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Sung MR, Tomasini P, Le LW, Kamel-Reid S, Tsao MS, Liu G, Bradbury PA, Shepherd FA, Li JJ, Feld R, Leighl NB. Effects of Ethnicity on Outcomes of Patients With EGFR Mutation–Positive NSCLC Treated With EGFR Tyrosine Kinase Inhibitors and Surgical Resection. JTO Clin Res Rep 2022; 3:100259. [PMID: 35112092 PMCID: PMC8790496 DOI: 10.1016/j.jtocrr.2021.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 12/09/2022] Open
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Schmid S, Zhan L, Dietrich K, Khan K, Chowdhury M, Herman M, Patel D, Zaeimi F, Leighl NB, Sacher A, Feld R, Shepherd FA, Donahoe L, de Perrot M, Cho BCJ, Liu G, Bradbury PA. Treatment Patterns and Outcomes of Patients With Advanced Pleural Mesothelioma at an Academic Referral Centre. Clin Lung Cancer 2021; 23:e43-e53. [PMID: 34531139 DOI: 10.1016/j.cllc.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/21/2021] [Accepted: 08/05/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Overall survival (OS) for malignant pleural mesothelioma (MPM) in vulnerable subgroups remains poorly understood with scarce data available to guide treatment decisions. The study describes real-world detailed treatment patterns and outcomes of patients with advanced MPM overall and specifically in elderly and poor performance status (PS) patients. METHODS Retrospective chart review was performed for all patients with histologically confirmed MPM seen at University Health Network/Princess Margaret Cancer Centre (UHN-PM). RESULTS A total of 667 patients with MPM were identified and 304 advanced-disease MPM (aMPM) patients had continuing care at UHN-PM (UP-cohort). In the UP-cohort, 77% of patients received ≥ one line of systemic treatment. Systemic therapy trial participation was 39%. Patients not treated with systemic therapy (29%) were more likely to be ≥ 75 years and PS ≥ 2. Median OS was 15.3 months (95%CI 13.6-18.3), with longer survival in treated vs. untreated patients (17.4 vs. 10.6 months; P = .01). Longer survival with systemic treatment was seen in patients ≥75 years (12.7 vs. 6.6 months) and patients with poor PS (9.1 vs. 5.9 months). Median progression-free-survival (PFS) and OS for patients treated with second-line therapy was poor (3.0 and 8.9 months, respectively). DISCUSSION In our real-world analysis of patients with aMPM treated at an academic referral centre, systemic treatment was given to the majority of patients and benefit was seen even in the elderly and poor PS patients frequently underrepresented in clinical trials. Trial participation was potentially facilitated by the formation of a dedicated multidisciplinary MPM clinic.
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Affiliation(s)
- Sabine Schmid
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medical Oncology and Haematology, Cantonal Hospital St.Gallen, Rorschacherstrasse 95, 9007 St.Gallen, Switzerland.
| | - Luna Zhan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Kristen Dietrich
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Khaleeq Khan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Maisha Chowdhury
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Michael Herman
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Oakville Trafalgar Memorial Hospital, Oakville, Canada
| | - Devalben Patel
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Fatemeh Zaeimi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Adrian Sacher
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Ronald Feld
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Laura Donahoe
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Marc de Perrot
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Penelope A Bradbury
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Young K, Jiang H, Marquez M, Yeung J, Shepherd FA, Renner E, Keshavjee S, Kim J, Ross H, Aliev T, Liu G, Leighl NB, Feld R, Bradbury P. Retrospective study of the incidence and outcomes from lung cancer in solid organ transplant recipients. Lung Cancer 2020; 147:214-220. [PMID: 32738417 DOI: 10.1016/j.lungcan.2020.07.020] [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: 04/16/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Organ transplant recipients (OTR) have an increased risk of developing post-transplant malignancies with lung cancer being one of the most common. In this retrospective study, we investigated incidence, use of systemic therapy and outcomes from lung cancer in OTR. MATERIALS AND METHODS Patients diagnosed with lung cancer following a solid organ transplant at the University Health Network, Toronto, ON, CA, from January 1, 1980 to June 30, 2016 were included. Data for the study population, patient characteristics, treatments and outcomes were abstracted from solid OTR databases, our cancer registry and patient charts. Univariate Kaplan-Meier curves estimated median overall survival (OS) by histology, stage and systemic therapy. RESULTS Amongst 7944 OTR (heart [N = 765], lung [n = 1668], liver [n = 2238], kidney [n = 3273]), 101 (1.3 %) developed lung cancer which were included in our analyses. Of these, 81 % were non-small cell lung cancer (NSCLC), 11 % small cell lung cancer (SCLC) and 8% neuroendocrine tumor (NET). Median OS (months) was 25 in those that presented with Stage I/II NSCLC (44 %); 25 for Stage III NSCLC (7%); 3 for Stage IV NCLC (31 %); 10 for Limited stage SCLC (6%); 2 for Extensive stage (ES) SCLC (5%). NSCLC patients that received palliative chemotherapy had an OS of 8 months; ES-SCLC patients that received chemotherapy had an OS of 6 months. Of all patients who received platinum doublets (n = 16), 10 (62.5 %) required dose reductions at some point. Five patients experienced febrile neutropenia (31 %); two (12 %) had other toxicities leading to discontinuation. CONCLUSION Patients with stage I/II NSCLC and NET had poorer survival compared to historical norms in non-transplant patients. Patients who had stage III NSCLC or received palliative systemic therapy had survivals at or slightly below historic norms, although numbers were small. Chemotherapy can be administered in selected OTR patients though dose reductions and febrile neutropenia were common.
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Affiliation(s)
- Kelvin Young
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada.
| | - Haiyan Jiang
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Max Marquez
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Jonathan Yeung
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Frances A Shepherd
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Eberhard Renner
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Shaf Keshavjee
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Joseph Kim
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Heather Ross
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Tim Aliev
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Geoffrey Liu
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Natasha B Leighl
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Ronald Feld
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
| | - Penelope Bradbury
- University Health Network, University of Toronto, 610 University Avenue Toronto, M5G2M9, Ontario, Canada
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Soldera SV, Kavanagh J, Pintilie M, Leighl NB, de Perrot M, Cho J, Hope A, Feld R, Bradbury PA. Systemic Therapy Use and Outcomes After Relapse from Preoperative Radiation and Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma. Oncologist 2018; 24:e510-e517. [PMID: 30478189 DOI: 10.1634/theoncologist.2018-0501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/13/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multimodality therapy with preoperative radiation (RT) followed by extrapleural pneumonectomy (EP) for patients with operable malignant pleural mesothelioma (MPM) has demonstrated encouraging results. At relapse, there are few data on the tolerance and efficacy of systemic therapies after prior multimodality therapy. MATERIALS AND METHODS We conducted a retrospective analysis of patients with relapsed MPM after RT and EPP ± adjuvant chemotherapy to determine overall survival (OS; date of relapse to death) and the proportion of patients that received systemic therapy and associated response rate (RR). OS was estimated using Kaplan-Meier method and potential prognostic variables were examined. RESULTS Fifty-three patients were included (2008-2016). Median OS was 4.8 months (median follow-up 4.4 months, range 0.03-34.8). Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2, disease-free interval (DFI) <1 year, and hemoglobin ≤110 g/L at recurrence were associated with worse prognosis. Thirty-six percent of patients received any systemic therapy, whereas it was omitted in 62% because of poor PS. RR was 15% (0 complete responses, 15% partial responses) in 13 individuals with response-evaluable disease. Therapy was discontinued because of toxicity (6/15) or disease progression (5/15), and median number of cycles was four. CONCLUSION Patients with relapsed MPM following RT and EPP, especially those with ECOG PS ≥2, DFI <1 year, and hemoglobin ≤110 g/L at recurrence, have poor prognosis and low RR to first-line systemic therapy. Earlier detection and novel diagnostic markers of relapse as well as potential neoadjuvant or adjuvant systemic therapy should be investigated in future studies. IMPLICATIONS FOR PRACTICE The results of this study have reinforced the importance of careful selection of appropriate candidates for this combined-modality approach and favor prompt detection of recurrence with early and regular postoperative imaging and biopsy of suspected relapsed disease along with rapid initiation of systemic therapy even in patients with very low burden of disease. Furthermore, with the emergence of new systemic agents targeting different histological subtypes of malignant pleural mesothelioma, histological sampling of recurrence could inform therapeutic decisions in the future.
