responders (40%) based on differentially expressed genes encoding for pemetrexed target enzymes. Genes showing a strong correlation with these target genes were selected for measurement of corresponding protein expressions by immunohistochemical (IHC) staining. A semi-quantitative IHC scoring method was applied to construct a prediction model for response to pemetrexed. A retrospective cohort of patients with advanced NSCLC treated with first-line pemetrexed-based chemotherapy was used for external validation. Results From ninety-one patients resected tumour samples were collected. The majority of patients had early or locally advanced NSCLC (96.3%). Gene expression profiling revealed five markers, which mRNA levels strongly correlated to pemetrexed target genes mRNA levels: TPX2, CPA3, EZH2, MCM2 and TOP2A. Of 63 (69%) patients IHC staining scores of these markers were obtained, which significantly differed between predicted non-responders and responders (P < 0.05). The optimized prediction model included EZH2 (OR = 0.56, 95% CI 0.35–0.90) and TPX2 (OR = 0.55, 95% CI 0.30–1.01). The model had a sensitivity of 86.8%, specificity of 63.6% and showed a good ability to distinct between responders and non-responders (C-index 0.86). In the external study population (N = 23) the majority of patients had metastatic NSCLC (95.7%). Partial response (PR) was established in 26.1%. The sensitivity decreased drastically to 33.3%, with a specificity of 82.4% and a C-index of 0.73. Conclusions Using external validation this prediction model with IHC staining of target enzyme correlated markers showed a good discrimination, but lacked sensitivity. The role of IHC markers as response predictors for pemetrexed in clinical practice remains questionable. Electronic supplementary material The online version of this article (10.1186/s12885-019-5645-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Visser
- Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands.,Department of Pulmonary Medicine, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - J Hou
- Department of Cell Biology, Erasmus MC, Rotterdam, the Netherlands
| | - K Bezemer
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - L L de Vogel
- Department of Pathology, Erasmus MC, Rotterdam, the Netherlands
| | - J P J J Hegmans
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - S Philipsen
- Department of Cell Biology, Erasmus MC, Rotterdam, the Netherlands
| | - J G J V Aerts
- Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands. .,Department of Pulmonary Medicine, Erasmus MC Cancer Institute, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Mokhles S, Nuyttens JJME, de Mol M, Aerts JGJV, Maat APWM, Birim Ö, Bogers AJJC, Takkenberg JJM. Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making. BMC Cancer 2018; 18:79. [PMID: 29334910 PMCID: PMC5769349 DOI: 10.1186/s12885-018-3986-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/02/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. METHODS Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. RESULTS In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. CONCLUSIONS Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict.
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Affiliation(s)
- S Mokhles
- Department of Cardio-thoracic Surgery, Erasmus-MC, Room Bd-577, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - J J M E Nuyttens
- Department of Radiation Oncology, Erasmus-MC-Cancer Institute, Rotterdam, The Netherlands
| | - M de Mol
- Department of Pulmonary Disease, Amphia Hospital, Breda, The Netherlands
| | - J G J V Aerts
- Department of Pulmonary Disease, Erasmus-MC, Rotterdam, The Netherlands.,Department of Pulmonary Disease, Amphia Hospital, Breda, The Netherlands
| | - A P W M Maat
- Department of Cardio-thoracic Surgery, Erasmus-MC, Room Bd-577, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Ö Birim
- Department of Cardio-thoracic Surgery, Erasmus-MC, Room Bd-577, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A J J C Bogers
- Department of Cardio-thoracic Surgery, Erasmus-MC, Room Bd-577, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J J M Takkenberg
- Department of Cardio-thoracic Surgery, Erasmus-MC, Room Bd-577, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Yousaf-Khan AU, van der Aalst CM, Aerts JGJV, den Bakker MA, de Koning HJ. Uniform and blinded cause of death verification of the NELSON lung cancer screening participants. Lung Cancer 2017; 111:131-134. [PMID: 28838383 DOI: 10.1016/j.lungcan.2017.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/07/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022]
Abstract
Primary outcome of the Dutch-Belgian lung cancer screening trial (NELSON) is lung cancer-specific mortality. Accurate assessment of the cause of death (CoD) is crucial. As death certificates regarding the CoD can be inaccurate, a clinical expert committee (CEC) was formed to assign the CoD. In this study, the medical files of deceased lung cancer patients were reviewed and the outcomes were compared with official death certificates. The first 266 completed medical files of Dutch deceased participants who were diagnosed with lung cancer during the study or of those with lung cancer on the death certificate were selected and blinded towards arms and patients identity. The end product of the review process consisted of six possible categories which defined the graduation of certainty that lung cancer was the primary CoD. The percentage agreement and the Cohen's kappa statistics between the two CEC-memberswere calculated. The sensitivity and specificity of the official death certificates were determined. The results indicated that, the overall concordance and the Cohen's kappa between the CEC-memberswere 86.1% and 0.57(0.45-0.69, p<0.001), respectively. This level increased with the numbers of cases evaluated. The sensitivity and the specificity of the official death certificate were 92.6% and 98.8%; 6.5% cases were reclassified to lung cancer specific death, which is lower than in the National Lung Screening trial(22.0%). Concluding, each death should be reviewed by at least two members. So far, in the NELSON trial, possible biases related to lung cancer death seem relatively small.
