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Rodrigues G, Higgins KA, Rimner A, Amini A, Chang JY, Chun SG, Donington J, Edelman MJ, Gubens MA, Iyengar P, Movsas B, Ning MS, Park HS, Wolf A, Simone CB. American Radium Society Appropriate Use Criteria for Unresectable Locally Advanced Non-Small Cell Lung Cancer. JAMA Oncol 2024:2817451. [PMID: 38602670 DOI: 10.1001/jamaoncol.2024.0294] [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: 04/12/2024]
Abstract
Importance The treatment of locally advanced non-small cell lung cancer (LA-NSCLC) has been informed by more than 5 decades of clinical trials and other relevant literature. However, controversies remain regarding the application of various radiation and systemic therapies in commonly encountered clinical scenarios. Objective To develop case-referenced consensus and evidence-based guidelines to inform clinical practice in unresectable LA-NSCLC. Evidence Review The American Radium Society (ARS) Appropriate Use Criteria (AUC) Thoracic Committee guideline is an evidence-based consensus document assessing various clinical scenarios associated with LA-NSCLC. A systematic review of the literature with evidence ratings was conducted to inform the appropriateness of treatment recommendations by the ARS AUC Thoracic Committee for the management of unresectable LA-NSCLC. Findings Treatment appropriateness of a variety of LA-NSCLC scenarios was assessed by a consensus-based modified Delphi approach using a range of 3 points to 9 points to denote consensus agreement. Committee recommendations were vetted by the ARS AUC Executive Committee and a 2-week public comment period before official approval and adoption. Standard of care management of good prognosis LA-NSCLC consists of combined concurrent radical (60-70 Gy) platinum-based chemoradiation followed by consolidation durvalumab immunotherapy (for patients without progression). Planning and delivery of locally advanced lung cancer radiotherapy usually should be performed using intensity-modulated radiotherapy techniques. A variety of palliative and radical fractionation schedules are available to treat patients with poor performance and/or pulmonary status. The salvage therapy for a local recurrence after successful primary management is complex and likely requires both multidisciplinary input and shared decision-making with the patient. Conclusions and Relevance Evidence-based guidance on the management of various unresectable LA-NSCLC scenarios is provided by the ARS AUC to optimize multidisciplinary patient care for this challenging patient population.
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Affiliation(s)
- George Rodrigues
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arya Amini
- City of Hope National Medical Center, Duarte, California
| | - Joe Y Chang
- The University of Texas, MD Anderson Cancer Center, Houston
| | - Stephen G Chun
- The University of Texas, MD Anderson Cancer Center, Houston
| | | | - Martin J Edelman
- Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | - Matthew A Gubens
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Puneeth Iyengar
- The University of Texas at Southwestern Medical Center, Dallas
| | | | - Matthew S Ning
- The University of Texas, MD Anderson Cancer Center, Houston
| | | | - Andrea Wolf
- Mount Sinai Health System, New York, New York
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2
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Potter AL, Xu NN, Senthil P, Srinivasan D, Lee H, Gazelle GS, Chelala L, Zheng W, Fintelmann FJ, Sequist LV, Donington J, Palmer JR, Yang CFJ. Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility. J Clin Oncol 2024:JCO2301780. [PMID: 38537159 DOI: 10.1200/jco.23.01780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/21/2023] [Accepted: 02/02/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE Pack-year smoking history is an imperfect and biased measure of cumulative tobacco exposure. The use of pack-year smoking history to determine lung cancer screening eligibility in the current US Preventive Services Task Force (USPSTF) guideline may unintentionally exclude many high-risk individuals, especially those from racial and ethnic minority groups. It is unclear whether using a smoking duration cutoff instead of a smoking pack-year cutoff would improve the selection of individuals for screening. METHODS We analyzed 49,703 individuals with a smoking history from the Southern Community Cohort Study (SCCS) and 22,126 individuals with a smoking history from the Black Women's Health Study (BWHS) to assess eligibility for screening under the USPSTF guideline versus a proposed guideline that replaces the ≥20-pack-year criterion with a ≥20-year smoking duration criterion. RESULTS Under the USPSTF guideline, only 57.6% of Black patients with lung cancer in the SCCS would have qualified for screening, whereas a significantly higher percentage of White patients with lung cancer (74.0%) would have qualified (P < .001). Under the proposed guideline, the percentage of Black and White patients with lung cancer who would have qualified for screening increased to 85.3% and 82.0%, respectively, eradicating the disparity in screening eligibility between the groups. In the BWHS, using a 20-year smoking duration cutoff instead of a 20-pack-year cutoff increased the percentage of Black women with lung cancer who would have qualified for screening from 42.5% to 63.8%. CONCLUSION Use of a 20-year smoking duration cutoff instead of a 20-pack-year cutoff greatly increases the proportion of patients with lung cancer who would qualify for screening and eliminates the racial disparity in screening eligibility between Black versus White individuals; smoking duration has the added benefit of being easier to calculate and being a more precise assessment of smoking exposure compared with pack-year smoking history.
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Affiliation(s)
- Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Nuo N Xu
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Priyanka Senthil
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Deepti Srinivasan
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - G Scott Gazelle
- Department of Radiology, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Lydia Chelala
- Department of Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | | | - Lecia V Sequist
- Mass General Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Jessica Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago Hospital, Chicago, IL
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA
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Donington J, Hu X, Zhang S, Song Y, Arunachalam A, Chirovsky D, Gao C, Lerner A, Jiang A, Signorovitch J, Samkari A. Event-free survival as a predictor of overall survival and recurrence burden of patients with non-small cell lung cancer receiving neoadjuvant therapy. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01193-5. [PMID: 38092284 DOI: 10.1016/j.jtcvs.2023.12.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Event-free survival has replaced overall survival as a primary end point in many recent and ongoing clinical trials. This study aims to examine the correlation between real-world event-free survival and overall survival and to assess the clinical and economic burden associated with disease recurrence among patients with resected stage II to III non-small cell lung cancer who received neoadjuvant therapy in the United States. METHODS This retrospective study used the Surveillance, Epidemiology, and End Results Medicare database (2007-2019) to identify patients with newly diagnosed, resected, stage II to IIIB (N2) non-small cell lung cancer who received neoadjuvant therapy. The correlation between real-world event-free survival and overall survival was assessed using the normal scores rank correlation and landmark analysis. Overall survival, all-cause health care resource use and costs, and non-small cell lung cancer-related health care resource use and costs were compared between patients with and without recurrence. RESULTS A total of 221 patients met the eligibility criteria (median follow-up time from neoadjuvant treatment initiation: 32.7 months). The mean age was 72.1 years, and 57.0% of patients were male. Real-world, event-free survival and overall survival are positively and significantly correlated (0.68; 95% CI, 0.52-0.79). Patients with recurrence had significantly shorter median overall survival (19.3 vs 116.9 months), 4.59 times increased risk of death (95% CI, 2.56-8.26), and significantly higher all-cause and non-small cell lung cancer-related health care resource use and costs (adjusted mean monthly costs per patient difference: $5758 and $3187, respectively [all P < .001]). CONCLUSIONS These findings help validate event-free survival as a clinically meaningful end point and strong predictor for overall survival and highlight the need for additional novel therapies that may delay or prevent recurrence in resectable stage II and III non-small cell lung cancer.
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Affiliation(s)
| | | | - Su Zhang
- Analysis Group, Inc, Boston, Mass
| | - Yan Song
- Analysis Group, Inc, Boston, Mass
| | | | | | - Chi Gao
- Analysis Group, Inc, Boston, Mass
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4
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Van Schil PE, Asamura H, Nishimura KK, Rami-Porta R, Kim YT, Bertoglio P, Cangir AK, Donington J, Fang W, Giroux DJ, Lievens Y, Liu H, Lyons G, Sakai S, Travis WD, Ugalde P, Jeffrey Yang CF, Yotsukura M, Detterbeck F. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revisions of the T-Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2023:S1556-0864(23)02411-5. [PMID: 38070600 DOI: 10.1016/j.jtho.2023.12.006] [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: 10/30/2023] [Revised: 11/21/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION An international database was created by the International Association for the Study of Lung Cancer to inform on the ninth edition of the TNM classification of lung cancer. The present analyses concern its T component. METHODS Data on 124,581 patients diagnosed with lung cancer from January 1, 2011 to December 31, 2019 were submitted to the International Association for the Study of Lung Cancer database. Of these, 33,982 met the inclusion criteria for the clinical T analysis, and 30,715 met the inclusion criteria for the pathologic postsurgical analysis. Survival was measured from the date of diagnosis or operation for clinically and pathologically staged tumors, respectively. T descriptors were evaluated in univariate analysis and multivariable Cox regression analysis adjusted for age, sex, pathologic type, and geographic region. RESULTS Comprehensive survival analysis revealed that the existing eighth edition T component criteria performed adequately in the ninth edition data set. Although pathologic chest wall or parietal pleura involvement (PL 3) yielded a worse survival compared with the other T3 descriptors, with a similar survival as T4 tumors, this difference was not observed for clinical chest wall or PL 3 tumors. Because of these inconsistent findings, no reallocation of chest wall or PL 3 tumors is advised. CONCLUSIONS The T subcommittee members proposed not to implement any changes and keep the current eighth-edition T descriptors for the ninth edition.
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Affiliation(s)
- Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
| | | | | | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, People's Republic of China
| | | | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Hui Liu
- Sun Yat-Sen University Cancer Center, Guangdong Sheng, People's Republic of China
| | - Gustavo Lyons
- Thoracic Surgery Department, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paula Ugalde
- Department of Thoracic Surgery, Brigham & Women's Hospital, Boston, Massachusetts
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Massachusetts
| | - Masaya Yotsukura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
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Copeland J, Neal E, Phillips W, Hofferberth S, Lathan C, Donington J, Colson Y. Restructuring lung cancer care to accelerate diagnosis and treatment in patients vulnerable to healthcare disparities using an innovative care model. MethodsX 2023; 11:102338. [PMID: 37701734 PMCID: PMC10494257 DOI: 10.1016/j.mex.2023.102338] [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: 05/11/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023] Open
Abstract
The diagnosis and treatment of lung cancer is challenged by complex diagnostic pathways and fragmented care that can lead to disparities for vulnerable patients. Our model involved a multi-institutional, multidisciplinary conference to address the complexity of lung cancer care in vulnerable patient populations. The conference was conducted using a process adapted from the problem-solving method entitled FastTrack, pioneered by General Electric. Conference attendees established critical social determinants of health specific to lung cancer and designed a practical care model to accelerate diagnosis and treatment in this population. The resulting care delivery model, the Lung Cancer Strategist Program (LCSP), was led by a lung cancer trained advanced practice provider (APP) to expedite diagnosis, surgical and oncologic consultation, and treatment of a suspicious lung nodule. We compared the timeliness of care, care efficiency, and oncologic outcomes in 100 LCSP patients and 100 routine referral patients at the same thoracic surgery clinic. Patient triage through our integrated care model transitioned initial referral evaluation to a lung cancer trained APP to coordinate multidisciplinary patient-centered care that was highly individualized and significantly reduced the time to diagnosis and treatment among vulnerable patients at high-risk for treatment delay due to healthcare disparities.•To develop the Lung Cancer Strategist Program care model, we used a three-step (Design, Meeting, and Culmination), team-based, problem-solving process entitled FastTrack.•An advantage of FastTrack is its ability to overcome barriers embedded within hierarchal and institutional social systems, empowering those closest to the relevant issue to propose and enact meaningful change.•Under this framework, we engaged a diverse field of experts to assess systemic barriers in lung cancer care and design an innovative care pathway to improve the timeliness and efficiency of lung cancer care in patients at risk for healthcare disparities.