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Affiliation(s)
- Sara V Soldera
- Department of Hematology and Oncology, CISSS Montérégie Centre/Hôpital Charles-Lemoyne, Université Sherbrooke, Quebec, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Kavanagh
- Department of Radiology, University Health Network, University of Toronto, Toronto, Canada
| | - Melania Pintilie
- Biostatistics Division, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Natasha B Leighl
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Marc de Perrot
- Department of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Ronald Feld
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Penelope A Bradbury
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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Jao K, Tomasini P, Kamel-Reid S, Korpanty GJ, Mascaux C, Sakashita S, Labbé C, Leighl NB, Liu G, Feld R, Bradbury PA, Hwang DM, Pintilie M, Tsao MS, Shepherd FA. The prognostic effect of single and multiple cancer-related somatic mutations in resected non-small-cell lung cancer. Lung Cancer 2018; 123:22-29. [PMID: 30089591 DOI: 10.1016/j.lungcan.2018.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Somatic mutations are becoming increasingly important biomarkers for treatment selection and outcome in patients with non-small-cell lung cancer (NSCLC). The role of multiple somatic mutations in early-stage NSCLC is unclear. METHODS Tissue from 214 patients with resected NSCLC at the Princess Margaret Cancer Centre was analyzed by next-generation sequencing by Mi-SEQ or Sequenom multiplex platforms. Associations between mutation status, baseline patient characteristics and outcomes (disease-free survival (DFS) after surgical resection and overall survival (OS)) were investigated. RESULTS Somatic mutations were identified in 184 patients with resected stage I-III NSCLC: None (n = 30), single (n = 101) and multiple (≥2, n = 83). Multiple mutations were significantly associated with younger age (p = 0.0006), female sex (p = 0.012), smoking status (p = 0.002) and adenocarcinoma histology (p = 0.0001).TP53, KRAS and EGFR were the most common mutations. TP53 mutation was the most frequent co-mutation occurring in 72% of patients with multiple mutations. In resected stage I-III patients, multiple mutations were significantly associated with worse DFS (HR = 2.56, p = 0.003) but not OS on univariate analysis. Patients with KRAS and EGFR mutations were also associated with shorter DFS (HR = 2.52, p = 0.016 and HR = 4.37, p = 0.001 respectively) but no OS difference. TP53 mutation was associated with both shorter DFS (HR = 2.21, p = 0.02) and OS (HR = 3.08, p = 0.02). In subgroup univariate analysis, poorer DFS was associated with multiple mutations (p = 0.0015), EGFR (HR = 3.14, p = 0.006), and TP53 (HR = 2.46, p = 0.018) in patients with stage I disease. CONCLUSION The presence of known somatic mutations is associated with worse DFS in resected NSCLC. The differences are both statistically significant and clinically relevant. The presence of EGFR, KRAS and TP53 mutations was also associated with adverse outcomes. Larger datasets are required to validate whether mutational status is an independent prognostic factor in early stage NSCLC.
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Affiliation(s)
- Kevin Jao
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
| | - Pascale Tomasini
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille. Multidisciplinary Oncology and Therapeutic Innovations department, Marseille, 13015, France
| | - Suzanne Kamel-Reid
- Laboratory Genetics, University Health Network, Toronto, Ontario, Canada
| | - Gregorz J Korpanty
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Céline Mascaux
- Aix Marseille University, Assistance Publique Hôpitaux de Marseille. Multidisciplinary Oncology and Therapeutic Innovations department, Marseille, 13015, France
| | - Shingo Sakashita
- Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibraraki, Japan
| | - Catherine Labbé
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Ronald Feld
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Penelope A Bradbury
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - David M Hwang
- Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Melania Pintilie
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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Zer A, Sung MR, Walia P, Khoja L, Maganti M, Labbe C, Shepherd FA, Bradbury PA, Feld R, Liu G, Iazzi M, Zawisza D, Nouriany N, Leighl NB. Correlation of Neutrophil to Lymphocyte Ratio and Absolute Neutrophil Count With Outcomes With PD-1 Axis Inhibitors in Patients With Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018; 19:426-434.e1. [PMID: 29803574 DOI: 10.1016/j.cllc.2018.04.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [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: 10/27/2017] [Revised: 03/14/2018] [Accepted: 04/24/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Programmed death-1 (PD-1) axis inhibitors have become standard therapy in advanced non-small-cell lung cancer (NSCLC). Response might be delayed and pseudo-progression occasionally occurs in patients who eventually benefit from treatment. Additional markers beyond programmed death ligand 1 (PD-L1) expression are needed to assist in patient selection, response evaluation, and treatment decisions. MATERIALS AND METHODS The relationship between prospectively collected clinical outcomes (response, disease control rate [DCR], treatment duration, overall survival) and hematologic parameters (neutrophil to lymphocyte ratio [NLR], absolute neutrophil count [ANC], and platelet to lymphocyte ratio [PLR]) was explored retrospectively in advanced NSCLC patients treated with PD-1 axis inhibitors at a major cancer center from May 2013 to August 2016. Hematologic parameters at baseline and during treatment (week 2 or 3 and week 8) were included. RESULTS Of 88 patients treated with PD-1 axis inhibitors, 22 (25%) experienced partial response. Baseline NLR ≤4 was associated with superior DCR (74% vs. 50%; P = .025), treatment duration (P = .037), time to progression (P = .053), and overall survival (P = .019), with no differential association according to PD-L1 tumor expression. Lower NLR and ANC during treatment were also associated with response to treatment (P = .025 and P = .017, respectively), and treatment duration (P = .036 and P = .008). No association was found between baseline PLR and DCR, response, treatment duration, nor overall survival. CONCLUSION Baseline NLR ≤4 and lower NLR and ANC during treatment might correlate with disease control and treatment response and should be explored further as potential predictors of treatment benefit in larger studies.
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Affiliation(s)
- Alona Zer
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mike R Sung
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Preet Walia
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Leila Khoja
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Manjula Maganti
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Catherine Labbe
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Penelope A Bradbury
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ronald Feld
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Melissa Iazzi
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Dianne Zawisza
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nazanin Nouriany
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Department of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
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Korpanty GJ, Kamel-Reid S, Pintilie M, Hwang DM, Zer A, Liu G, Leighl NB, Feld R, Siu LL, Bedard PL, Tsao MS, Shepherd FA. Lung cancer in never smokers from the Princess Margaret Cancer Centre. Oncotarget 2018; 9:22559-22570. [PMID: 29854298 PMCID: PMC5978248 DOI: 10.18632/oncotarget.25176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [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: 09/27/2017] [Accepted: 03/23/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Lung cancer in never smokers represents a distinct epidemiological, clinical, and molecular entity. Results Most 712 never smoking lung cancer patients were female (72%) with a median age at diagnosis of 62.2 years (18–94). Caucasians (46%), East Asians (42%), adenocarcinoma histology (87%) and presentation with metastatic disease at diagnosis (59%) were common. Of 515 patients with available archival tissue, the most common identified single mutations were EGFR (52.2%), followed by ALK (7.5%), KRAS (2.3%), TP53 (1.3%), ERBB2 (1%), BRAF (0.4%), PIK3CA (0.4%), SMAD4 (0.4%), CTNNB1 (0.2%), AKT1 (0.2%), and NRAS (0.2%); 8% tumors had multiple mutations, while 25.8% had none identified. Median overall survival (mOS) was 42.2 months (mo) for the entire cohort. Patients with mutations in their tumors had significantly better mOS (69.5 mo) when compared to those without (31.0 mo) (HR = 0.59; 95% CI: 0.44–0.79; p < 0.001). Earlier stage (p < 0.001), adenocarcinoma histology (p = 0.012), good performance status (p < 0.001) and use of targeted therapy (p < 0.001) were each independently associated with longer survival. Patients with ALK-translocation-positive tumours have significantly longer OS compared to those without any mutations (p = 0.0029) and to those with other and null mutations (p = 0.022). Conclusions Lung cancer in never smokers represents a distinct clinical and molecular entity characterized by a high incidence of targetable mutations and long survival. Methods We analyzed retrospectively the data from electronic patient records of never smokers diagnosed with lung cancer treated at the Princess Margaret Cancer Centre (Toronto) between 1988–2015 to characterize demographic and clinical features, pathology, molecular profile (using hotspot or targeted sequencing panels), treatment and survival.