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Affiliation(s)
- A U Yousaf-Khan
- Erasmus Medical Center, University Medical Center Rotterdam, Department of Public Health, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands.
| | - C M van der Aalst
- Erasmus Medical Center, University Medical Center Rotterdam, Department of Public Health, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
| | - J G J V Aerts
- Erasmus Medical Center, University Medical Center Rotterdam, Department of Pulmonary Medicine, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands; Amphia Hospital Breda, Department of Pulmonary Medicine, P.O. box 90158, The Netherlands
| | - M A den Bakker
- Maasstad Hospital Rotterdam, Department of Pathology, P.O. box 9100, The Netherlands
| | - H J de Koning
- Erasmus Medical Center, University Medical Center Rotterdam, Department of Public Health, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands
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18
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van Kruijsdijk RCM, Visseren FLJ, Boni L, Groen HJM, Dingemans AMC, Aerts JGJV, van der Graaf Y, Ardizzoni A, Smit EF. Pemetrexed plus carboplatin versus pemetrexed in pretreated patients with advanced non-squamous non-small-cell lung cancer: treating the right patients based on individualized treatment effect prediction. Ann Oncol 2016; 27:1280-6. [PMID: 27052652 DOI: 10.1093/annonc/mdw154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/21/2015] [Accepted: 03/28/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Translating results from randomized clinical trials (RCTs) to individual patients in clinical practice is challenging, as treatment effects can vary substantially among individuals. Data from RCTs can be used for individualized treatment effect prediction, to identify patients who benefit from specific treatments. In this study, we developed and validated a prediction model for estimating absolute treatment effect of pemetrexed plus carboplatin versus single-agent pemetrexed in the second-line treatment of non-squamous non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Using data of relapsed patients with advanced non-squamous NSCLC from the NVALT-7 trial, a Weibull model for prediction of gain in median progression-free survival (PFS) by pemetrexed-carboplatin was derived based on patient and tumor characteristics. The model was externally validated in the GOIRC 02-2006 trial. The applicability of the model for guiding clinical decision-making was evaluated using decision curve analysis. RESULTS A wide distribution of predicted gain in median PFS by pemetrexed-carboplatin over pemetrexed was found, with a median of 0.7 months (interquartile range: -0.1 to 1.5 months). Patients who benefited most included women, those with stage IV, high body mass index and/or adenocarcinoma. External validation showed satisfactory calibration and moderate discrimination (C-index: 0.61, 95% confidence interval 0.56-0.67). Decision curve analysis confirmed that the model adequately identified patients who benefit from pemetrexed-carboplatin, as prediction-based treatment led to improvement in net benefit with regard to PFS and overall survival when assuming a treatment threshold of 0-5 months gain in PFS, compared with other treatment strategies. CONCLUSIONS The effects of pemetrexed-carboplatin can be predicted for individual patients based on routinely available patient and tumor characteristics. There is important heterogeneity in the effects on PFS of pemetrexed-carboplatin versus pemetrexed in pretreated patients with advanced non-squamous NSCLC. Individualized prediction of treatment effect could be used to guide shared decision-making by discriminating patients who benefit most, to improve clinical outcome. CLINICAL TRIAL NUMBERS NVALT-7: ISRCTN38269072 (ISRCTN registry), GOIRC 02-2006: NCT00786331 (clinicaltrials.gov).