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Affiliation(s)
- Jessica Copeland
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eliza Neal
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Will Phillips
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Hofferberth
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher Lathan
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Jessica Donington
- Division of Thoracic Surgery, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Yolonda Colson
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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6
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Cameron RB, Hines JB, Torri V, Porcu L, Donington J, Bestvina CM, Vokes E, Dolezal JM, Esposito A, Garassino MC. What is the ideal endpoint in early-stage immunotherapy neoadjuvant trials in lung cancer? Ther Adv Med Oncol 2023; 15:17588359231198446. [PMID: 37720499 PMCID: PMC10504845 DOI: 10.1177/17588359231198446] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Numerous clinical trials investigating neoadjuvant immune checkpoint inhibitors (ICI) have been performed over the last 5 years. As the number of neoadjuvant trials increases, attention must be paid to identifying informative trial endpoints. Complete pathologic response has been shown to be an appropriate surrogate endpoint for clinical outcomes, such as event-free survival or overall survival, in breast cancer and bladder cancer, but it is less established for non-small-cell lung cancer (NSCLC). The simultaneous advances reported with adjuvant ICI make the optimal strategy for early-stage disease debatable. Considering the long time required to conduct trials, it is important to identify optimal endpoints and discover surrogate endpoints for survival that can help guide ongoing clinical research. Endpoints can be grouped into two categories: medical and surgical. Medical endpoints are measures of survival and drug activity; surgical endpoints describe the feasibility of neoadjuvant approaches at a surgical level as well as perioperative attrition and complications. There are also several exploratory endpoints, including circulating tumor DNA clearance and radiomics. In this review, we outline the advantages and disadvantages of commonly reported endpoints for clinical trials of neoadjuvant regimens in NSCLC.
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Affiliation(s)
- Robert B. Cameron
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Jacobi B. Hines
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Valter Torri
- Department of Oncology, Institute of Pharmacological Research ‘Mario Negri’, IRCCS, Milan, Italy
| | - Luca Porcu
- Department of Oncology, Institute of Pharmacological Research ‘Mario Negri’, IRCCS, Milan, Italy
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
| | - Jessica Donington
- Department of Surgery, Section Thoracic Surgery, University of Chicago, Chicago, IL, USA
| | - Christine M. Bestvina
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Everett Vokes
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - James M. Dolezal
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Alessandra Esposito
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Marina C. Garassino
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, 5841 S Maryland Avenue, Chicago, IL 60637, USA
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7
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Mitchell OD, Gilliam K, del Gaudio D, McNeely KE, Smith S, Acevedo M, Gaduraju M, Hodge R, Ramsland ASS, Segal J, Das S, Hathaway F, Bryan DS, Tawde S, Galasinski S, Wang P, Tjota MY, Husain AN, Armato SG, Donington J, Ferguson MK, Turaga K, Churpek JE, Kindler HL, Drazer MW. Germline Variants Incidentally Detected via Tumor-Only Genomic Profiling of Patients With Mesothelioma. JAMA Netw Open 2023; 6:e2327351. [PMID: 37556141 PMCID: PMC10413174 DOI: 10.1001/jamanetworkopen.2023.27351] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/08/2023] [Indexed: 08/10/2023] Open
Abstract
IMPORTANCE Patients with mesothelioma often have next-generation sequencing (NGS) of their tumor performed; tumor-only NGS may incidentally identify germline pathogenic or likely pathogenic (P/LP) variants despite not being designed for this purpose. It is unknown how frequently patients with mesothelioma have germline P/LP variants incidentally detected via tumor-only NGS. OBJECTIVE To determine the prevalence of incidental germline P/LP variants detected via tumor-only NGS of mesothelioma. DESIGN, SETTING, AND PARTICIPANTS A series of 161 unrelated patients with mesothelioma from a high-volume mesothelioma program had tumor-only and germline NGS performed during April 2016 to October 2021. Follow-up ranged from 18 months to 7 years. Tumor and germline assays were compared to determine which P/LP variants identified via tumor-only NGS were of germline origin. Data were analyzed from January to March 2023. MAIN OUTCOMES AND MEASURES The proportion of patients with mesothelioma who had P/LP germline variants incidentally detected via tumor-only NGS. RESULTS Of 161 patients with mesothelioma, 105 were male (65%), the mean (SD) age was 64.7 (11.2) years, and 156 patients (97%) self-identified as non-Hispanic White. Most (126 patients [78%]) had at least 1 potentially incidental P/LP germline variant. The positive predictive value of a potentially incidental germline P/LP variant on tumor-only NGS was 20%. Overall, 26 patients (16%) carried a P/LP germline variant. Germline P/LP variants were identified in ATM, ATR, BAP1, CHEK2, DDX41, FANCM, HAX1, MRE11A, MSH6, MUTYH, NF1, SAMD9L, and TMEM127. CONCLUSIONS AND RELEVANCE In this case series of 161 patients with mesothelioma, 16% had confirmed germline P/LP variants. Given the implications of a hereditary cancer syndrome diagnosis for preventive care and familial counseling, clinical approaches for addressing incidental P/LP germline variants in tumor-only NGS are needed. Tumor-only sequencing should not replace dedicated germline testing. Universal germline testing is likely needed for patients with mesothelioma.
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Affiliation(s)
- Owen D. Mitchell
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | - Katie Gilliam
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | | | - Kelsey E. McNeely
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | - Shaili Smith
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | - Maria Acevedo
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | - Meghana Gaduraju
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | - Rachel Hodge
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | | | - Jeremy Segal
- Department of Pathology, The University of Chicago, Illinois
| | - Soma Das
- Department of Human Genetics, The University of Chicago, Illinois
| | - Feighanne Hathaway
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | | | - Sanjukta Tawde
- Department of Human Genetics, The University of Chicago, Illinois
| | | | - Peng Wang
- Department of Pathology, The University of Chicago, Illinois
| | | | - Aliya N. Husain
- Department of Pathology, The University of Chicago, Illinois
| | | | | | | | - Kiran Turaga
- Department of Surgery, The University of Chicago, Illinois
| | - Jane E. Churpek
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin, Madison
| | - Hedy L. Kindler
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
| | - Michael W. Drazer
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Illinois
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8
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Chun SG, Rimner A, Amini A, Chang JY, Donington J, Edelman MJ, Geng Y, Gubens MA, Higgins KA, Iyengar P, Movsas B, Ning MS, Park HS, Rodrigues G, Wolf A, Simone CB. American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma. JAMA Oncol 2023:2805042. [PMID: 37186595 DOI: 10.1001/jamaoncol.2023.1175] [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: 05/17/2023]
Abstract
Importance Thymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management. Objective To develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma. Evidence Review Case variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures. Findings The ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs. Conclusions and Relevance The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.
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Affiliation(s)
- Stephen G Chun
- The University of Texas MD Anderson Cancer Center, Houston
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arya Amini
- City of Hope National Medical Center, Duarte, California
| | - Joe Y Chang
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Martin J Edelman
- Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | - Yimin Geng
- The University of Texas MD Anderson Cancer Center, Houston
| | - Matthew A Gubens
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | | | - Puneeth Iyengar
- The University of Texas at Southwestern Medical Center, Dallas
| | | | - Matthew S Ning
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - George Rodrigues
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Andrea Wolf
- Mount Sinai Health System, New York, New York
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9
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Khouzam MS, Wood DE, Vigneswaran W, Goyal A, Czerlanis C, Blackmon SH, Donington J, Albain KS, Freeman RK, Abdelsattar ZM. Impact of Federal Lung Cancer Screening Policy on the Incidence of Early-stage Lung Cancer. Ann Thorac Surg 2023; 115:827-833. [PMID: 36470567 DOI: 10.1016/j.athoracsur.2022.11.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/21/2022] [Accepted: 11/07/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND In December 2013 the US Preventative Services Task Force (USPSTF) recommended annual lung cancer screening for high-risk patients. The Centers for Medicare & Medicaid Services (CMS) later announced coverage in 2015. The impact of these federal decisions at the population level is unknown. METHODS Using the Surveillance, Epidemiology, and End Results database, we studied changes in lung cancer incidence by stage and linked to US census data to obtain age-adjusted estimates standardized to the US population. Based on age at diagnosis we stratified patients as age-eligible or age-ineligible for screening. We used difference-in-differences regression to determine the effect of screening on lung cancer incidence by stage. RESULTS For all age groups the incidence of early-stage lung cancer both before and after the USPSTF guidelines remained relatively stable at 12.8 ± 0.52 and 13.5 ± 0.92 per 100,000 patients, respectively (P = .068). However the difference-in-differences analysis estimated an absolute increase in the age-adjusted incidence by 3.4 per 100,000 persons in the age-eligible group after the announcement of the guidelines (P = .007). The effect was even larger after the CMS decision (4.3/100,000 persons, P < .001). Similarly there was a 14.2 per 100,000 persons absolute reduction in the incidence of advanced-stage lung cancer (P < .001). CONCLUSIONS The 2013 USPSTF lung cancer screening guidelines and CMS coverage decisions were associated with an increased incidence of early-stage lung cancer and decreased incidence of advance-staged lung cancer at the population level.
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Affiliation(s)
- Matthew S Khouzam
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, Washington
| | - Wickii Vigneswaran
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Amit Goyal
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Cheryl Czerlanis
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | | | - Jessica Donington
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Kathy S Albain
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Richard K Freeman
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Zaid M Abdelsattar
- Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois.