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Affiliation(s)
- Grzegorz J Korpanty
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Melania Pintilie
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David M Hwang
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Alona Zer
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ronald Feld
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philippe L Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ming-Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Labbé C, Cabanero M, Korpanty GJ, Tomasini P, Doherty MK, Mascaux C, Jao K, Pitcher B, Wang R, Pintilie M, Leighl NB, Feld R, Liu G, Bradbury PA, Kamel-Reid S, Tsao MS, Shepherd FA. Prognostic and predictive effects of TP53 co-mutation in patients with EGFR-mutated non-small cell lung cancer (NSCLC). Lung Cancer 2017; 111:23-29. [PMID: 28838393 DOI: 10.1016/j.lungcan.2017.06.014] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [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: 04/22/2017] [Revised: 06/15/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION TP53 mutations are common in non-small cell lung cancer (NSCLC) and have been reported as prognostic of poor outcome. The impact of TP53 co-mutations in epidermal growth factor receptor (EGFR)-mutated NSCLC is unclear. MATERIALS AND METHODS Tissue from 105 patients with EGFR-mutated NSCLC at Princess Margaret Cancer Centre was analyzed by next-generation or Sanger sequencing to determine TP53 mutational status. Associations between TP53 status and baseline patient and tumor characteristics, treatments and outcomes (relapse-free survival [RFS] after surgical resection, overall survival [OS], overall response rate [ORR] and progression-free survival [PFS] on EGFR tyrosine kinase inhibitors [TKIs]), were investigated. RESULTS Dual TP53/EGFR mutations were found in 43/105 patients (41%). Among 76 patients who underwent surgical resection, neither RFS (HR 0.99, CI 0.56-1.75, p=0.96) nor OS (HR 1.39, CI 0.70-2.77; p=0.35) was associated with TP53 status. Sixty patients (24 TP53 MUT; 36 TP53 WT) received first-generation EGFR TKIs for advanced disease. ORR was not significantly different (TP53 MUT 54%, WT 66%, p=0.42). There was a non-significant trend towards shorter PFS on EGFR TKIs with TP53 mutation (HR 1.74, CI 0.98-3.10, p=0.06). When limited to TP53 missense mutations (n=17), PFS was significantly shorter (HR 1.91, CI 1.01-3.60, p=0.04). Among 11 evaluable patients treated with T790M inhibitors, ORR was not significantly different (TP53 MUT 3/3 [100%], WT 7/8 [88%]). CONCLUSIONS Patients with dual TP53/EGFR mutations, especially missense mutations, had marginally lower response rates and shorter PFS when treated with EGFR TKI therapy. Larger datasets are required to validate these observations.
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Affiliation(s)
- Catherine Labbé
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada; Division of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Ste-Foy, Québec, QC, G1V 4G5, Canada.
| | - Michael Cabanero
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Grzegorz J Korpanty
- Canadian Cancer Trials Group, Queen's University, 10 Stuard Street, Kingston, ON, K7L 3N6, Canada.
| | - Pascale Tomasini
- Aix-Marseille University, Public Assistance, Marseille Hospitals, 80 Rue Brochier, 13005 Marseille, France.
| | - Mark K Doherty
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Céline Mascaux
- Aix-Marseille University, Public Assistance, Marseille Hospitals, 80 Rue Brochier, 13005 Marseille, France.
| | - Kevin Jao
- Division of Medical Oncology and Hematology, Hôpital du Sacré-Coeur de Montréal, 5400 Boulevard Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
| | - Bethany Pitcher
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Rick Wang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Melania Pintilie
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Natasha B Leighl
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Ronald Feld
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Geoffrey Liu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Penelope Ann Bradbury
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
| | - Suzanne Kamel-Reid
- Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Frances A Shepherd
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
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9
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Soldera SV, Kavanagh J, Pintilie M, Feld R, Leighl NB, Cho J, de Perrot M, Bradbury PA. Systemic therapy use and outcomes after relapse from accelerated hemithoracic radiation and surgery for malignant pleural mesothelioma (MPM). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8559] [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: 11/20/2022] Open
Abstract
8559 Background: The prognosis of patients (pts) with MPM remains poor. Accelerated hemithoracic radiation followed by extrapleural pneumonectomy and adjuvant chemotherapy in ypN2 disease (SMART) provides encouraging results. The ability to administer systemic therapy (Tx) and response rate (RR) after recurrence remains unclear. We therefore examined subsequent lines of Tx and outcomes following relapse after SMART. Methods: A retrospective analysis of pts diagnosed with recurrent MPM following SMART was conducted at a single institution. OS was determined from date of relapse to death and was estimated using the Kaplan-Meier method. Potential prognostic variables were tested utilizing the log-rank test. Results: Out of 86 pts undergoing SMART from 2008 to 2016, 53 (62%) developed recurrent disease of which 36% had pathological confirmation. Two cases with initial epithelial subtype on surgical specimen relapsed with different histology (sarcomatoid and small cell). In 48% of pts, relapse was unclear at first imaging (n = 42) and a median of 98 days (range 6-966) lapsed between first suspicion and final diagnosis. The median age at relapse was 66 years (range 45-79), 47% had a performance status (PS) ≥2 (n = 45) and 64% were of epithelial subtype. After a median follow up of 7.6 mo, the median OS was 5.2 mo. PS ≥2 was associated with worse OS (2.8 vs 10.7 mo, p < 0.001). Of 42 pts followed after relapse, 36% received any Tx (19% 1 line; 12% 2 lines; 5% ≥3 lines). Tx was omitted in 62% of pts due to poor PS (26/42). First line Tx consisted of platinum doublet in 93% of pts (n = 15). Of 13 pts with response evaluable disease, RR was 15% (0 CR, 15% PR). Of note, 0/13 pts had neoadjuvant Tx and 3/13 pts had adjuvant Tx (10, 13 and 38 mo lapsed between end of adjuvant Tx and start of Tx in the relapsed setting). 6/15 pts discontinued Tx due to toxicity, 5/15 due to progression and median number of cycles was 4. Conclusions: Pts with relapsed MPM following SMART have poor prognosis and low RR to first line Tx. Poor performance status at relapse is a poor prognostic factor. Earlier detection, novel diagnostic markers of relapse and consideration of maintenance strategies should be investigated in future studies.
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Affiliation(s)
| | | | | | - Ronald Feld
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - John Cho
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
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10
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Doherty MK, Korpanty GJ, Tomasini P, Alizadeh M, Jao K, Labbé C, Mascaux CM, Martin P, Kamel-Reid S, Tsao MS, Pintilie M, Liu G, Bradbury PA, Feld R, Leighl NB, Chung C, Shepherd FA. Treatment options for patients with brain metastases from EGFR / ALK -driven lung cancer. Radiother Oncol 2017; 123:195-202. [DOI: 10.1016/j.radonc.2017.03.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/30/2017] [Accepted: 03/12/2017] [Indexed: 12/16/2022]
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11
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O'Kane GM, Bradbury PA, Feld R, Leighl NB, Liu G, Pisters KM, Kamel-Reid S, Tsao MS, Shepherd FA. Uncommon EGFR mutations in advanced non-small cell lung cancer. Lung Cancer 2017; 109:137-144. [PMID: 28577943 DOI: 10.1016/j.lungcan.2017.04.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [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: 02/14/2017] [Revised: 04/03/2017] [Accepted: 04/21/2017] [Indexed: 01/04/2023]
Abstract
Molecular profiling in advanced non-small cell lung cancer (NSCLC) has allowed for the detection of actionable mutations, which has revolutionized the treatment paradigm in this highly fatal disease. Mutations involving the epidermal growth factor receptor (EGFR) gene are most common and the 'classical mutations', exon 19 deletions and the point mutation L858R at exon 21, predict response to EGFR tyrosine kinase inhibitors (TKIs). The 'uncommon' EGFR mutations account for 10-18% of all EGFR mutations and primarily consist of exon 20 insertions, exon 18 point mutations and complex mutations. Improved detection techniques have broadened the spectrum of reported aberrations within the 'uncommon group' but response to TKIs is variable and not fully elucidated. This review provides an overview of the biology and incidence of uncommon EGFR mutations and summarizes reported outcomes when treated with EGFR-TKIs.