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Affiliation(s)
- R C M van Kruijsdijk
- Department of Vascular Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F L J Visseren
- Department of Vascular Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Boni
- Clinical Trials Coordinating Center, Instituto Toscano Tumori, University Hospital Careggi, Florence, Italy
| | - H J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen
| | - A M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center, Maastricht
| | - J G J V Aerts
- Department of Pulmonary Diseases, Amphia Hospital, Breda
| | - Y van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Ardizzoni
- Department of Medical Oncology, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - E F Smit
- Department of Pulmonary Diseases, Vrije Universiteit VU Medical Center, Amsterdam, The Netherlands
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Abstract
PURPOSE To test the reliability and validity of the Cancer Treatment Satisfaction Questionnaire (CTSQ), to assess its relation with quality of life (QoL), and to assess the interpretability of the domain scores in lung cancer patients receiving intravenous chemotherapy. METHODS Patients with stage IIIB and IV non-squamous non-small cell lung carcinoma treated with pemetrexed were enrolled in our study. They completed the 16-item CTSQ and two other (health-related) QoL questionnaires. Information about sociodemographic characteristics, cancer stage, and the experience of adverse events was collected. Internal consistency, construct validity, and clinical interpretability were calculated. RESULTS Fifty-five patients completed the CTSQ. Correlations of the CTSQ items with its domain were all above 0.40. A high correlation between item 8 and the expectations of therapy and satisfaction with therapy domain was observed (0.50 and 0.48, respectively). The CTSQ domains demonstrated good internal consistency and low to moderate correlations of the CTSQ with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and World Health Organization Quality of Life-BREF. No significant differences in mean domain scores were observed in relation to the number and severity of different adverse events and chemotherapy-related adverse events. CONCLUSIONS The Dutch version of the CTSQ was found to be a reliable and valid instrument to assess satisfaction and expectations of treatment in lung cancer patients receiving intravenous chemotherapy. Furthermore, the CTSQ proved to be of additional informative value as not all of its domains correlated with the various domains of the existing HRQoL instruments.
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Affiliation(s)
- K Cheung
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Inspectorate of Health Care, The Hague, The Netherlands.
| | - M de Mol
- Department of Pulmonary Diseases, Amphia Hospital Breda, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S Visser
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pulmonary Diseases, Amphia Hospital Breda, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B L Den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Inspectorate of Health Care, The Hague, The Netherlands.
| | - J G J V Aerts
- Department of Pulmonary Diseases, Amphia Hospital Breda, Breda, The Netherlands
- Department of Pulmonary Diseases, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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van der Leest C, Amelink A, van Klaveren RJ, Hoogsteden HC, Sterenborg HJCM, Aerts JGJV. Optical detection of preneoplastic lesions of the central airways. ISRN Oncol 2012; 2012:957835. [PMID: 22550600 PMCID: PMC3324886 DOI: 10.5402/2012/957835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 01/16/2012] [Indexed: 01/01/2023]
Abstract
Current routine diagnosis of premalignant lesions of the central airways is hampered due to a limited sensitivity (white light bronchoscopy) and resolution (computer tomography (CT), positron emission tomography (PET)) of currently used techniques. To improve the detection of these subtle mucosal abnormalities, novel optical imaging bronchoscopic techniques have been developed over the past decade. In this review we highlight the technological developments in the field of endoscopic imaging, and describe their advantages and disadvantages in clinical use.