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Donington J, Hu X, Zhang S, Song Y, Gao C, Arunachalam A, Chirovsky D, Lerner A, Jiang A, Signorovitch J, Samkari A. 95P Neoadjuvant treatment pattern and association between real-world event-free survival (rwEFS) and overall survival (OS) in patients (pts) with resected early-stage non-small cell lung cancer (eNSCLC). J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00350-7] [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: 04/03/2023]
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11
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Erwin PA, Lee AC, Ahmad U, Antonoff M, Arndt A, Backhus L, Berry M, Birdas T, Cassivi SD, Chang AC, Cooke DT, Crabtree T, DeCamp M, Donington J, Fernandez F, Force S, Gaissert H, Hofstetter W, Huang J, Kent M, Kim AW, Lin J, Martin LW, Meyerson S, Mitchell JD, Molena D, Odell D, Onaitis M, Puri V, Putnam JB, Reddy R, Schipper P, Seder CW, Shrager J, Tong B, Veeramachaneni N, Watson T, Whyte R, Ferguson MK. Consensus for Thoracoscopic Lower Lobectomy: Essential Components and Targets for Simulation. Ann Thorac Surg 2022; 114:1895-1901. [PMID: 34688617 DOI: 10.1016/j.athoracsur.2021.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/20/2021] [Accepted: 09/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation and determining which steps are most useful for simulation training. METHODS After randomly selecting experienced thoracic surgeons to participate, an initial list of components to a lower lobectomy was distributed. Feedback was provided by the participants, and modifications were made based on anonymous responses in a Delphi process. Components were declared essential once at least 80% of participants came to an agreement. The steps were then rated based on cognitive and technical difficulty followed by listing the components most appropriate for simulation. RESULTS After 3 rounds of voting 18 components were identified as essential to performance of a video-assisted thoracic surgery for lower lobectomy. The components deemed the most difficult were isolation and division of the basilar and superior segmental branches of the pulmonary artery, isolation and division of the lower lobe bronchus, and dissection of lymphovascular tissue to expose the target bronchus. The steps determined to be most amenable for simulation were isolation and division of the branches of the pulmonary artery, the lower lobe bronchus, and the inferior pulmonary vein. CONCLUSIONS Using a Delphi process a list of essential components for a video-assisted thoracic surgery for lower lobectomy was established. Furthermore 3 components were identified as most appropriate for simulation-based training, providing insights for future simulation development.
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Affiliation(s)
- Philip A Erwin
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Andy C Lee
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Usman Ahmad
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Cleveland, Ohio
| | - Mara Antonoff
- Department of Thoracic and Cardiovascular Surgery MD Anderson Cancer Center Houston, Texas
| | - Andrew Arndt
- Department of Surgery Northwestern University, Chicago, Illinois
| | - Leah Backhus
- Department of Cardiothoracic Surgery Stanford University, Stanford, California
| | - Mark Berry
- Department of Cardiothoracic Surgery Stanford University, Stanford, California
| | - Thomas Birdas
- Department of Surgery, Indiana University, Indianapolis, Indiana
| | | | - Andrew C Chang
- Department of Surgery, University of Michigan Ann Arbor, Michigan
| | - David T Cooke
- Department of Surgery, University of California, Davis Health, Sacramento, California
| | - Traves Crabtree
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Malcolm DeCamp
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | | | | | - Seth Force
- Department of Surgery, Emory University, Atlanta, Georgia
| | - Henning Gaissert
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Wayne Hofstetter
- Department of Thoracic and Cardiovascular Surgery MD Anderson Cancer Center Houston, Texas
| | - James Huang
- Department of Surgery, Memorial Sloan Kettering, New York, New York
| | - Michael Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anthony W Kim
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jules Lin
- Department of Surgery, University of Michigan Ann Arbor, Michigan
| | - Linda W Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Shari Meyerson
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - John D Mitchell
- Department of Surgery, University of Colorado Aurora, Colorado
| | - Daniela Molena
- Department of Surgery, Memorial Sloan Kettering, New York, New York
| | - David Odell
- Department of Surgery Northwestern University, Chicago, Illinois
| | - Mark Onaitis
- Department of Surgery, University of California-San Diego, La Jolla, California
| | - Varun Puri
- Department of Surgery, Washington University, St. Louis, Missouri
| | - Joe B Putnam
- Department of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Rishindra Reddy
- Department of Surgery, University of Michigan Ann Arbor, Michigan
| | - Paul Schipper
- Department of Surgery, Oregon Health and Sciences University, Portland, Oregon
| | | | - Joseph Shrager
- Department of Cardiothoracic Surgery Stanford University, Stanford, California
| | - Betty Tong
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - Thomas Watson
- Department of Surgery, Beaumont Health-Detroit, Royal Oak, Michigan
| | - Richard Whyte
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark K Ferguson
- Department of Surgery, University of Chicago, Chicago, Illinois.
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Erwin P, Donington J. Oncologic endpoints and implication of trial design in the era of immunotherapy for resectable non-small cell lung cancer. J Thorac Cardiovasc Surg 2022; 165:1949-1953. [PMID: 36528434 DOI: 10.1016/j.jtcvs.2022.10.047] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
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13
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Kalchiem-Dekel O, Falcon CJ, Bestvina CM, Liu D, Kaplanis LA, Wilhelm C, Eichholz J, Harada G, Wirth LJ, Digumarthy SR, Lee RP, Kadosh D, Mendelsohn RB, Donington J, Gainor JF, Drilon A, Lin JJ. Brief Report: Chylothorax and Chylous Ascites During RET Tyrosine Kinase Inhibitor Therapy. J Thorac Oncol 2022; 17:1130-1136. [PMID: 35788405 PMCID: PMC9427698 DOI: 10.1016/j.jtho.2022.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Spontaneous chylous effusions are rare; however, they have been observed by independent investigators in patients treated with RET tyrosine kinase inhibitors (TKIs). METHODS This multicenter, retrospective study evaluated the frequency of chylous effusions in patients treated with RET TKIs. Clinicopathologic features and management of patients with chylous effusions were evaluated. RESULTS A pan-cancer cohort of 7517 patients treated with one or more multikinase inhibitor or selective RET TKI and a selective TKI cohort of 96 patients treated with selpercatinib or pralsetinib were analyzed. Chylous effusions were most common with selpercatinib (7%), followed by agerafenib (4%), cabozantinib (0.3%), and lenvatinib (0.02%); none were observed with pralsetinib. Overall, 12 patients had chylothorax, five had chylous ascites, and five had both. Time from TKI initiation to diagnosis ranged from 0.5 to 50 months. Median fluid triglyceride level was lower in chylothoraces than in chylous ascites (397 mg/dL [interquartile range: 304-4000] versus 3786 mg/dL [interquartile range: 842-6596], p = 0.035). Malignant cells were present in 13% (3 of 22) of effusions. Chyle leak was not identified by lymphangiography. After initial drainage, 76% of patients with chylothorax and 80% with chylous ascites required additional interventions. Selpercatinib dose reduction and discontinuation rates in those with chylous effusions were 47% and 0%, respectively. Median time from diagnosis to disease progression was not reached (95% confidence interval: 14.5-undefined); median time from diagnosis to TKI discontinuation was 11.4 months (95% confidence interval: 8.2-14.9). CONCLUSIONS Chylous effusions can emerge during treatment with selected RET TKIs. Recognition of this side effect is key to prevent potential misattribution of worsening effusions to progressive malignancy.
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Affiliation(s)
- Or Kalchiem-Dekel
- Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell College of Medicine, New York, New York
| | | | | | - Dazhi Liu
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Clare Wilhelm
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Lori J Wirth
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Subba R Digumarthy
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert P Lee
- Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell College of Medicine, New York, New York
| | - David Kadosh
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robin B Mendelsohn
- Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell College of Medicine, New York, New York
| | | | - Justin F Gainor
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell College of Medicine, New York, New York
| | - Jessica J Lin
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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14
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Rezania K, Soliven B, Garassino MC, Donington J. Postoperative complications of thymectomy in myasthenia gravis: does steroid use play a role? Ann Thorac Surg 2022; 115:1558. [PMID: 36007565 DOI: 10.1016/j.athoracsur.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Kourosh Rezania
- Department of Neurology, The University of Chicago, 5841 S. Maryland Avenue, MC 2030, Chicago, IL 60637.
| | - Betty Soliven
- Department of Neurology, The University of Chicago, 5841 S. Maryland Avenue, MC 2030, Chicago, IL 60637
| | - Marina Chiara Garassino
- Department of Neurology, The University of Chicago, 5841 S. Maryland Avenue, MC 2030, Chicago, IL 60637
| | - Jessica Donington
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
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15
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Lee ACH, Edobor A, Lysandrou M, Mirle V, Sadek A, Johnston L, Piech R, Rose R, Hart J, Amundsen B, Jendrisak M, Millis JM, Donington J, Madariaga ML, Barth RN, di Sabato D, Shanmugarajah K, Fung J. The Effect of Normothermic Machine Perfusion on the Immune Profile of Donor Liver. Front Immunol 2022; 13:788935. [PMID: 35720395 PMCID: PMC9201055 DOI: 10.3389/fimmu.2022.788935] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 05/02/2022] [Indexed: 12/29/2022] Open
Abstract
Background Normothermic machine perfusion (NMP) allows viability assessment and potential resuscitation of donor livers prior to transplantation. The immunological effect of NMP on liver allografts is undetermined, with potential implications on allograft function, rejection outcomes and overall survival. In this study we define the changes in immune profile of human livers during NMP. Methods Six human livers were placed on a NMP device. Tissue and perfusate samples were obtained during cold storage prior to perfusion and at 1, 3, and 6 hours of perfusion. Flow cytometry, immunohistochemistry, and bead-based immunoassays were used to measure leukocyte composition and cytokines in the perfusate and within the liver tissue. Mean values between baseline and time points were compared by Student’s t-test. Results Within circulating perfusate, significantly increased frequencies of CD4 T cells, B cells and eosinophils were detectable by 1 hour of NMP and continued to increase at 6 hours of perfusion. On the other hand, NK cell frequency significantly decreased by 1 hour of NMP and remained decreased for the duration of perfusion. Within the liver tissue there was significantly increased B cell frequency but decreased neutrophils detectable at 6 hours of NMP. A transient decrease in intermediate monocyte frequency was detectable in liver tissue during the middle of the perfusion run. Overall, no significant differences were detectable in tissue resident T regulatory cells during NMP. Significantly increased levels of pro-inflammatory and anti-inflammatory cytokines were seen following initiation of NMP that continued to rise throughout duration of perfusion. Conclusions Time-dependent dynamic changes are seen in individual leukocyte cell-types within both perfusate and tissue compartments of donor livers during NMP. This suggests a potential role of NMP in altering the immunogenicity of donor livers prior to transplant. These data also provide insights for future work to recondition the intrinsic immune profile of donor livers during NMP prior to transplantation.