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Affiliation(s)
- Grainne M O'Kane
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
| | - Penelope A Bradbury
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Ronald Feld
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Katherine-M Pisters
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Suzanne Kamel-Reid
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Ming S Tsao
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON M5G 2M9, Canada
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12
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de Perrot M, Dong Z, Bradbury P, Patsios D, Keshavjee S, Leighl NB, Hope A, Feld R, Cho J. Impact of tumour thickness on survival after radical radiation and surgery in malignant pleural mesothelioma. Eur Respir J 2017; 49:49/3/1601428. [DOI: 10.1183/13993003.01428-2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/13/2016] [Indexed: 11/05/2022]
Abstract
Tumour thickness was assessed to determine if this parameter could refine patients' selection for multimodality therapy in malignant pleural mesothelioma.We reviewed 65 consecutive treatment-naïve malignant pleural mesothelioma patients undergoing surgery for mesothelioma after radiation therapy (SMART). Total tumour thickness was determined by measuring the maximal thickness on nine predefined sectors on the chest wall, mediastinum and diaphragm.After a median follow-up of 19 months, 40 patients (62%) developed recurrence and 36 died (55%). Total tumour thickness, ranging between 2.4 and 21 cm (median 6.9 cm), correlated with tumour volume (p<0.0001, R2=0.29) and maximum standardised uptake value (p=0.006, R2=0.11). Total tumour thickness had a significant impact on overall survival and disease-free survival in univariate analysis. In multivariate analysis, total tumour thickness remained an independent predictor of survival (p=0.02, hazard ratio (HR) 1.12, 95% CI 1.02–1.23) and disease-free survival (p=0.01, HR 1.13, 95% CI 1.03–1.24) along with epithelial histologic subtype (p<0.0001, HR 0.25, 95% CI 0.13–0.50) and pN2 disease (p=0.03, HR 2.15, 95% CI 1.07–4.33). Diaphragmatic tumour thickness correlated best with time to recurrence (p=0.002, R2=0.22) and time to death (p=0.003, R2=0.2).The impact of tumour thickness on survival and disease-free survival independent of histologic subtypes and nodal disease is extremely encouraging. This parameter could potentially be used to refine the clinical staging of malignant pleural mesothelioma and optimise patient selection for radical treatment.
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13
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Kim L, Saieg M, Di Maio M, Gallo C, Butts C, Ciardiello F, Feld R, Cheng D, Gebbia V, Burgio MA, Alam Y, Signoriello S, Rossi A, Leighl N, Maione P, Morabito A, Liu G, Tsao MS, Perrone F, Gridelli C. Biomarker analysis of the phase 3 TORCH trial for first line erlotinib versus chemotherapy in advanced non-small cell lung cancer patients. Oncotarget 2017; 8:57528-57536. [PMID: 28915692 PMCID: PMC5593664 DOI: 10.18632/oncotarget.15725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/09/2016] [Accepted: 02/01/2017] [Indexed: 12/12/2022] Open
Abstract
Background The TORCH phase III trial compared the efficacy of first-line erlotinib followed by chemotherapy at progression (experimental arm) with the reverse sequence (standard arm) in unselected advanced non-small cell lung cancer (NSCLC) patients. Here we report biomarker analyses. Methods EGFR and KRAS mutation, expression of EGFR family members and of cMET and PTEN and EGFR and ABCG2 germline polymorphisms were tested on tumor tissue or blood samples to either confirm previously proposed predictive role or describe it in an explorative setting. Progression-free survival (PFS) was the primary end-point, overall survival, response rate and side effects (diarrhoea and skin toxicity) were secondary end-points. Interactions between biomarkers and treatment were studied with multivariable models (either Cox model or logistic regression). Statistical analyses accounted for multiple comparisons. Results At least one biomarker was assessed in 324 out of 760 patients in the TORCH study. EGFR mutation was more common in female (P = 0.0001), East Asians (P < 0.0001) and never smoker (P < 0.0001) patients; low MET protein expression by IHC (H-score <200) was more frequent in squamous (P < 0.00009) and ABCG2 C/A or A/A polymorphism was more frequent among East-Asian patients (P = 0.0003). A significant interaction was found for EGFR mutation in PFS and response rate analyses while no predictive effect on OS was found for any biomarker. No biomarker tested was prognostic for PFS and OS. No polymorphism was significantly associated with skin toxicity or diarrhea. Conclusion In the present study, beyond the known role of EGFR mutation, no other biomarker has predictive or prognostic role.
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Affiliation(s)
- Lucia Kim
- Department of Pathology, University Health Network, Princess Margaret Cancer Center and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Pathology, Inha University School of Medicine, Incheon, South Korea
| | - Mauro Saieg
- Department of Pathology, University Health Network, Princess Margaret Cancer Center and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Santa Casa Medical School, Sao Paulo, SP, Brazil
| | - Massimo Di Maio
- National Cancer Institute, G. Pascale Foundation, IRCCS, Naples, Italy.,University of Turin, Turin, Italy
| | - Ciro Gallo
- Department of Mental Health and Preventive Medicine, Chair of Statistics, Second University of Naples, Naples, Italy
| | - Charles Butts
- Medical Oncology, Cross Cancer Institute, Edmonton, Canada
| | | | - Ronald Feld
- Division of Hematology and Oncology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Dengxiao Cheng
- Division of Hematology and Oncology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Marco Angelo Burgio
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRCCS, Meldola, Italy
| | - Yasmin Alam
- Medical Oncology, Windsor Regional Cancer Centre, Windsor, Canada
| | - Simona Signoriello
- Department of Mental Health and Preventive Medicine, Chair of Statistics, Second University of Naples, Naples, Italy
| | - Antonio Rossi
- Department of Oncology/Hematology, Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
| | - Natasha Leighl
- Division of Hematology and Oncology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Paolo Maione
- Department of Oncology/Hematology, Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy
| | | | - Geoffrey Liu
- Division of Hematology and Oncology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network, Princess Margaret Cancer Center and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Francesco Perrone
- National Cancer Institute, G. Pascale Foundation, IRCCS, Naples, Italy
| | - Cesare Gridelli
- Department of Oncology/Hematology, Division of Medical Oncology, "S.G. Moscati" Hospital, Avellino, Italy.,On behalf of the TORCH Investigators
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14
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O'Kane G, Labbe C, Su S, Tse B, Tam V, Tse T, Doherty M, Stewart E, Brown C, Cosio AP, Patel D, Liang M, Gill G, Rett A, Leung Y, Naik H, Eng L, Mittmann N, Leighl N, Feld R, Bradbury P, Shepherd F, Xu W, Howell D, Liu G. P2.03b-008 The Impact of Brain Metastases and Their Treatment on Health Utility Scores in Molecular Subsets of Lung Cancer Patients. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Zer A, Moskovitz M, Hwang D, Hershko-Klement A, Fridel L, Korpanty G, Dudnik E, Peled N, Shochat T, Leighl N, Liu G, Feld R, Burkes R, Wollner M, Tsao M, Shepherd F. OA21.02 ALK-Rearranged Non-Small Cell Lung Cancer is Associated with a High Rate of Venous Thromboembolism. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Zer A, Moskovitz M, Hwang DM, Hershko-Klement A, Fridel L, Korpanty GJ, Dudnik E, Peled N, Shochat T, Leighl NB, Liu G, Feld R, Burkes R, Wollner M, Tsao MS, Shepherd FA. ALK-Rearranged Non-Small-Cell Lung Cancer Is Associated With a High Rate of Venous Thromboembolism. Clin Lung Cancer 2016; 18:156-161. [PMID: 27913214 DOI: 10.1016/j.cllc.2016.10.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [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: 07/14/2016] [Revised: 10/14/2016] [Accepted: 10/18/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with lung cancer are at increased risk for venous thromboembolism (VTE), particularly those receiving chemotherapy. It is estimated that 8% to 15% of patients with advanced non-small-cell lung cancer (NSCLC) experience a VTE in the course of their disease. The incidence in patients with specific molecular subtypes of NSCLC is unknown. We undertook this review to determine the incidence of VTE in patients with ALK (anaplastic lymphoma kinase)-rearranged NSCLC. PATIENTS AND METHODS We identified all patients with ALK-rearranged NSCLC diagnosed and/or treated at the Princess Margaret Cancer Centre (PM CC) in Canada between July 2012 and January 2015. Retrospective data were extracted from electronic medical records. We then included a validation cohort comprising all consecutive patients with ALK-rearranged NSCLC treated in 2 tertiary centers in Israel. RESULTS Within the PM CC cohort, of 55 patients with ALK-rearranged NSCLC, at a median follow-up of 22 months, 23 (42%) experienced VTE. Patients with VTE were more likely to be white (P = .006). The occurrence of VTE was associated with a trend toward worse prognosis (overall survival hazard ratio = 2.88, P = .059). Within the validation cohort (n = 43), the VTE rate was 28% at a median follow-up of 13 months. Combining the cohorts (n = 98), the VTE rate was 36%. Patients with VTE were younger (age 52 vs. 58 years, P = .04) and had a worse Eastern Cooperative Oncology Group performance status (P = .04). VTE was associated with shorter overall survival (hazard ratio = 5.71, P = .01). CONCLUSION The rate of VTE in our ALK-rearranged cohort was 3- to 5-fold higher than previously reported for the general NSCLC population. This warrants confirmation in larger cohorts.