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Affiliation(s)
- C van der Leest
- Department of Respiratory Diseases, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands
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21
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Surmont V, Aerts JGJV, van Klaveren RJ, Tournoy K, Tan KY, Vernhout RM, Schmitz PIM, Legrand C, Hoogsteden HC, van Meerbeeck JP. A randomized phase II study comparing two schedules of the 21-day regimen of gemcitabine and carboplatin in advanced non-small cell lung cancer. Oncology 2010; 78:267-70. [PMID: 20523087 DOI: 10.1159/000315733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 01/25/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE Carboplatin area under the curve (AUC) 5 ml/min on day 1 with gemcitabine 1,250 mg/m(2) on day 1 and day 8 is a widely used regimen in advanced non-small cell lung cancer. Grade 3-4 thrombocytopenia and neutropenia are frequent. The aim of this study is to investigate whether toxicity of gemcitabine/carboplatin could be reduced by administering carboplatin on day 8 instead of day 1 without a decrease in response rate (RR). METHODS Patients received gemcitabine 1,250 mg/m(2) on days 1 and 8, carboplatin AUC 5 on day 1 (arm A) or day 8 (arm B). Drugs were administered over a 21-day cycle. Toxicity and RR were evaluated weekly and every second cycle, respectively. RESULTS 71 patients were enrolled into the study. We found 79% (95% CI 61-91%) grade 3-4 toxicity (neutropenia and thrombocytopenia) in arm A and 50% (95% CI 32-68%) in arm B; 66% grade 3-4 thrombocytopenia in arm A and 26% in arm B. We observed 30% grade 4 hematological toxicity in arm A and 3% in arm B. In arm A an overall RR of 20% (95% CI 7.7-38.6%) was seen, and 18.2% (95% CI 7-35.5%) in arm B. CONCLUSIONS Although the study was prematurely closed, the current data are of interest. The schedule with carboplatin on day 8 is associated with substantially lower grade 3-4 neutropenia and thrombocytopenia with comparable dose intensity and RR.
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Affiliation(s)
- V Surmont
- Department of Pulmonology, Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands.
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22
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Surmont V, Aerts JGJV, Tan KY, Schramel F, Vernhout R, Hoogsteden HC, van Klaveren RJ. Non-Cross Resistant Sequential Single Agent Chemotherapy in First-Line Advanced Non-Small Cell Lung Cancer Patients: Results of a Phase II Study. J Oncol 2009; 2009:457418. [PMID: 19920864 PMCID: PMC2777239 DOI: 10.1155/2009/457418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 07/17/2009] [Accepted: 08/19/2009] [Indexed: 11/25/2022]
Abstract
Background. sequential chemotherapy can maintain dose intensity and preclude cumulative toxicity by increasing drug diversity. Purpose. to investigate the toxicity and efficacy of the sequential regimen of gemcitabine followed by paclitaxel in first line advanced stage non-small cell lung cancer (NSCLC) patients with good performance status (PS). Patients and methods. gemcitabine 1250 mg/m(2) was administered on day 1 and 8 of course 1 and 2; Paclitaxel 150 mg/m(2) on day 1 and 8 of course 3 and 4. Primary endpoint was response rate (RR), secondary endpoints toxicity and time to progression (TTP). Results. Of the 21 patients (median age 56, range 38-80 years; 62% males, 38% females) 10% (2/21) had stage IIIB, 90% (19/21) stage IV, 15% PS 0, 85% PS 1. 20% of patients had a partial response, 30% stable disease, 50% progressive disease. Median TTP was 12 weeks (range 6-52 weeks), median overall survival (OS) 8 months (range 1-27 months), 1-year survival was 33%. One patient had grade 3 hematological toxicity, 2 patients a grade 3 peripheral neuropathy. Conclusions. sequential administration of gemcitabine followed by paclitaxel in first line treatment of advanced NSCLC had a favourable toxicity profile, a median TTP and OS comparable with other sequential trials and might, therefore, be a treatment option for NSCLC patients with high ERCC1 expression.