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Affiliation(s)
| | - Arianna Edobor
- Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Maria Lysandrou
- Biological Sciences Division, University of Chicago, Chicago, IL, United States
| | - Vikranth Mirle
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Amir Sadek
- Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Laura Johnston
- Biological Sciences Division, University of Chicago, Chicago, IL, United States
| | - Ryan Piech
- Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Rebecca Rose
- Department of Surgery, University of Chicago, Chicago, IL, United States
| | - John Hart
- Department of Pathology, University of Chicago, Chicago, IL, United States
| | - Beth Amundsen
- Gift of Hope Tissue and Donor Network, Itasca, IL, United States
| | - Martin Jendrisak
- Gift of Hope Tissue and Donor Network, Itasca, IL, United States
| | | | - Jessica Donington
- Section of Transplant Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Maria Lucia Madariaga
- Section of Transplant Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Rolf N Barth
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States
| | - Diego di Sabato
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States
| | | | - John Fung
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States
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Kalchiem-Dekel O, Falcon CJ, Bestvina CM, Liu D, Kaplanis LA, Wilhelm C, Eichholz J, Harada G, Wirth LJ, Lee RP, Kadosh D, Mendelsohn RB, Donington J, Gainor JF, Drilon AE, Lin JJ. Chylothorax and chylous ascites during RET tyrosine kinase inhibitor therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9080 Background: Spontaneous, atraumatic chylous effusions are rare. Investigators have observed a higher than anticipated incidence of chylothorax and chylous ascites in patients (pts) treated with RET tyrosine kinase inhibitors (TKIs). A systematic analysis of the occurrence of chylous effusions during RET TKI therapy and management strategies was thus performed. Methods: In this multicenter, retrospective study, the frequency of biochemically confirmed chylothorax or chylous ascites in pts treated with multikinase inhibitors (MKIs) with anti-RET activity or selective RET TKIs was determined. Clinicopathologic features and management of pts with chylous effusions were assessed. Results: A pan-cancer cohort of 7517 pts treated with at least 1 of 17 MKIs and selective RET TKIs and an independent cohort of 96 pts treated with the selective RET TKIs, selpercatinib or pralsetinib, were identified. Across cohorts, chylous effusions were identified in 22 pts and were most common with selpercatinib (7%; 15/217), followed by the MKIs agerafenib (4%; 1/24), cabozantinib (0.3%; 3/918), and lenvatinib (0.3%; 3/1185). Chylous effusions were not noted in 28 pts treated with pralsetinib. The distribution of malignancies included lung adenocarcinoma (54%) medullary thyroid carcinoma (23%), renal cell carcinoma (19%), and desmoplastic small round cell tumor (4%). Of the 22 pts, 12 had chylothorax, 5 had chylous ascites, and 5 had both. The cumulative incidence of chylous effusions from TKI initiation at 12 months was 3.09%. Median fluid triglyceride level was lower in chylothorax than in chylous ascites [397 mg/dL (IQR 282-4000) vs. 3786 mg/dL (IQR 676-6596), p = 0.035]. Median pleural fluid triglyceride level was higher with selpercatinib compared to MKIs [4,000 mg/dL (IQR 356-4425) vs. 287 mg/dL (IQR 216-395); p = 0.017]. Malignant cells were identified in the effusions from 12% (2/17) and 10% (1/10) of pts with chylothoraces and chylous ascites, respectively. Median time to disease progression from radiographic index and biochemical index across the full cohort was 1.5 years (IQR: 0.6-2.4) and 1.0 year (IQR: 0.1-1.2), respectively. Anatomic chyle leak was not identified in 6 pts who underwent lymphangiography. After initial drainage, additional drainage procedures were required in all cases with chylothorax and 50% of cases with chylous ascites. Chylous effusions prompted TKI dose reduction in 47% (7/15) of pts treated with selpercatinib and 14% (1/7) treated with MKI; none discontinued TKI due to chylous effusions. Conclusions: Chylous effusions can emerge on treatment with certain MKIs or selective RET TKIs. Recognition of this potential side effect is key to prevent misattribution of worsening effusions to progressive malignancy and to motivate a better understanding of its biology and management.
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Affiliation(s)
| | | | | | - Dazhi Liu
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Clare Wilhelm
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Lori J. Wirth
- Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert P. Lee
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Kadosh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Justin F. Gainor
- Department of Medicine, Massachusetts General Hospital, Boston, MA
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Lee ACH, Edobor A, Wigakumar T, Lysandrou M, Johnston LK, McMullen P, Mirle V, Diaz A, Piech R, Rose R, Jendrisak M, di Sabato D, Shanmugarajah K, Fung J, Donington J, Madariaga ML. Donor leukocyte trafficking during human ex vivo lung perfusion. Clin Transplant 2022; 36:e14670. [PMID: 35396887 PMCID: PMC9540615 DOI: 10.1111/ctr.14670] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/09/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
Background Ex vivo lung perfusion (EVLP) is used to assess and preserve lungs prior to transplantation. However, its inherent immunomodulatory effects are not completely understood. We examine perfusate and tissue compartments to determine the change in immune cell composition in human lungs maintained on EVLP. Methods Six human lungs unsuitable for transplantation underwent EVLP. Tissue and perfusate samples were obtained during cold storage and at 1‐, 3‐ and 6‐h during perfusion. Flow cytometry, immunohistochemistry, and bead‐based immunoassays were used to measure leukocyte composition and cytokines. Mean values between baseline and time points were compared by Student's t test. Results During the 1st hour of perfusion, perfusate neutrophils increased (+22.2 ± 13.5%, p < 0.05), monocytes decreased (−77.5 ± 8.6%, p < 0.01) and NK cells decreased (−61.5 ± 22.6%, p < 0.01) compared to cold storage. In contrast, tissue neutrophils decreased (−22.1 ± 12.2%, p < 0.05) with no change in monocytes and NK cells. By 6 h, perfusate neutrophils, NK cells, and tissue neutrophils were similar to baseline. Perfusate monocytes remained decreased, while tissue monocytes remained unchanged. There was no significant change in B cells or T cell subsets. Pro‐inflammatory cytokines (IL‐1b, G‐CSF, IFN‐gamma, CXCL2, CXCL1 granzyme A, and granzyme B) and lymphocyte activating cytokines (IL‐2, IL‐4, IL‐6, IL‐8) increased during perfusion. Conclusions Early mobilization of innate immune cells occurs in both perfusate and tissue compartments during EVLP, with neutrophils and NK cells returning to baseline and monocytes remaining depleted after 6 h. The immunomodulatory effect of EVLP may provide a therapeutic window to decrease the immunogenicity of lungs prior to transplantation.
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Affiliation(s)
| | - Arianna Edobor
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | | | - Maria Lysandrou
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Laura K Johnston
- Office of Shared Research Facilities, University of Chicago, Chicago, Illinois, USA
| | - Phillip McMullen
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Vikranth Mirle
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ashley Diaz
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ryan Piech
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Rebecca Rose
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | | | - Diego di Sabato
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | | | - John Fung
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Jessica Donington
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Abstract
Surgical care for early stage non-small-cell lung cancer continuously evolves with new procedures, techniques and care pathways. The most obvious recent change was the transition to minimally invasive procedures, but numerous other aspects of care have also been refined to improve safety and tolerability. These care advancements are essential as we move into an era with increased early detection as a result of screening and greater indications for the use of adjuvant and neoadjuvant strategies.
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Amini A, Verma V, Simone CB, Chetty IJ, Chun SG, Donington J, Edelman MJ, Higgins KA, Kestin LL, Movsas B, Rodrigues GB, Rosenzweig KE, Rybkin II, Slotman BJ, Wolf A, Chang JY. American Radium Society Appropriate Use Criteria for Radiation Therapy in Oligometastatic or Oligoprogressive Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 112:361-375. [PMID: 34571054 DOI: 10.1016/j.ijrobp.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/28/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Recent randomized studies have suggested improvements in progression-free and overall survival with the addition of stereotactic body radiation therapy (SBRT, also known as SABR) in patients with oligometastatic non-small cell lung cancer. Given the novelty and complexity of incorporating SBRT in the oligometastatic setting, the multidisciplinary American Radium Society Lung Cancer Panel was assigned to create appropriate use criteria on SBRT as part of consolidative local therapy for patients with oligometastatic and oligoprogressive non-small cell lung cancer. METHODS AND MATERIALS A review of the current literature was conducted from January 1, 2008, to December 25, 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to systematically search the PubMed database to retrieve a comprehensive set of relevant articles. RESULTS Based on representation in existing randomized trials, the panel defined the term "oligometastasis" as ≤3 metastatic deposits (not including the primary tumor) in the previously untreated setting or after first-line systemic therapy after the initial diagnosis. "Oligoprogression" also referred to ≤3 discrete areas of progression in the setting of prior or ongoing receipt of systemic therapy. In all appropriate patients, the panel strongly recommends enrollment in a clinical trial whenever available. For oligometastatic disease, administering first-line systemic therapy followed by consolidative radiation therapy (to all sites plus the primary/nodal disease) is preferred over up-front radiation therapy. Owing to a dearth of data, the panel recommended that consolidative radiation therapy be considered on a case-by-case basis for 4 to 5 sites of oligometastatic disease, driver mutation-positive oligometastatic disease without progression on up-front targeted therapy, and oligoprogressive cases. CONCLUSIONS Although SBRT/SABR appears to be both safe and effective in treating patients with limited metastatic sites of disease, many clinical circumstances require individualized management and strong multidisciplinary discussion on account of the limited existing data.
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Affiliation(s)
- Arya Amini
- City of Hope National Medical Center, Duarte, California.
| | - Vivek Verma
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Charles B Simone
- New York Proton Center, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Stephen G Chun
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | | | - Martin J Edelman
- Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | - Benjamin J Slotman
- Amsterdam University Medical Center, De Boelelaan, Amsterdam, The Netherlands
| | - Andrea Wolf
- Mount Sinai School of Medicine, New York, New York
| | - Joe Y Chang
- The University of Texas, M.D. Anderson Cancer Center, Houston, Texas
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Gutiontov S, Turchan W, Rouhani S, Chervin CS, Segal J, Bestvina C, Donington J, Hoffman P, Chmura S, Connell P, Juloori A, Malik R, Ferguson M, Patel J, Vokes E, Weichselbaum R, Pitroda S. P14.27 Pathogenic Genomic Alterations of CDKN2A Predict Immunotherapy Resistance in NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.533] [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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21
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Chun SG, Simone CB, Amini A, Chetty IJ, Donington J, Edelman MJ, Higgins KA, Kestin LL, Movsas B, Rodrigues GB, Rosenzweig KE, Slotman BJ, Rybkin II, Wolf A, Chang JY. American Radium Society Appropriate Use Criteria: Radiation Therapy for Limited-Stage SCLC 2020. J Thorac Oncol 2020; 16:66-75. [PMID: 33166720 DOI: 10.1016/j.jtho.2020.10.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Combined modality therapy with concurrent chemotherapy and radiation has long been the standard of care for limited-stage SCLC (LS-SCLC). However, there is controversy over best combined modality practices for LS-SCLC. To address these controversies, the American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) Committee have developed updated consensus guidelines for the treatment of LS-SCLC. METHODS The ARS AUC are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for LS-SCLC. Agreement or consensus was defined as less than or equal to 3 rating points from the panel median. The consensus ratings and recommendations were then vetted by the ARS Executive Committee and subject to public comment before finalization. RESULTS The ARS Thoracic AUC committee developed multiple consensus recommendations for LS-SCLC. There was strong consensus that patients with unresectable LS-SCLC should receive concurrent chemotherapy with radiation delivered either once or twice daily. For medically inoperable T1-T2N0 LS-SCLC, either concurrent chemoradiation or stereotactic body radiation followed by adjuvant chemotherapy is a reasonable treatment option. The panel continues to recommend whole-brain prophylactic cranial irradiation after response to chemoradiation for LS-SCLC. There was panel agreement that prophylactic cranial irradiation with hippocampal avoidance and programmed cell death protein-1/programmed death-ligand 1-directed immune therapy should not be routinely administered outside the context of clinical trials at this time. CONCLUSIONS The ARS Thoracic AUC Committee provide consensus recommendations for LS-SCLC that aim to provide a groundwork for multidisciplinary care and clinical trials.