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Affiliation(s)
- Alona Zer
- Rabin Medical Center, Petach Tikva, Israel.
| | | | - David M Hwang
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | | | | | - Grzegorz J Korpanty
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | | | - Nir Peled
- Rabin Medical Center, Petach Tikva, Israel
| | | | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Ronald Feld
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | | | | | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
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17
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Miller AB, Feld R, Fontana R, Gohagan JK, Jatoi I, Lawrence W, Miller A, ProroK PC, Rajput A, Sherman M, Welch G, Wright P, Yurgalevitch S, Albertsen P. Changes in and Impact of the Death Review Process in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Rev Recent Clin Trials 2016; 10:206-11. [PMID: 26238119 DOI: 10.2174/1574887110666150730120752] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/14/2015] [Accepted: 07/16/2015] [Indexed: 11/22/2022]
Abstract
Death review was conducted for the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial to avoid the biases associated with causes of death entered on death certificates. An algorithm selected deaths for review. Records on diagnosis and terminal illness were perused in the coordinating center and by the chair of the death review committee (DRC). Identifying information and randomization arm was removed. Three reviewers independently determined the cause of death. Disagreement was resolved at a meeting of the DRC. This process was subsequently simplified. The cause of death was determined by one DRC member and compared to the death certificate. With agreement the case was finalized. When discordant, the records were sent to a second DRC member. If the reviewers agreed, the case was finalized. If not, a third member reviewed. If two of the three reviewers agreed, the case was sent back to the discordant reviewer. If the reviewer remained discordant the case was resolved by a conference call. Of the 4728 death reviews that were completed, the DRC confirmed the death certificate underlying cause for over 90%. Between 5% and 13% of the certified deaths were regarded as indirect causes of death, associated with the treatment of the ascertained cancer; differential for prostate cancer, 11% in the intervention arm and 6% in the control. Without review, between 1% and 6% of the deaths that occurred would not have been assigned to the relevant PLCO cancer. The DRC completed 76% of those requiring review before the process ceased.
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Affiliation(s)
- Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada.
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18
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Karim S, Feld R, Leighl NB, Shepherd FA, Bradbury PA, Liu G, Graham DM. A Phase I/Ib study of MEK162 (binimetinib), a MEK inhibitor, in combination with carboplatin and pemetrexed in patients with non-squamous NSCLC. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps2609] [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)
- Safiya Karim
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University Health Network, Division of Medical Oncology and Hematology, Toronto, ON, Canada
| | | | | | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
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19
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Labbe C, Korpanty G, Tomasini P, Doherty M, Mascaux C, Jao K, Pitcher B, Pintilie M, Leighl NB, Feld R, Liu G, Bradbury PA, Kamel-Reid S, Tsao MS, Shepherd FA. Prognostic and predictive effects of TP53 mutation in patients with EGFR-mutated non-small cell lung cancer (NSCLC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.11585] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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)
| | | | - Pascale Tomasini
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Mark Doherty
- Department of Medical Oncology, University College Hospital Galway, Galway, Ireland
| | - Celine Mascaux
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Kevin Jao
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Bethany Pitcher
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Melania Pintilie
- Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University Health Network, Division of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Ming Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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20
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Doherty M, Korpanty G, Tomasini P, Alizadeh M, Jao K, Labbe C, Mascaux C, Martin P, Kamel-Reid S, Pintilie M, Liu G, Bradbury PA, Feld R, Leighl NB, Chung C, Shepherd FA. Effect of brain metastases on survival and systemic treatment of EGFR/ALK-driven non-small cell lung cancer (NSCLC). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e20527] [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)
- Mark Doherty
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Pascale Tomasini
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Moein Alizadeh
- Centre Integre de Cancerologie de Laval, Laval, QC, Canada
| | - Kevin Jao
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Celine Mascaux
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Petra Martin
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Melania Pintilie
- Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University Health Network, Division of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Caroline Chung
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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21
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Labbe C, Stewart EL, Brown C, Perez Cosio A, Vennettilli A, Patel D, Cheng NY, Liang M, Gill G, Rett A, Leung Y, Naik H, Eng L, Mittmann N, Leighl NB, Feld R, Bradbury PA, Shepherd FA, Howell D, Liu G. Real-world EQ5D health utility values for metastatic lung cancer patients by molecular alteration and response to therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6567] [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)
| | - Erin L. Stewart
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Catherine Brown
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Devalben Patel
- Princess Margaret Cancer Centre, University Health Network, Ontario Cancer Institute, Toronto, ON, Canada
| | | | - Mindy Liang
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Yvonne Leung
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hiten Naik
- University of Toronto, Toronto, ON, Canada
| | - Lawson Eng
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nicole Mittmann
- HOPE Research Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University Health Network, Division of Medical Oncology and Hematology, Toronto, ON, Canada
| | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | | | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Zer A, Hershko-Klement A, Hwang D, Korpanty G, Leighl N, Liu G, Feld R, Burkes R, Tsao M, Shepherd F. 176P: ALK-rearranged non-small cell lung cancer is associated with a high rate of venous thromboembolism. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30286-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mordant P, McRae K, Cho J, Keshavjee S, Waddell TK, Feld R, de Perrot M. Impact of induction therapy on postoperative outcome after extrapleural pneumonectomy for malignant pleural mesothelioma: does induction-accelerated hemithoracic radiation increase the surgical risk? Eur J Cardiothorac Surg 2016; 50:433-8. [PMID: 27005976 DOI: 10.1093/ejcts/ezw074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 01/28/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with malignant pleural mesothelioma (MPM) eligible for extrapleural pneumonectomy (EPP) may benefit from induction chemotherapy (CT) as historically described, or from induction-accelerated hemithoracic intensity-modulated radiation therapy (IMRT) as a potential alternative. However, the impact of the type of induction therapy on postoperative morbidity and mortality remains unknown. METHODS We performed a retrospective study including every patient who underwent EPP for MPM in our institution between January 2001 and December 2014. Patients without induction treatment (n = 7) or undergoing both induction CT and IMRT (n = 2) were then excluded. The remaining patients (study group) were divided according to the type of induction treatment in Group 1-CT and Group 2-IMRT. Major complications were defined by complications of Grade 3 or higher according to the National Cancer Institute Common Terminology Criteria for Adverse Events 4.0 guidelines. Red blood cell (RBC) transfusion was analysed as a number of packs, and dichotomized as <3 vs ≥3 packs. Plasma and platelet transfusion were analysed as a number of units, and dichotomized as no transfusion versus any plasma or platelet transfusion. RESULTS Altogether, 126 patients (mean age 61.3 ± 8.1 years, males 82.5%, right side 60.3%, 90-day mortality rate 4.8%) accounted for the study group. Sixty-four patients were included in Group 1-CT and 62 patients were included in Group 2-IMRT. When compared with Group 1-CT, Group 2-IMRT was characterized by older patients (59.3 ± 9.2 vs 63.3 ± 8.3 years, P = 0.012), more right-sided resections (46.8 vs 74.1%, P = 0.003), more advanced disease (pathological stage IV: 28.1 vs 53.2%, P = 0.007), less RBC transfusions (5.1 ± 3.0 vs 3.0 ± 2.4 packs, P < 0.001), less plasma or platelet transfusions (31.2 vs 9.6%, P = 0.005) and similar rate of major complications (29.6 vs 35.4%, P = 0.614). The 90-day mortality rate was 6.2% in Group 1-CT (n = 4) and 3.2% in Group 2-RT (n = 2, P = 0.680). Induction with IMRT was significantly associated with a decreased risk of transfusion with RBCs [odds ratio (OR) = 0.10, 95% confidence interval (CI) 0.04-0.23, P < 0.001] as well as plasma and platelets (OR = 0.25, 95% CI 0.086-0.67, P = 0.008). CONCLUSIONS In this large single-centre series of EPP for MPM, the implementation of induction IMRT was not associated with any significant increase in the surgical risks above and beyond induction CT. The switch from induction CT to induction IMRT was associated with resection in older patients with more advanced tumours, less transfusion requirements, comparable postoperative morbidity and 90-day mortality.