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Affiliation(s)
- V. Surmont
- Department of Pulmonology, Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
| | - J. G. J. V. Aerts
- Department of Pulmonology, Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
- Department of Pulmonology, Amphia Hospital, Breda, The Netherlands
| | - K. Y. Tan
- Department of Pulmonology, St. Franciscus Gasthuis, Rotterdam, The Netherlands
| | - F. Schramel
- Department of Pulmonology, St. Antonius, Nieuwegein, The Netherlands
| | - R. Vernhout
- Department of Trials and Statistics, Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
| | - H. C. Hoogsteden
- Department of Pulmonology, Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
| | - R. J. van Klaveren
- Department of Pulmonology, Erasmus MC-Daniel Den Hoed Cancer Center, Rotterdam, The Netherlands
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El Sharouni SY, Aerts JGJV, Senan S, De Ruysscher DKM, Groen HJM, Paul MA, Smit EF, Vonk EJA, Verhagen AF, Schramel FMNH. [Treatment of patients with stage III non-small cell lung cancer: concurrent high-dose chemotherapy and radiotherapy]. Ned Tijdschr Geneeskd 2008; 152:2714-2717. [PMID: 19192584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The treatment of patients with locally advanced non-small cell lung cancer (stage III) has changed significantly in the past few years. Patients with a non-resectable stage IIIA/B tumour are given combined treatment consisting ofchemotherapy and radiotherapy. These can be administered sequentially or concurrently. It has been shown recently that concurrent chemoradiotherapy gives a survival advantage in comparison with sequential chemoradiotherapy. Cisplatin and etoposide are usually the drugs of choice for chemotherapy in patients with stage III cancer. A biologically effective dose of radiotherapy equivalent to 60-66 Gy, over a maximum of 6.5 weeks, should be given. Surgery is possible for a selected group of patients, provided a complete objective mediastinal response has been achieved after chemoradiotherapy and a complete resection appears to be technically feasible. It is recommended to apply this treatment in a research setting. High-dose concurrent chemoradiotherapy is advised as the standard treatment for stage III non-small cell lung cancer in patients in good physical condition.
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Affiliation(s)
- S Y El Sharouni
- Universitaire Medisch Centrum Utrecht, afd. Radiotherapie, Q00.118, Heidelberglaan 100, 3584 CX Utrecht.
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24
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Aerts JGJV, Amelink A, van der Leest C, Hegmans JPJJ, Hemmes A, den Hamer B, Sterenborg HCJM, Hoogsteden HC, Lambrecht BN. HIF1a expression in bronchial biopsies correlates with tumor microvascular saturation determined using optical spectroscopy. Lung Cancer 2007; 57:317-21. [PMID: 17485134 DOI: 10.1016/j.lungcan.2007.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 03/12/2007] [Accepted: 03/22/2007] [Indexed: 11/22/2022]
Abstract
Tumor hypoxia is generally considered to be related to aggressive behaviour of a tumor. As in lung cancer direct determination of oxygenation is difficult, hypoxia-related proteins have been studied. A number of studies on these proteins show different results and the usefulness of these protein expressions remains questionable. In this article, we relate one of these hypoxia-related proteins (hypoxia-inducible factor, HIF1a) to a direct in vivo spectroscopic measurement of tumor blood saturation performed during bronchoscopy. Seventeen samples from malignancies and non-malignant tissues were studied. Microvascular saturation levels in the no malignancy group equalled 87+/-11.5% (range 71-100%) and in the malignant group 43+/-21% (range 6-63%). This difference was statistically significant (p<0.0002). There was a significant difference in the spectroscopically determined saturations between the biopsies with negative expression of HIF1a and the biopsies with positive expression of HIF1a (p<0.005). From these data, it can be concluded that HIF1a expression is related to a low microvascular blood saturation as determined in vivo by optical spectroscopy. This study may lead to a better acceptance of the usage of different techniques to establish hypoxia in order to study the effect of hypoxia on therapeutic interventions and prognosis of lung cancer.
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Affiliation(s)
- J G J V Aerts
- Department of Pulmonary Diseases, Amphia Hospital, Breda, The Netherlands.