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Affiliation(s)
- Stephen G Chun
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas.
| | | | - Arya Amini
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | | | - Martin J Edelman
- Department of Hematology and Oncology, Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, Georgia
| | - Larry L Kestin
- MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, Michigan
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - George B Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Kenneth E Rosenzweig
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Igor I Rybkin
- Department of Hematology and Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Andrea Wolf
- Department of Thoracic Surgery, Mount Sinai School of Medicine, New York, New York
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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22
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Amini A, Verma V, Simone C, Chetty I, Choi JI, Chun S, Donington J, Edelman M, Higgins K, Kestin L, Mohindra P, Movsas B, Rodrigues G, Rosenzweig K, Rybkin I, Shepherd A, Slotman B, Wolf A, Chang J. American Radium Society® (ARS) Appropriate Use Criteria on Radiation Therapy in Oligometastatic or Oligoprogressive Non-Small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.02.582] [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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23
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Higgins KA, Simone CB, Amini A, Chetty IJ, Donington J, Edelman MJ, Chun SG, Kestin LL, Movsas B, Rodrigues GB, Rosenzweig KE, Slotman BJ, Rybkin II, Wolf A, Chang JY. American Radium Society Appropriate Use Criteria on Radiation Therapy for Extensive-Stage SCLC. J Thorac Oncol 2020; 16:54-65. [PMID: 33011389 DOI: 10.1016/j.jtho.2020.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/22/2020] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The standard-of-care therapy for extensive-stage SCLC has recently changed with the results of two large randomized trials revealing improved survival with the addition of immunotherapy to first-line platinum or etoposide chemotherapy. This has led to a lack of clarity around the role of consolidative thoracic radiation and prophylactic cranial irradiation in the setting of chemoimmunotherapy. METHODS The American Radium Society Appropriate Use Criteria are evidence-based guidelines for specific clinical conditions that are reviewed by a multidisciplinary expert panel. The guidelines include a review and analysis of current evidence with the application of consensus methodology (modified Delphi) to rate the appropriateness of treatments recommended by the panel for extensive-stage SCLC. RESULTS Current evidence supports either prophylactic cranial irradiation or surveillance with magnetic resonance imaging every 3 months for patients without evidence of brain metastases. Patients with brain metastases should receive whole-brain radiation with a recommended dose of 30 Gy in 10 fractions. Consolidative thoracic radiation can be considered in selected cases with the recommended dose ranging from 30 to 54 Gy; this recommendation was driven by expert opinion owing to the limited strength of evidence, as clinical trials addressing this question remain ongoing. CONCLUSIONS Radiation therapy remains an integral component in the treatment paradigm for ES-SCLC.
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Affiliation(s)
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
| | | | - Arya Amini
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Jessica Donington
- Department of Thoracic Surgery, The University of Chicago, Chicago, Illinois
| | - Martin J Edelman
- Department of Medical Oncology, Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | - Stephen G Chun
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Larry L Kestin
- Department of Radiation Oncology, MHP Cancer Institute, Pontiac, Michigan
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - George B Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Kenneth E Rosenzweig
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Igor I Rybkin
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan; Department of Medical Oncology, Henry Ford Health System, Detroit, Michigan
| | - Andrea Wolf
- Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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24
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Kumar S, Chmura S, Robinson C, Lin SH, Gadgeel SM, Donington J, Feliciano J, Stinchcombe TE, Werner-Wasik M, Edelman MJ, Moghanaki D. Alternative Multidisciplinary Management Options for Locally Advanced NSCLC During the Coronavirus Disease 2019 Global Pandemic. J Thorac Oncol 2020; 15:1137-1146. [PMID: 32360578 PMCID: PMC7194660 DOI: 10.1016/j.jtho.2020.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 04/02/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is currently accelerating. Patients with locally advanced NSCLC (LA-NSCLC) may require treatment in locations where resources are limited, and the prevalence of infection is high. Patients with LA-NSCLC frequently present with comorbidities that increase the risk of severe morbidity and mortality from COVID-19. These risks may be further increased by treatments for LA-NSCLC. Although guiding data is scarce, we present an expert thoracic oncology multidisciplinary (radiation oncology, medical oncology, surgical oncology) consensus of alternative strategies for the treatment of LA-NSCLC during a pandemic. The overarching goals of these approaches are the following: (1) reduce the number of visits to a health care facility, (2) reduce the risk of exposure to severe acute respiratory syndrome–coronavirus-2, (3) attenuate the immunocompromising effects of lung cancer therapies, and (4) provide effective oncologic therapy. Patients with resectable disease can be treated with definitive nonoperative management if surgical resources are limited or the risks of perioperative care are high. Nonoperative options include chemotherapy, chemoimmunotherapy, and radiation therapy with sequential schedules that may or may not affect long-term outcomes in an era in which immunotherapy is available. The order of treatments may be on the basis of patient factors and clinical resources. Whenever radiation therapy is delivered without concurrent chemotherapy, hypofractionated schedules are appropriate. For patients who are confirmed to have COVID-19, usually, cancer therapies may be withheld until symptoms have resolved with negative viral test results. The risk of severe treatment-related morbidity and mortality is increased for patients undergoing treatment for LA-NSCLC during the COVID-19 pandemic. Adapting alternative treatment strategies as quickly as possible may save lives and should be implemented through communication with the multidisciplinary cancer team.
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Affiliation(s)
- Sameera Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | - Steven Chmura
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Steven H Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Shirish M Gadgeel
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Josephine Feliciano
- Department of Medical Oncology, Johns Hopkins University, Baltimore, Maryland
| | | | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Martin J Edelman
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Drew Moghanaki
- Department of Radiation Oncology, Emory University, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia
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25
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Milner R, Donington J, Matthews JB, Posner M, Turaga K, Angelos P. Is it ethically appropriate to continue surgical clinical trials during the COVID-19 pandemic? Surgery 2020; 168:1-3. [PMID: 32482342 PMCID: PMC7184004 DOI: 10.1016/j.surg.2020.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Ross Milner
- Department of Surgery, The University of Chicago Medicine, Chicago, IL.
| | - Jessica Donington
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | | | - Mitchell Posner
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - Kiran Turaga
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - Peter Angelos
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
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26
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Donington J. Commentary: Why does neoadjuvant therapy suddenly make sense for early stage non-small cell lung cancer? J Thorac Cardiovasc Surg 2020; 160:1383-1384. [PMID: 32622568 DOI: 10.1016/j.jtcvs.2020.04.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Jessica Donington
- Section of Thoracic Surgery, University of Chicago Medicine and Biologic Sciences, Chicago, Ill.
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27
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Aldaghlawi F, Kurman JS, Lilly JA, Hogarth DK, Donington J, Ferguson MK, Murgu SD. A Systematic Review of Digital vs Analog Drainage for Air Leak After Surgical Resection or Spontaneous Pneumothorax. Chest 2020; 157:1346-1353. [PMID: 31958444 DOI: 10.1016/j.chest.2019.11.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/29/2019] [Revised: 10/27/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The concerns regarding air leak after lung surgery or spontaneous pneumothorax include detection and duration. Prior studies have suggested that digital drainage systems permit shorter chest tube duration and hospital length of stay (LOS) by earlier detection of air leak cessation. We conducted a systematic review to assess the impact of digital drainage on chest tube duration and hospital LOS after pulmonary surgery and spontaneous pneumothorax. METHODS Ovid MEDLINE, PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar were searched from inception through January 2019. We included randomized controlled trials, cohort studies, and case series of adult patients, using digital or traditional drainage devices for air leaks of either postsurgical or spontaneous pneumothorax origin. RESULTS Of 1,272 references reviewed, 23 articles were included. Nineteen articles addressed postoperative air leak, and four articles pertained to air leak after spontaneous pneumothorax. Thirteen studies were randomized controlled trials. Digital drainage resulted in significantly shorter chest tube duration in eight of 18 studies and shorter hospital LOS in six of 14 studies for postoperative air leak. For postpneumothorax air leak, digital drainage resulted in significantly shorter chest tube duration in two of three studies and hospital LOS in one of two studies with an analog control group. CONCLUSIONS Most studies show no significant differences in chest tube duration and hospital LOS with digital vs analog drainage systems for patients with air leak after pulmonary resection. For post-spontaneous pneumothorax air leak, the limited published evidence suggests shorter chest tube duration and hospital LOS with digital drainage systems.
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Affiliation(s)
- Fadi Aldaghlawi
- Department of Medicine, Indiana University Goshen Health, Goshen, IN
| | - Jonathan S Kurman
- Division of Pulmonary and Critical Care, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jason A Lilly
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - D Kyle Hogarth
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL
| | - Jessica Donington
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Mark K Ferguson
- Section of Thoracic Surgery, Department of Surgery, University of Chicago, Chicago, IL
| | - Septimiu D Murgu
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
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28
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Ceppa DP, Dolejs SC, Boden N, Phelan S, Yost KJ, Edwards M, Donington J, Naunheim KS, Blackmon S. Gender Bias and Its Negative Impact on Cardiothoracic Surgery. Ann Thorac Surg 2020; 109:14-17. [DOI: 10.1016/j.athoracsur.2019.06.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
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29
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Donington J. IBS25.02 Western Perspective. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.250] [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: 11/17/2022]
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30
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Osarogiagbon RU, Veronesi G, Fang W, Ekman S, Suda K, Aerts JG, Donington J. Early-Stage NSCLC: Advances in Thoracic Oncology 2018. J Thorac Oncol 2019; 14:968-978. [PMID: 30851441 PMCID: PMC6534444 DOI: 10.1016/j.jtho.2019.02.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/22/2019] [Accepted: 02/24/2019] [Indexed: 12/21/2022]
Abstract
2018 was a banner year for all thoracic oncology, but especially for early-stage NSCLC. Three seminal events occurred in the approximately 18 months from mid-2017 to the end of 2018: in June 2017 at the American Society of Clinical Oncology Annual Meeting a small, relatively unheralded study from Max Diehn's group at Stanford University reported on the use of a novel "cancer personalized profiling by deep sequencing" circulating tumor-DNA technology to identify minimal residual disease in patients after curative-intent radiation or surgery for NSCLC; in April 2018 at the American Association for Cancer Research Annual Meeting, Drew Pardoll presented a small pilot study of 21 patients who had received two doses of preoperative nivolumab; in September 2018, at the 19th World Conference on Lung Cancer, Harry J. De Koning presented the long-awaited results of the Dutch-Belgian Lung Cancer Screening Trial (NELSON). These three seminal studies, along with others which are reviewed in this paper, promise to accelerate our progress towards a world in which lung cancer is identified early, more patients undergo curative-intent treatment that achieves the promised cure, and those at risk for failure after treatment are identified early, when the cancer remains most vulnerable. The day is around the corner when lung cancer is defanged and no longer the worldwide terror it currently is. We herein present an overview of the most recent body of work that moves us inexorably towards that day.