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Affiliation(s)
- Pierre Mordant
- Division of Thoracic Surgery, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - John Cho
- Department of Radiation Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ronald Feld
- Department of Medical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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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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Tagawa T, Anraku M, Morodomi Y, Takenaka T, Okamoto T, Takenoyama M, Ichinose Y, Maehara Y, Cho BCJ, Feld R, Tsao MS, Leighl N, Bezjak A, Keshavjee S, de Perrot M. Clinical role of a new prognostic score using platelet-to-lymphocyte ratio in patients with malignant pleural mesothelioma undergoing extrapleural pneumonectomy. J Thorac Dis 2015; 7:1898-906. [PMID: 26716028 DOI: 10.3978/j.issn.2072-1439.2015.11.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To investigate the prognostic value of platelet-to-lymphocyte ratio (PLR) and create a new prognostic score in patients with malignant pleural mesothelioma (MPM) undergoing extrapleural pneumonectomy (EPP). METHODS Of 85 patients who underwent EPP for MPM over 10 years at Toronto General Hospital, 65 patients whose blood test results before initial therapy were available were retrospectively analyzed as a training cohort to identify and develop a prognostic score. Receiver operating characteristic (ROC) analysis was performed to examine cutoff values of hematologic parameters for survival. The prognostic score was externally validated in a cohort of 32 patients who underwent EPP for MPM over 13 years at two institutes in Japan. RESULTS In the training cohort, multivariate analysis confirmed sex (P=0.0053) and PLR (P=0.049) as independent predictors of overall survival. The prognostic score was established using sex and PLR. The score was defined as follows: female:male =0:1 point; PLR <215:>215=0:1 point. The patients were classified into three risk groups according to the sum of the points: risk 0 (0 point), 1 (1 point), and 2 (2 points). Median survival time of the patients in the training cohort according to the risk groups were not reached, 32.0 and 19.4 months for risk 0 (n=6), 1 (n=36) and 2 (n=23), respectively (P=0.0006). In the validation cohort, median survival time was not reached, 45.9 and 14.5 months for risk 0 (n=4), 1 (n=18) and 2 (n=10), respectively (P=0.0002). CONCLUSIONS The new prognostic score using PLR is simple and useful for predicting the prognosis of patients with MPM undergoing EPP. Further study should be done to examine the role of this scoring system to optimize treatment strategy.
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Affiliation(s)
- Tetsuzo Tagawa
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Masaki Anraku
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Yosuke Morodomi
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Tomoyoshi Takenaka
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Tatsuro Okamoto
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Mitsuhiro Takenoyama
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Yukito Ichinose
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Yoshihiko Maehara
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - B C John Cho
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Ronald Feld
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Ming-Sound Tsao
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Natasha Leighl
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Andrea Bezjak
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Shaf Keshavjee
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Marc de Perrot
- 1 Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada ; 2 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ; 3 Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ; 4 Division of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan ; 5 Department of Radiation Oncology, 6 Department of Medical Oncology, 7 Department of Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
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Brade A, MacRae R, Laurie SA, Bezjak A, Burkes R, Chu Q, Goffin JR, Cho J, Hope A, Sun A, Leighl N, Capobianco S, Feld R, Mahalingam E, Hossain A, Iscoe N, Shepherd FA. Phase II Study of Concurrent Pemetrexed, Cisplatin, and Radiation Therapy for Stage IIIA/B Unresectable Non-Small Cell Lung Cancer. Clin Lung Cancer 2015; 17:133-41. [PMID: 26872764 DOI: 10.1016/j.cllc.2015.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Concurrent thoracic radiation and platinum-based chemotherapy is the standard of care for treatment of unresectable stage IIIA-IIIB non-small-cell lung cancer (NSCLC), but the optimal drug regimen has not been established. PATIENTS AND METHODS In the present single-arm phase II trial, patients with previously untreated, unresectable stage IIIA-IIIB NSCLC (all histologic types) were treated with pemetrexed-cisplatin (500 mg/m(2) intravenously on days 1 and 22, 20 mg/m(2) intravenously on days 1-5 and days 22-26) concurrent with radiotherapy (61-66 Gy in 31-35 fractions), followed by 2 cycles of consolidation pemetrexed-cisplatin (75 mg(2)) therapy. The primary endpoint was the 1-year overall survival (OS) rate. The study treatment was considered active if the 1-year OS rate was ≥ 70%. RESULTS A total of 39 patients, including 6 from the previous phase I trial who had been treated at the recommended phase II dose, were eligible for analysis. The most common drug-related grade 3 to 4 adverse events during the concurrent phase were hematologic and 5.1% of patients experienced grade 3 esophagitis. The response rate was 45.9% (17 of 37 patients), with no complete responses. The 1-, 2-, and 3-year OS survival rates were 79.5%, 56.4%, and 46.2%, respectively. The median OS, time to progressive disease, and progression-free survival was 30.3, 13.7, and 11.8 months, respectively. CONCLUSION Full-dose cisplatin and pemetrexed can be administered concurrently with conventional doses of thoracic radiation. The median and 1-year OS rates were favorable compared with published clinical trials in this setting. The regimen was tolerable, and the toxicity profile was consistent with the known toxicity profiles of pemetrexed, cisplatin, and radiation.
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Affiliation(s)
- Anthony Brade
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
| | - Robert MacRae
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Scott A Laurie
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Bezjak
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ronald Burkes
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Quincy Chu
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - John R Goffin
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - John Cho
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Alex Sun
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Natasha Leighl
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Essai Mahalingam
- Eli Lilly Canada Inc, Medicines Development Unit, Toronto, ON, Canada
| | | | - Neill Iscoe
- Eli Lilly Canada Inc., Scarborough, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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de Perrot M, Feld R, Leighl NB, Hope A, Waddell TK, Keshavjee S, Cho BCJ. Accelerated hemithoracic radiation followed by extrapleural pneumonectomy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2015; 151:468-73. [PMID: 26614413 DOI: 10.1016/j.jtcvs.2015.09.129] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [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: 04/13/2015] [Revised: 08/24/2015] [Accepted: 09/13/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate a new protocol of accelerated hemithoracic intensity-modulated radiation therapy (IMRT) followed by extrapleural pneumonectomy (EPP) for patients with resectable malignant pleural mesothelioma (MPM). METHODS A total of 25 Gy of radiation was delivered in 5 daily fractions over 1 week to the entire ipsilateral hemithorax with concomitant boost of 5 Gy to volumes at high risk based on computed tomography and positron emission tomography scan findings. EPP was performed at 6 ± 2 days after the end of radiation therapy. Adjuvant chemotherapy was offered to patients with ypN2 disease. RESULTS A total of 62 patients were included between November 2008 and October 2014. One patient died in the hospital 2 months after EPP, for an operative mortality of 1.6%, and 2 died after discharged from the hospital for an overall treatment-related mortality (grade 5 toxicity) of 4.8%. Twenty-four patients (39%) developed grade 3 to 5 (grade 3+) complications. On final pathology, 94% of the patients were stage III or IV, and 52% had ypN2 disease. The median survival for all patients as an intention-to-treat analysis was 36 months. The median overall survival and disease-free survival was 51 and 47 months, respectively, in epithelial subtypes, compared with 10 and 8 months in biphasic subtypes (P = .001). Ipsilateral chest recurrence occurred in 8 patients. CONCLUSIONS Accelerated hemithoracic IMRT followed by EPP has become our preferred approach for resectable MPM. The results have been encouraging in patients with epithelial subtype.