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25
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Aerts JGJV, Delahaye M, van der Kwast TH, Davidson B, Hoogsteden HC, van Meerbeeck JP. The high post-test probability of a cytological examination renders further investigations to establish a diagnosis of epithelial malignant pleural mesothelioma redundant. Diagn Cytopathol 2006; 34:523-7. [PMID: 16850492 DOI: 10.1002/dc.20486] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the study was to establish in a prospective and blinded manner the diagnostic yield of morphology, immunocytochemistry (ICH) and electron microscopy (EM) in the cytological analysis of malignant pleural mesothelioma (MPM). Pleural fluid from consecutive patients, 14 with a histologically proven MPM, 12 with a malignant pleuritis due to adenocarcinoma (AC), and 13 with a reactive pleural effusion (RM), was separately analyzed. Smears were incubated with monoclonal antibodies (Tag72, Ber-Ep4, anti-CEA, EMA). These were considered suggestive for MPM when only EMA stained positive, for AC when three out of four markers stained positive, and for RM when no marker stained positive. The post-test probability of the morphological, ICH, and EM analysis were 92, 100, 92% or MPM, 91, 100, 86% for AC, and 88, 88, 90% for RM, respectively. We concluded that the high post-test probability of a combined morphological and ICH diagnosis of MPM warrants to cease further diagnostic procedures in these patients. Electron microscopy did not add to accuracy of diagnosis.
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Affiliation(s)
- J G J V Aerts
- Department of Pulmonary Diseases, Erasmus MC, Rotterdam, the Netherlands.
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26
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Aerts JGJV, Surmont V, van Klaveren RJ, Tan KY, Senan S, van Wijhe G, Vernhout R, Verhoeven GT, Hoogsteden HC, van Meerbeeck JP. A phase II study of induction therapy with carboplatin and gemcitabine among patients with locally advanced non-small cell lung cancer. J Thorac Oncol 2006; 1:532-6. [PMID: 17409913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The objectives of this trial were to evaluate the activity and safety of gemcitabine carboplatin as induction therapy in patients with locally advanced non-small cell lung cancer METHODS Patients received two cycles of gemcitabine (1250 mg/m on day 1 and 8), plus carboplatin (area under the curve = 5 on day 1), after which response was established. Patients received a third course only in the case of an objective response (OR). Non-responding patients were directly irradiated. Toxicity was assessed according to the NCI-CTC version 2, radiation toxicity was assessed according to RTOG criteria. Response evaluation was performed according to RECIST criteria. RESULTS We identified 42 patients, of whom 37 were eligible. Of these, 51% (95% CI, 34%-68%) achieved an OR, all partial responses. No disease progression on therapy was established. Toxicity was mostly hematological: 35% trombocytopenia grade 3 and 4, and 40% neutropenia grade 3 and 4. No severe bleeding or hospitalization because of febrile neutropenia occurred. CONCLUSIONS Gemcitabine and carboplatin administered according to a 3-week schedule is an active and safe induction regimen. Pending the results of a phase III study, we believe that it is a reasonable alternative among patients for whom cisplatin-based chemotherapy is contraindicated.
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Affiliation(s)
- J G J V Aerts
- Department of Pulmonary Diseases, Erasmus MC, Rotterdam, The Netherlands.
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27
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Aerts JGJV, de Jongh F, van Iperen CE, Lam KH, Hoogsteden HC, van Meerbeeck JPAM. [Pulmonary problems associated with lymphoplasmacytic lymphoma (Waldenström's macroglobulinemia)]. Ned Tijdschr Geneeskd 2002; 146:999-1002. [PMID: 12058634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
A 62-year-old man, known for some years due to lymphoplasmacytic lymphoma, was admitted with progressive dyspnoea. Multiple lung infiltrates were found upon X-ray examination. Because of the suspicion of an infection, a bronchoscopy with bronchoalveolar lavage was performed. No infectious cause could be established. Upon cytological examination, a highly increased level of kappa-positive B-lymphoid cells was found, as is seen in cases of lymphoplasmacytic lymphoma (Waldenström's macroglobulinaemia). Following chemotherapy, the dyspnoea lessened and the pulmonary infiltrates disappeared. In patients with a lymphoproliferative disorder, pulmonary infiltrates due to infection are found relatively frequently. This case report highlights a rare complication of the disease, namely pulmonary infiltrates caused by infiltration of lymphoplasmacytic cells, emphasising the importance of cytological examination of broncho-alveolar lavage fluid.
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Affiliation(s)
- J G J V Aerts
- Afd. Longziekten, Academisch Ziekenhuis Rotterdam-Daniel den Hoed Kliniek, Rotterdam
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