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Affiliation(s)
| | - Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, China
| | - Simon Ekman
- Thoracic Oncology Center, Karolinska University Hospital/Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Kenichi Suda
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Joachim G Aerts
- Thoracic Oncology Department, Erasumus University Medical Center, Rotterdam, Netherlands
| | - Jessica Donington
- Section of Thoracic Surgery, University of Chicago, Chicago, Illinois
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31
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Sulaiman I, Wu BG, Li Y, Scott AS, Malecha P, Scaglione B, Wang J, Basavaraj A, Chung S, Bantis K, Carpenito J, Clemente JC, Shen N, Bessich J, Rafeq S, Michaud G, Donington J, Naidoo C, Theron G, Schattner G, Garofano S, Condos R, Kamelhar D, Addrizzo-Harris D, Segal LN. Evaluation of the airway microbiome in nontuberculous mycobacteria disease. Eur Respir J 2018; 52:13993003.00810-2018. [PMID: 30093571 DOI: 10.1183/13993003.00810-2018] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/29/2018] [Indexed: 01/15/2023]
Abstract
Aspiration is associated with nontuberculous mycobacterial (NTM) pulmonary disease and airway dysbiosis is associated with increased inflammation. We examined whether NTM disease was associated with a distinct airway microbiota and immune profile.297 oral wash and induced sputum samples were collected from 106 participants with respiratory symptoms and imaging abnormalities compatible with NTM. Lower airway samples were obtained in 20 participants undergoing bronchoscopy. 16S rRNA gene and nested mycobacteriome sequencing approaches characterised microbiota composition. In addition, inflammatory profiles of lower airway samples were examined.The prevalence of NTM+ cultures was 58%. Few changes were noted in microbiota characteristics or composition in oral wash and sputum samples among groups. Among NTM+ samples, 27% of the lower airway samples were enriched with Mycobacterium A mycobacteriome approach identified Mycobacterium in a greater percentage of samples, including some nonpathogenic strains. In NTM+ lower airway samples, taxa identified as oral commensals were associated with increased inflammatory biomarkers.The 16S rRNA gene sequencing approach is not sensitive in identifying NTM among airway samples that are culture-positive. However, associations between lower airway inflammation and microbiota signatures suggest a potential role for these microbes in the inflammatory process in NTM disease.
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Affiliation(s)
- Imran Sulaiman
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Benjamin G Wu
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Yonghua Li
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Adrienne S Scott
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Patrick Malecha
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Benjamin Scaglione
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Jing Wang
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Ashwin Basavaraj
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Samuel Chung
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Katrina Bantis
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Joseph Carpenito
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Jose C Clemente
- Dept of Genetics and Genomic Sciences and Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nan Shen
- Dept of Genetics and Genomic Sciences and Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamie Bessich
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Samaan Rafeq
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Gaetene Michaud
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Jessica Donington
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Charissa Naidoo
- Medicine and Health Sciences, Stellenbosch University, DST/NRF of Excellence for Biomedical Tuberculosis Research and SA MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics Tygerberg, Cape Town, South Africa
| | - Grant Theron
- Medicine and Health Sciences, Stellenbosch University, DST/NRF of Excellence for Biomedical Tuberculosis Research and SA MRC Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics Tygerberg, Cape Town, South Africa
| | - Gail Schattner
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Suzette Garofano
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Rany Condos
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - David Kamelhar
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Doreen Addrizzo-Harris
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Leopoldo N Segal
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA.,Dept of Medicine, New York University School of Medicine, New York, NY, USA
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Donington J. ES06.04 Surgical Considerations in OMD. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.038] [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: 10/28/2022]
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Kalemkerian GP, Narula N, Kennedy EB, Biermann WA, Donington J, Leighl NB, Lew M, Pantelas J, Ramalingam SS, Reck M, Saqi A, Simoff M, Singh N, Sundaram B. Molecular Testing Guideline for the Selection of Patients With Lung Cancer for Treatment With Targeted Tyrosine Kinase Inhibitors: American Society of Clinical Oncology Endorsement of the College of American Pathologists/International Association for the Study of Lung Cancer/Association for Molecular Pathology Clinical Practice Guideline Update. J Clin Oncol 2018; 36:911-919. [PMID: 29401004 DOI: 10.1200/jco.2017.76.7293] [Citation(s) in RCA: 326] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose In response to advances in the field, the College of American Pathologists (CAP), the International Association for the Study of Lung Cancer (IASLC), and the Association for Molecular Pathology (AMP) recently updated their recommendations for molecular testing for the selection of patients with lung cancer for treatment with targeted tyrosine kinase inhibitors. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. Methods The molecular testing guideline was reviewed for developmental rigor by methodologists. Then an ASCO Expert Panel reviewed the content and the recommendations. Results The ASCO Expert Panel determined that the recommendations from the CAP/IASLC/AMP molecular testing guideline are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the guideline with minor modifications. Recommendations This update clarifies that any sample with adequate cellularity and preservation may be tested and that analytical methods must be able to detect mutation in a sample with as little as 20% cancer cells. It strongly recommends against evaluating epidermal growth factor receptor (EGFR) expression by immunohistochemistry for selection of patients for EGFR-targeted therapy. New for 2018 are recommendations for stand-alone ROS1 testing with additional confirmation testing in all patients with advanced lung adenocarcinoma, and RET, ERBB2 (HER2), KRAS, and MET testing as part of larger panels. ASCO also recommends stand-alone BRAF testing in patients with advanced lung adenocarcinoma. Recommendations are also provided for testing methods for lung cancers that have a nonadenocarcinoma non-small-cell component, for patients with targetable mutations who have relapsed on targeted therapy, and for testing the presence of circulating cell-free DNA. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Gregory P Kalemkerian
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Narula
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Erin B Kennedy
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - William A Biermann
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jessica Donington
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Natasha B Leighl
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madelyn Lew
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - James Pantelas
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suresh S Ramalingam
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Martin Reck
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Saqi
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Michael Simoff
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Baskaran Sundaram
- Gregory P. Kalemkerian and Madelyn Lew, University of Michigan, Ann Arbor; James Pantelas, Greater Detroit Area; Michael Simoff, Henry Ford Hospital, Detroit, MI; Navneet Narula, Weill Cornell Medical College; Jessica Donington, New York University School of Medicine: Anjali Saqi, Columbia University Medical Center, New York, NY; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; William A. Biermann, Chestnut Hill Hospital and Mercy Suburban Hospital, East Norriton; Baskaran Sundaram, Thomas Jefferson Medical School, Philadelphia, PA; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, ON, Canada; Suresh S. Ramalingam, Winship Cancer Institute of Emory University, Atlanta, GA; Martin Reck, Lung Clinic Grosshansdorf, Grosshansdorf, Germany; and Navneet Singh, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Moghanaki D, Simone CB, Rimner A, Karas TZ, Donington J, Shirvani SM, Daly M, Videtic GM, Movsas B. The value of collaboration between thoracic surgeons and radiation oncologists while awaiting evidence in operable stage i non-small cell lung cancer. J Thorac Cardiovasc Surg 2017; 155:429-431. [PMID: 29245205 DOI: 10.1016/j.jtcvs.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/20/2017] [Accepted: 09/02/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Drew Moghanaki
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, Va
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland, Baltimore, Md
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tomer Z Karas
- Department of Cardiothoracic Surgery, Miami VA Healthcare System, Miami, Fla
| | - Jessica Donington
- Department of Cardiothoracic Surgery, New York University, New York, NY
| | - Shervin M Shirvani
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Phoenix, Ariz
| | - Megan Daly
- Department of Radiation Oncology, University of California, Davis, Sacramento, Calif
| | | | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Mich
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Donington J. MS 23.02 When Do Surgeons Quit Resection During Surgery? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.274] [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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Soo RA, Stone ECA, Cummings KM, Jett JR, Field JK, Groen HJM, Mulshine JL, Yatabe Y, Bubendorf L, Dacic S, Rami-Porta R, Detterbeck FC, Lim E, Asamura H, Donington J, Wakelee HA, Wu YL, Higgins K, Senan S, Solomon B, Kim DW, Johnson M, Yang JCH, Sequist LV, Shaw AT, Ahn MJ, Costa DB, Patel JD, Horn L, Gettinger S, Peters S, Wynes MW, Faivre-Finn C, Rudin CM, Tsao A, Baas P, Kelly RJ, Leighl NB, Scagliotti GV, Gandara DR, Hirsch FR, Spigel DR. Scientific Advances in Thoracic Oncology 2016. J Thorac Oncol 2017; 12:1183-1209. [PMID: 28579481 DOI: 10.1016/j.jtho.2017.05.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 12/21/2022]
Abstract
Lung cancer care is rapidly changing with advances in genomic testing, the development of next-generation targeted kinase inhibitors, and the continued broad study of immunotherapy in new settings and potential combinations. The International Association for the Study of Lung Cancer and the Journal of Thoracic Oncology publish this annual update to help readers keep pace with these important developments. Experts in thoracic cancer and care provide focused updates across multiple areas, including prevention and early detection, molecular diagnostics, pathology and staging, surgery, adjuvant therapy, radiotherapy, molecular targeted therapy, and immunotherapy for NSCLC, SCLC, and mesothelioma. Quality and value of care and perspectives on the future of lung cancer research and treatment have also been included in this concise review.