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Affiliation(s)
- Marc de Perrot
- Division of Thoracic Surgery, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Ronald Feld
- Division of Medical Oncology, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Division of Medical Oncology, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K Waddell
- Division of Thoracic Surgery, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - B C John Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre and Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Mordant P, Mcrae K, Cho J, Keshavjee S, Waddell T, Feld R, De Perrot M. O-135IMPACT OF INDUCTION THERAPY ON POSTOPERATIVE OUTCOME AFTER EXTRAPLEURAL PNEUMONECTOMY FOR MALIGNANT PLEURAL MESOTHELIOMA: DOES INDUCTION ACCELERATED HEMITHORACIC RADIATION INCREASE THE SURGICAL RISK? Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.135] [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: 11/12/2022] Open
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Lim C, Tsao M, Le L, Shepherd F, Feld R, Burkes R, Liu G, Kamel-Reid S, Hwang D, Tanguay J, da Cunha Santos G, Leighl N. Biomarker testing and time to treatment decision in patients with advanced nonsmall-cell lung cancer. Ann Oncol 2015; 26:1415-21. [DOI: 10.1093/annonc/mdv208] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/20/2015] [Indexed: 11/14/2022] Open
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Ellis P, Coakley N, Feld R, Kuruvilla S, Ung Y. Use of the epidermal growth factor receptor inhibitors gefitinib, erlotinib, afatinib, dacomitinib, and icotinib in the treatment of non-small-cell lung cancer: a systematic review. Curr Oncol 2015; 22:e183-215. [PMID: 26089730 PMCID: PMC4462541 DOI: 10.3747/co.22.2566] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION This systematic review addresses the use of epidermal growth factor receptor (egfr) inhibitors in three populations of advanced non-small-cell lung cancer (nsclc) patients-unselected, selected, and molecularly selected-in three treatment settings: first line, second line, and maintenance. METHODS Ninety-six randomized controlled trials found using the medline and embase databases form the basis of this review. RESULTS In the first-line setting, data about the efficacy of egfr tyrosine kinase inhibitors (tkis) compared with platinum-based chemotherapy are inconsistent. Results from studies that selected patients based on clinical characteristics are also mixed. There is high-quality evidence that an egfrtki is preferred over a platinum doublet as initial therapy for patients with an activating mutation of the EGFR gene. The egfrtkis are associated with a higher likelihood of response, longer progression-free survival, and improved quality of life. Multiple trials of second-line therapy have compared an egfrtki with chemotherapy. Meta-analysis of those data demonstrates similar progression-free and overall survival. There is consequently no preferred sequence for second-line egfrtki or second-line chemotherapy. The egfrtkis have also been evaluated as switch-maintenance therapy. No molecular marker could identify patients in whom a survival benefit was not observed; however, the magnitude of the benefit was modest. CONCLUSIONS Determination of EGFR mutation status is essential to making appropriate treatment decisions in patients with nsclc. Patients who are EGFR mutation-positive should be treated with an egfrtki as first-line therapy. An egfrtki is still appropriate therapy in patients who are EGFR wild-type, but the selected agent should be administered as second- or third-line therapy.
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Affiliation(s)
- P.M. Ellis
- Department of Oncology, McMaster University, Hamilton, ON
- Juravinski Cancer Centre, Hamilton, ON
| | - N. Coakley
- Department of Oncology, McMaster University, Hamilton, ON
- Cancer Care Ontario, Program in Evidence-Based Care, Hamilton, ON
| | - R. Feld
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, and University Health Network, University of Toronto, Toronto, ON
| | - S. Kuruvilla
- Department of Oncology, The University of Western Ontario, and London Regional Cancer Program, London, ON
| | - Y.C. Ung
- Department of Radiation Oncology, University of Toronto, and Odette Cancer Centre, Toronto, ON
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Tomasini P, Sung M, Kamel-Reid S, Tsao MS, Liu G, Bradbury PA, Shepherd FA, Feld R, Leighl NB. EGFR mutations in NSCLC: Does ethnicity influence outcomes? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e17633] [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)
- Pascale Tomasini
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Mike Sung
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Ming Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
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32
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Korpanty G, Kamel-Reid S, Tsao MS, Hwang DM, Zer A, Liu G, Leighl NB, Feld R, Gill B, Pintilie M, Shepherd FA. Personalized treatment outcomes in never smokers with advanced non-small cell lung cancer (NSCLC) in the Princess Margaret Cancer Centre. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e19006] [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)
| | - Suzanne Kamel-Reid
- Laboratory Genetics, University Health Network, Toronto, Toronto, ON, Canada
| | - Ming Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - David M Hwang
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Alona Zer
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Bethany Gill
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Melania Pintilie
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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33
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Tomasini P, Jao K, Kamel-Reid S, Stockley T, Tsao MS, Liu G, Leighl NB, Feld R, Bradbury PA, Pintilie M, Mascaux C, Shepherd FA. Predictive value of coexisting KRAS and TP53 mutations on response to chemotherapy in non-small cell lung cancer (NSCLC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.11060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- Pascale Tomasini
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Kevin Jao
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | | | - Ming Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Melania Pintilie
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Celine Mascaux
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
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34
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Jao K, Tomasini P, Kamel-Reid S, Tsao MS, Korpanty GJ, Mascaux C, Liu G, Leighl NB, Feld R, Bradbury PA, Ennis M, Shepherd FA. Prognostic effect of single versus multiple somatic mutations in non-small cell lung cancer (NSCLC). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.7521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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)
- Kevin Jao
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Pascale Tomasini
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Ming Sound Tsao
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Celine Mascaux
- Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
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35
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Lim CH, Sung M, Nouriany NZ, Sawczak M, Paul T, Perera-Low N, Feld R, Liu G, Shepherd FA, Leighl NB. Patients with advanced non-small cell lung cancer (NSCLC): Are research biopsies a barrier to participation in clinical trials? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.6534] [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)
| | - Mike Sung
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Tuhina Paul
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
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36
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Doherty M, Leighl NB, Feld R, Bradbury PA, Wang L, Nie J, Yen P, Pniak M, Nguyen LT, Butler MO, de Perrot M. Phase I/II study of tumor-infiltrating lymphocyte (TIL) infusion and low-dose interleukin-2 (IL-2) in patients with advanced malignant pleural mesothelioma (MPM). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps7586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- Mark Doherty
- Department of Medical Oncology, University College Hospital Galway, Galway, Ireland
| | | | - Ronald Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Lisa Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Jessica Nie
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - P Yen
- The Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Michael Pniak
- Immune Therapy Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Marc de Perrot
- Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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37
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Payne DG, Feld R. Concurrent radiotherapy and chemotherapy in lung cancer at the Princess Margaret Hospital. Antibiot Chemother (1971) 2015; 41:96-101. [PMID: 2854451 DOI: 10.1159/000416188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- D G Payne
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
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Feld R, Payne D, Hodson I, Coy P. Complications of treatment of small cell carcinoma of the lung. Experience from a recent Canadian trial. Antibiot Chemother (1971) 2015; 41:204-9. [PMID: 2854441 DOI: 10.1159/000416205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R Feld
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Canada
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39
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Arriagada R, Bertino JR, Bleehen NM, Brodin O, Feld R, Goldie JH, Hansen HH, Ihde DC, Le Chevalier T, Souhami RL. Consensus report on combined radiotherapy and chemotherapy modalities in lung cancer. Antibiot Chemother (1971) 2015; 41:232-41. [PMID: 2854445 DOI: 10.1159/000416210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R Arriagada
- Radiotherapy Department, Institut Gustave-Roussy, Villejuif, France
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Di Maio M, Gallo C, Leighl NB, Piccirillo MC, Daniele G, Nuzzo F, Gridelli C, Gebbia V, Ciardiello F, De Placido S, Ceribelli A, Favaretto AG, de Matteis A, Feld R, Butts C, Bryce J, Signoriello S, Morabito A, Rocco G, Perrone F. Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials. J Clin Oncol 2015; 33:910-5. [PMID: 25624439 DOI: 10.1200/jco.2014.57.9334] [Citation(s) in RCA: 308] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Information about symptomatic toxicities of anticancer treatments is not based on direct report by patients, but rather on reports by clinicians in trials. Given the potential for under-reporting, our aim was to compare reporting by patients and physicians of six toxicities (anorexia, nausea, vomiting, constipation, diarrhea, and hair loss) within three randomized trials. PATIENTS AND METHODS In one trial, elderly patients with breast cancer received adjuvant chemotherapy; in two trials, patients with advanced non-small-cell lung cancer received first-line treatment. Toxicity was prospectively collected by investigators (graded by National Cancer Institute Common Toxicity Criteria [version 2.0] or Common Terminology Criteria for Adverse Events [version 3]). At the end of each cycle, patients completed the European Organisation for Research and Treatment of Cancer quality-of-life questionnaires, including toxicity-related symptom items. Possible answers were "not at all," "a little," "quite a bit," and "very much." Analysis was limited to the first three cycles. For each toxicity, agreement between patients and physicians and under-reporting by physicians (ie, toxicity reported by patients but not reported by physicians) were calculated. RESULTS Overall, 1,090 patients (2,482 cycles) were included. Agreement between patients and physicians was low for all toxicities. Toxicity rates reported by physicians were always lower than those reported by patients. For patients who reported toxicity (any severity), under-reporting by physicians ranged from 40.7% to 74.4%. Examining only patients who reported "very much" toxicity, under-reporting by physicians ranged from 13.0% to 50.0%. CONCLUSION Subjective toxicities are at high risk of under-reporting by physicians, even when prospectively collected within randomized trials. This strongly supports the incorporation of patient-reported outcomes into toxicity reporting in clinical trials.