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Affiliation(s)
- Ross A Soo
- Cancer Science Institute of Singapore, National University of Singapore, Singapore; Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore; School of Surgery, University of Western Australia, Perth, Australia
| | - Emily C A Stone
- Department of Thoracic Medicine, St. Vincent's Hospital, Kinghorn Cancer Centre, Sydney, Australia
| | - K Michael Cummings
- Hollings Cancer Center Medical University of South Carolina, Charleston, South Carolina
| | | | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, United Kingdom
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - James L Mulshine
- Internal Medicine, Graduate College, Rush University Medical Center, Chicago, Illinois
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Sanja Dacic
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ramon Rami-Porta
- Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Network of Biomedical Research Centers in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain
| | | | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Hisao Asamura
- Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Jessica Donington
- Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - Heather A Wakelee
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Kristin Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | - James C H Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Republic of China
| | - Lecia V Sequist
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alice T Shaw
- Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Myung-Ju Ahn
- Section of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Daniel B Costa
- Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jyoti D Patel
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Leora Horn
- Division of Hematology/Oncology, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Scott Gettinger
- Medical Oncology, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Solange Peters
- Medical Oncology and Thoracic Malignancies, Oncology Department, University Hospital Center Vaudois, Lausanne, Switzerland
| | - Murry W Wynes
- International Association for the Study of Lung Cancer, Aurora, Colorado
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Charles M Rudin
- Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne Tsao
- Mesothelioma Program, Thoracic Chemo-Radiation Program, Department of Thoracic/Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Paul Baas
- Department of Chest Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ronan J Kelly
- Deptartment of Medical Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Natasha B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | | | - David R Gandara
- Thoracic Oncology Program, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Fred R Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
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Videtic GMM, Donington J, Giuliani M, Heinzerling J, Karas TZ, Kelsey CR, Lally BE, Latzka K, Lo SS, Moghanaki D, Movsas B, Rimner A, Roach M, Rodrigues G, Shirvani SM, Simone CB, Timmerman R, Daly ME. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol 2017; 7:295-301. [PMID: 28596092 DOI: 10.1016/j.prro.2017.04.014] [Citation(s) in RCA: 288] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/17/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE This guideline presents evidence-based recommendations for stereotactic body radiation therapy (SBRT) in challenging clinical scenarios in early-stage non-small cell lung cancer (NSCLC). METHODS AND MATERIALS The American Society for Radiation Oncology convened a task force to perform a systematic literature review on 4 key questions addressing: (1) application of SBRT to operable patients; (2) appropriate use of SBRT in tumors that are centrally located, large, multifocal, or unbiopsied; (3) individual tailoring of SBRT in "high-risk" clinical scenarios; and (4) SBRT as salvage therapy after recurrence. Guideline recommendations were created using a predefined consensus-building methodology supported by American Society for Radiation Oncology-approved tools for grading evidence quality and recommendation strength. RESULTS Although few randomized trials have been completed for SBRT, strong consensus recommendations based on extensive, consistent publications were generated for several questions, including recommendations for fractionation for central tumors and surgery versus SBRT in standard-risk medically operable patients with early-stage NSCLC. Lower quality evidence led to conditional recommendations on use of SBRT for tumors >5 cm, patients with prior pneumonectomy, T3 tumors with chest wall invasion, synchronous multiple primary lung cancer, and as a salvage therapy after prior radiation therapy. These areas of moderate- and low-quality evidence highlight the importance of clinical trial enrollment as well as the role of prospective data registries. CONCLUSIONS SBRT has an important role to play in treating early-stage NSCLC, particularly for medically inoperable patients with limited other treatment options. Shared decision-making with patients should be performed in all cases to ensure the patient understands the risks related to SBRT, the side effects, and the alternative treatments available.
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Affiliation(s)
| | - Jessica Donington
- Department of Cardiothoracic Surgery, New York University, New York, New York
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John Heinzerling
- Department of Radiation Oncology, Southeast Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina
| | - Tomer Z Karas
- Department of Cardiothoracic Surgery, Miami VA Healthcare System, Miami, Florida
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Brian E Lally
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Drew Moghanaki
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Roach
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Shervin M Shirvani
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Phoenix, Arizona
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Megan E Daly
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
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Edelman MJ, Hu C, Le QT, Donington J, D'Souza WD, Dicker A, Loo BW, Gore E, Videtic GM, Evans NR, Leach J, Diehn M, Feigenberg SJ, Chen Y, Bradley JD. Randomized phase II study of preoperative chemoradiotherapy (CRT)+/- Panitumumab (P) followed by consolidation chemotherapy (C) in potentially operable locally advanced (stage IIIa, N2+) non-small cell lung cancer (LANSCLC): Nrg oncology/RTOG 0839. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA
| | - Quynh-Thu Le
- Stanford University Medical Center, Stanford, CA
| | | | | | - Adam Dicker
- Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | - Joseph Leach
- Virginia Piper Cancer Institute, Minneapolis, MN
| | | | | | - Yuhchyau Chen
- University of Rochester Medical Center, Rochester, NY
| | - Jeffrey D Bradley
- Washington University School of Medicine in St. Louis, St. Louis, MO
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Pass HI, Goparaju C, Espin-Garcia O, Donington J, Carbone M, Patel D, Chen Z, Feld R, Cho J, Gadgeel S, Wozniak A, Chachoua A, Leighl N, Tsao MS, de Perrot M, Xu W, Liu G. Plasma Biomarker Enrichment of Clinical Prognostic Indices in Malignant Pleural Mesothelioma. J Thorac Oncol 2016; 11:900-9. [PMID: 26903362 DOI: 10.1016/j.jtho.2016.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 12/20/2015] [Revised: 01/23/2016] [Accepted: 02/12/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Prognostic models for malignant pleural mesothelioma (MPM) are needed to prevent potentially futile outcomes. We combined MPM plasma biomarkers with validated clinical prognostic indices to determine whether stratification of risk for death in 194 patients with MPM improved. METHODS Individuals were recruited from three different centers: a discovery cohort (83 patients with MPM) created by combining patients from two U.S. centers and a separate, independent cohort from Canada (111 patients with MPM). Univariable and multivariable analyses were performed on the initial discovery and independent cohorts separately. In the multivariable analyses, prognostic factors were adjusted for the European Organisation for Research and Treatment of Cancer (EORTC) prognostic index (PI) of mesothelioma. The prognostic significance of adding plasma biomarker data to the PI was determined by using the likelihood ratio test, comparing models with and without the addition of biomarker to the clinical PI. The predictive ability of the biomarker was then assessed formally using Harrell's C-index by applying the fitted model variables of the discovery cohort to the second, independent cohort, including and not including the biomarker with the PI. RESULTS Higher levels of osteopontin and mesothelin were individually associated with worse prognosis after adjusting for the PI. In the independent cohort, incorporating either plasma osteopontin or mesothelin into the baseline predictive PI model substantively and statistically significantly improved Harrell's C-statistic. In the final prognostic model, log-osteopontin, EORTC clinical prognostic index, and hemoglobin remained as independently significant predictors and the entire prognostic model improved the optimism-corrected Harrell's C-index significantly, from 0.718 (0.67-0.77) to 0.801 (0.77-0.84). CONCLUSIONS These data suggest a possible role for preoperative plasma biomarkers to improve the prognostic capability of the EORTC PI of MPM.
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Affiliation(s)
- Harvey I Pass
- Langone Medical Center, New York University, New York, New York.
| | | | - Osvaldo Espin-Garcia
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | | | | | - Devalben Patel
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Zhuo Chen
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Ronald Feld
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - John Cho
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Shirish Gadgeel
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | | | - Natasha Leighl
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Ontario Cancer Institute, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Luo Y, Pass HI, Donington J, Goparaju C, Canino C, Cioce M. Increasing ER stress response in pemetrexed-resistant mesothelioma cells. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yuying Luo
- New York University Langone Medical Center, New York, NY
| | | | | | | | - Claudia Canino
- New York University Langone Medical Center, New York, NY
| | - Mario Cioce
- New York University Langone Medical Center, New York, NY
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Joseph S, Harrington R, Walter D, Goldberg JD, Li X, Beck A, Litton T, Hirsch N, Blasberg J, Slomiany M, Rom W, Pass H, Donington J. Plasma osteopontin velocity differentiates lung cancers from controls in a CT screening population. Cancer Biomark 2013; 12:177-84. [PMID: 23568008 DOI: 10.3233/cbm-130306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION As CT screening is integrated into non-small cell lung cancer (NSCLC) care, additional parameters are needed to help distinguish cancers from benign nodules. Osteopontin (OPN), a secreted phosphoprotein, has elevated plasma levels in NSCLC. We hypothesize that changes in plasma OPN over time (i.e., OPN velocity [OPNV]) can differentiate NSCLC patients from those without cancer in a CT screening population. METHODS A nested case-control study was conducted within a NSCLC CT screening trial. Incident cancers with serial plasma were matched to controls. OPN was measured by ELISA. Demographic, OPN, and OPNV were compared between cancers and controls using Wilcoxon Signed Rank tests. RESULTS Ten incident cancers were identified. The pack years distributions were similar, but cancers were older (median of the paired difference: 5.35 years; p=0.002) and their surveillance intervals were shorter (median of the paired difference: -2 months; p=0. 03) than matched controls. Baseline OPN was similar (median of the paired difference: -5.15 ng/ml, p=0.50), but OPNV in the cancers was significantly greater than that of matched controls, (median of the paired difference: 1.06 ng/ml/month, p=0.01). Accuracy rate for prediction of disease status based on OPNV (adjusted for age and surveillance) was 83%. CONCLUSIONS These are early evidence for utility of monitoring plasma OPN during CT screening to assist in identification of NSCLCs.
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Affiliation(s)
- Sasha Joseph
- Thoracic Oncology Laboratory, Department of Cardiothoracic Surgery, NYU School of Medicine, New York, NY 10016, USA
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Donington J, Vaillères E, Bains M, Swisher S, Pass H. Management of the Apical Tumor: May 4, 2013, Minneapolis, MN. Semin Thorac Cardiovasc Surg 2013; 25:256-71. [DOI: 10.1053/j.semtcvs.2013.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e93S-e120S. [PMID: 23649456 PMCID: PMC3749714 DOI: 10.1378/chest.12-2351] [Citation(s) in RCA: 865] [Impact Index Per Article: 78.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/30/2012] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. METHODS We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. RESULTS We formulated recommendations for evaluating solid pulmonary nodules that measure > 8 mm in diameter, solid nodules that measure ≤ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefits and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. CONCLUSIONS Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management.
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Affiliation(s)
- Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | | | - William R Lynch
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI
| | | | | | | | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA; Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA
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Donington J, Ferguson M, Mazzone P, Handy J, Schuchert M, Fernando H, Loo B, Lanuti M, de Hoyos A, Detterbeck F, Pennathur A, Howington J, Landreneau R, Silvestri G. American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest 2013. [PMID: 23208335 DOI: 10.1378/chest.12-0790] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The standard treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I NSCLC are not candidates for lobectomy because of severe medical comorbidity. METHODS A panel of experts was convened through the Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons. Following a literature review, the panel developed 13 suggestions for evaluation and treatment through iterative discussion and debate until unanimous agreement was achieved. RESULTS Pretreatment evaluation should focus primarily on measures of cardiopulmonary physiology, as respiratory failure represents the greatest interventional risk. Alternative treatment options to lobectomy for high-risk patients include sublobar resection with or without brachytherapy, stereotactic body radiation therapy, and radiofrequency ablation. Each is associated with decreased procedural morbidity and mortality but increased risk for involved lobe and regional recurrence compared with lobectomy, but direct comparisons between modalities are lacking. CONCLUSIONS Therapeutic options for the treatment of high-risk patients are evolving quickly. Improved radiographic staging and the diagnosis of smaller and more indolent tumors push the risk-benefit decision toward parenchymal-sparing or nonoperative therapies in high-risk patients. Unbiased assessment of treatment options requires uniform reporting of treatment populations and outcomes in clinical series, which has been lacking to date.
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Affiliation(s)
- Jessica Donington
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, NY.
| | - Mark Ferguson
- Department of Surgery, University of Chicago, Chicago, IL
| | - Peter Mazzone
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Hiran Fernando
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
| | - Billy Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Alberto de Hoyos
- Department of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, IL
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John Howington
- Department of Surgery, Northshore University Health System, Evanston, IL
| | - Rodney Landreneau
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gerard Silvestri
- Division of Pulmonary Medicine and Critical Care, Medical University of South Carolina, Charleston, SC
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Donington J. Invited commentary. Ann Thorac Surg 2013; 95:418-9. [PMID: 23336861 DOI: 10.1016/j.athoracsur.2012.08.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 08/21/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Jessica Donington
- Department of Cardiothoracic Surgery, NYU Langone Medical Center, 530 1st Ave, Ste 9V, New York, NY 10016, USA.
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Pass HI, Levin SM, Harbut MR, Melamed J, Chiriboga L, Donington J, Huflejt M, Carbone M, Chia D, Goodglick L, Goodman GE, Thornquist MD, Liu G, de Perrot M, Tsao MS, Goparaju C. Fibulin-3 as a blood and effusion biomarker for pleural mesothelioma. N Engl J Med 2012; 367:1417-27. [PMID: 23050525 PMCID: PMC3761217 DOI: 10.1056/nejmoa1115050] [Citation(s) in RCA: 197] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND New biomarkers are needed to detect pleural mesothelioma at an earlier stage and to individualize treatment strategies. We investigated whether fibulin-3 in plasma and pleural effusions could meet sensitivity and specificity criteria for a robust biomarker. METHODS We measured fibulin-3 levels in plasma (from 92 patients with mesothelioma, 136 asbestos-exposed persons without cancer, 93 patients with effusions not due to mesothelioma, and 43 healthy controls), effusions (from 74 patients with mesothelioma, 39 with benign effusions, and 54 with malignant effusions not due to mesothelioma), or both. A blinded validation was subsequently performed. Tumor tissue was examined for fibulin-3 by immunohistochemical analysis, and levels of fibulin-3 in plasma and effusions were measured with an enzyme-linked immunosorbent assay. RESULTS Plasma fibulin-3 levels did not vary according to age, sex, duration of asbestos exposure, or degree of radiographic changes and were significantly higher in patients with pleural mesothelioma (105±7 ng per milliliter in the Detroit cohort and 113±8 ng per milliliter in the New York cohort) than in asbestos-exposed persons without mesothelioma (14±1 ng per milliliter and 24±1 ng per milliliter, respectively; P<0.001). Effusion fibulin-3 levels were significantly higher in patients with pleural mesothelioma (694±37 ng per milliliter in the Detroit cohort and 636±92 ng per milliliter in the New York cohort) than in patients with effusions not due to mesothelioma (212±25 and 151±23 ng per milliliter, respectively; P<0.001). Fibulin-3 preferentially stained tumor cells in 26 of 26 samples. In an overall comparison of patients with and those without mesothelioma, the receiver-operating-characteristic curve for plasma fibulin-3 levels had a sensitivity of 96.7% and a specificity of 95.5% at a cutoff value of 52.8 ng of fibulin-3 per milliliter. In a comparison of patients with early-stage mesothelioma with asbestos-exposed persons, the sensitivity was 100% and the specificity was 94.1% at a cutoff value of 46.0 ng of fibulin-3 per milliliter. Blinded validation revealed an area under the curve of 0.87 for plasma specimens from 96 asbestos-exposed persons as compared with 48 patients with mesothelioma. CONCLUSIONS Plasma fibulin-3 levels can distinguish healthy persons with exposure to asbestos from patients with mesothelioma. In conjunction with effusion fibulin-3 levels, plasma fibulin-3 levels can further differentiate mesothelioma effusions from other malignant and benign effusions. (Funded by the Early Detection Research Network, National Institutes of Health, and others.).
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Affiliation(s)
- Harvey I Pass
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
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Chajut A, Pass H, Goparaju C, Cohen D, Dan H, Ivanov S, Gibori H, Rosenwald S, Donington J, Dromi N, Hoshen M. Abstract 4053: One MicroRNA Has Prognostic Potential For Malignant Pleural Mesothelioma. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-4053] [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
Introduction: The current inability to forecast outcomes for malignant pleural mesothelioma prevents clinicians from providing aggressive multimodality therapy to the most appropriate individuals who may benefit from such an approach, and hence compromises their prognosis. It was previously shown that microRNAs (miRs) have a role in the cancer process, and that they can serve as biomarkers for different tumors or histological types. Here we investigated whether specific miRs could differentiate a largely surgically-treated group of mesotheliomas into good or bad prognosis categories.
Methods: In a retrospective study using snap frozen, immunohistochemically-proven mesothelioma surgical specimens, we looked for miRs associated with survival and time to progression. A training set of 44 and a test set of 98 mesothelioma tumor samples were analyzed by a custom ∼900 microRNA microarray platform and verified by qRT-PCR for cross-platform validation. Patients were segregated into good or bad time to progression (greater/less than 12 months) and into good or bad survival (greater/less than 15 months). Mann-Whitney tests for good vs. bad prognosis and Kaplan-Meier analysis were used to detect prognosticator miRs. The biological effect of the identified prognostic miR was tested in 2 mesothelioma cell lines. Functional implications as well as downstream targets of the potential prognostic miR were investigated in vitro.
Results: In both the training and test sets, one miR was an independent prognostic factor for time to progression as well as survival after surgical cytoreduction. The miR was expressed at higher levels in epithelial mesothelioma than in sarcomatoid cases, and the level of this miR could segregate patients with this histology into groups with differing prognosis. Thresholds set within the training set for microarray reading were fully valid in the test-set, as was the comparable threshold using qRT-PCR. Increased expression of this specific miR predicted throughout a more favorable prognosis, and overexpression of the miR in mesothelioma cell lines resulted in significantly decreased proliferation, migration, invasion, and colony formation. Moreover, major epigenetic regulatory genes, known in mesothelioma, are mediated by this miR as was demonstrated through downregulation of DNA methyltransferases as well as upregulation of demethylating genes. This suggests that a control mechanism might explain the clinical findings, supporting their validity.
Conclusions: One miR has the potential to be a prognostic biomarker in mesothelioma and shows the ability to change proliferation, migration, invasion upon over-expression in mesothelioma cell lines. Further validation of these findings as well as investigation of its downstream targets may give insight for potential therapies in the future, by allowing personalized treatment for patients who are more to benefit.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4053.
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Affiliation(s)
| | - Harvey Pass
- 2Thoracic Surgery, NYU Langone Medical Center, NY, NY
| | | | | | | | - Sergey Ivanov
- 2Thoracic Surgery, NYU Langone Medical Center, NY, NY
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Pass HI, Goparaju C, Ivanov S, Donington J, Carbone M, Hoshen M, Cohen D, Chajut A, Rosenwald S, Dan H, Benjamin S, Aharonov R. hsa-miR-29c* is linked to the prognosis of malignant pleural mesothelioma. Cancer Res 2010; 70:1916-24. [PMID: 20160038 DOI: 10.1158/0008-5472.can-09-3993] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The inability to forecast outcomes for malignant mesothelioma prevents clinicians from providing aggressive multimodality therapy to the most appropriate individuals who may benefit from such an approach. We investigated whether specific microRNAs (miR) could segregate a largely surgically treated group of mesotheliomas into good or bad prognosis categories. A training set of 44 and a test set of 98 mesothelioma tumors were analyzed by a custom miR platform, along with 9 mesothelioma cell lines and 3 normal mesothelial lines. Functional implications as well as downstream targets of potential prognostic miRs were investigated. In both the training and test sets, hsa-miR-29c* was an independent prognostic factor for time to progression as well as survival after surgical cytoreduction. The miR was expressed at higher levels in epithelial mesothelioma, and the level of this miR could segregate patients with this histology into groups with differing prognosis. Increased expression of hsa-miR-29c* predicted a more favorable prognosis, and overexpression of the miR in mesothelioma cell lines resulted in significantly decreased proliferation, migration, invasion, and colony formation. Moreover, major epigenetic regulation of mesothelioma is mediated by hsa-miR-29c* and was shown through downregulation of DNA methyltransferases as well as upregulation of demethylating genes. A single miR has the potential to be a prognostic biomarker in mesothelioma, and validation of these findings as well as investigation of its downstream targets may give insight for potential therapies in the future.
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Affiliation(s)
- Harvey I Pass
- Thoracic Surgery, NYU Langone Medical Center, New York, New York 10016, USA.
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Donington J. Invited commentary. Ann Thorac Surg 2009; 87:1702. [PMID: 19463581 DOI: 10.1016/j.athoracsur.2009.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 04/09/2009] [Accepted: 04/14/2009] [Indexed: 11/15/2022]
Affiliation(s)
- Jessica Donington
- New York University Medical Center, 530 1st Ave, Suite 9V, New York, NY 10016, USA.
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Abstract
Two cases of complications secondary to the use of microwave ablation (MWA) in non-small-cell lung cancer (NSCLC) are discussed herein. The first case involves a 62-year-old man with stage IB NSCLC who declined surgery and pursued MWA. Within 7 months, he had residual disease at the MWA treatment site, and surgery was performed. The patient was found to have pleural and chest wall involvement, making complete resection impossible. The second case involves an 86-year-old woman with a second local recurrence of NSCLC and previous treatment including surgery and chemoradiation therapy. She was initially a surgical candidate but declined surgery and pursued MWA. Within 6 months, she had residual disease at the MWA treatment site. A second MWA was performed, and she developed a large cavitary abscess at the MWA site and had subsequent clinical decline. Less invasive ablation therapies and stereotactic radiosurgery are being developed for patients with inoperable lung cancer. Because these modalities have recently been developed, trials that clearly show efficacy and survival benefit are yet to be completed. Ablation procedures can result in complications, including residual disease and cavitary lesions susceptible to infection. These cases highlight the caution that should still be observed when recommending lung ablation strategies and the importance of selecting appropriate patients.
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Affiliation(s)
- Sukhmani Padda
- Department of Medicine, Stanford University, Stanford, CA, USA
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