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Affiliation(s)
- Massimo Di Maio
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Ciro Gallo
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Natasha B Leighl
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Maria Carmela Piccirillo
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Gennaro Daniele
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Francesco Nuzzo
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Cesare Gridelli
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Vittorio Gebbia
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Fortunato Ciardiello
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Sabino De Placido
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Anna Ceribelli
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Adolfo G Favaretto
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Andrea de Matteis
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Ronald Feld
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Charles Butts
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Jane Bryce
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Simona Signoriello
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Alessandro Morabito
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Gaetano Rocco
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Francesco Perrone
- Massimo Di Maio, Maria Carmela Piccirillo, Gennaro Daniele, Francesco Nuzzo, Andrea de Matteis, Jane Bryce, Alessandro Morabito, Gaetano Rocco, and Francesco Perrone, Istituto Nazionale Tumori-Fondazione "G. Pascale" Istituto di Ricovero e Cura a Carattere Scientifico; Ciro Gallo, Fortunato Ciardiello, and Simona Signoriello, Second University; Sabino De Placido, Federico II University, Napoli; Cesare Gridelli, S.G. Moscati Hospital, Avellino; Vittorio Gebbia, Istituto La Maddalena, Palermo; Anna Ceribelli, Regina Elena National Cancer Institute, Roma; Adolfo G. Favaretto, Istituto Oncologico Veneto, Padova, Italy; Natasha B. Leighl and Ronald Feld, Princess Margaret Hospital/University Health Network, Toronto; and Charles Butts, Cross Cancer Institute, Edmonton, Alberta, Canada.
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Wong K, Chiu J, Shen X, Templeton A, Xu W, Chen E, Sherman M, Feld R, Knox J. Impact of Neutrophil-To-Lymphocyte Ratio (Nlr) and Platelet-To-Lymphocyte Ratio (Plr) on Outcomes in Hepatocellular Carcinoma (Hcc) Patients Treated with Sorafenib (Sor). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.114] [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: 11/12/2022] Open
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Di Maio M, Piccirillo M, Daniele G, Nuzzo F, Gridelli C, Gebbia V, Ciardiello F, De Placido S, Ceribelli A, Favaretto A, De Matteis A, Feld R, Butts C, Leighl N, Morabito A, Bryce J, Signoriello S, Gallo C, Perrone F. Symptomatic Toxicities Experienced During Anti-Cancer Treatment: Comparison of Patients' and Physicians' Reporting in Three Randomized Controlled Trials (Rcts). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu356.2] [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: 11/13/2022] Open
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Tsao M, Di Maio M, Kim L, Liu G, Xu J, Gebbia V, Burgio M, Alam Z, Valmadre G, Higgins B, Signoriello S, Rossi A, Leighl N, Maione P, Butts C, Ciardiello F, Feld R, Gallo C, Gridelli C, Perrone F. Cmet Expression and Activity of First-Line Erlotinib in Advanced Non-Small Cell Lung Cancer (Nsclc) Patients (Pts): Exploratory Analysis of the Randomized Phase III Torch Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.28] [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: 11/14/2022] Open
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Liu G, Di Maio M, Tsao M, Cheng D, Chen Z, Wierzbicki R, Riccardi F, Spatafora M, Adamo V, Favaretto A, Bianco R, Gregg R, Costanzo R, Signoriello S, Butts C, Ciardiello F, Feld R, Gallo C, Gridelli C, Perrone F. Epidermal Growth Factor Receptor (Egfr) and Abcg2 Polymorphisms and Treatment Outcome in the Randomized Phase III Torch Trial in Advanced Non-Small Cell Lung Cancer (Nsclc) Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.29] [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: 11/13/2022] Open
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Krug LM, Wozniak AJ, Kindler HL, Feld R, Koczywas M, Morero JL, Rodriguez CP, Ross HJ, Bauman JE, Orlov SV, Ruckdeschel JC, Mita AC, Fein L, He X, Hall R, Kawabe T, Sharma S. Randomized phase II trial of pemetrexed/cisplatin with or without CBP501 in patients with advanced malignant pleural mesothelioma. Lung Cancer 2014; 85:429-34. [PMID: 25047675 DOI: 10.1016/j.lungcan.2014.06.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 04/06/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND CBP501, a synthetic duodecapeptide, increases cisplatin influx into tumor cells through an interaction with calmodulin enhancing cisplatin cytotoxicity, and effects cell cycle progression by abrogating DNA repair at the G2 checkpoint. In phase I clinical trials of CBP501 alone or in combination with cisplatin, the most common toxicity was infusion-related urticaria. Activity of CBP501 plus cisplatin was observed in patients with ovarian cancer and mesothelioma, including some patients previously treated with cisplatin. METHODS Chemotherapy naïve patients with unresectable MPM were stratified by histology and performance status, and randomized 2:1 to pemetrexed/cisplatin plus CBP501 25mg/m(2) IV (Arm A) or pemetrexed/cisplatin alone (Arm B). The primary endpoint was progression free survival (PFS) at 4 months. RESULTS 65 patients were randomized, and 63 were treated. Patient characteristics in the two arms were balanced. Based on independent radiology review of the treated population, 25/40 patients (63%) in Arm A and 9/23 (39%) in Arm B had PFS≥4mo; the median PFS was 5.1mo (95% CI, 3.9, 6.5) vs 3.4mo (2.5, 6.7). Median OS was 13.3mo (9.2, 16.3) in Arm A and 12.8 (6.5, 16.1) in Arm B. Adverse events were not different than expected from standard chemotherapy, and comparable in the two arms, aside from infusion reactions which occurred in 70% of patients treated with CBP501. CONCLUSIONS While this randomized phase II trial met its primary endpoint of PFS at 4 months, other parameters such as response rate and overall survival suggest that the addition of CBP501 does not improve the efficacy of standard chemotherapy for MPM.
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Affiliation(s)
- L M Krug
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
| | | | | | - R Feld
- Princess Margaret Hospital, Toronto, ON, Canada
| | - M Koczywas
- City of Hope Cancer Center, Duarte, CA, USA
| | - J L Morero
- Hospital Maria Ferrer, Buenos Aires, Argentina
| | | | - H J Ross
- Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - J E Bauman
- University of New Mexico, Albuquerque, NM, USA
| | - S V Orlov
- St. Petersburg Medical University, St. Petersburg, Russia
| | | | - A C Mita
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - L Fein
- Centro Oncologico de Rosario, Rosario, Argentina
| | - X He
- ICON Clinical Research, North Wales, PA, USA
| | - R Hall
- ICON Clinical Research, North Wales, PA, USA
| | - T Kawabe
- CanBas Co., Ltd., Numazu City, Shizuoka, Japan
| | - S Sharma
- Huntsman Cancer Institute, Salt Lake City, UT, USA
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Singh P, Feld R, Colombe B, Farber J, Herman J, Gulati R, Maley W, Frank A. Sensitization and Anatomic Features of Late Renal Allograft Failure: Radiologic and Pathologic Findings of Quiescent and Symptomatic Failed Grafts. Transplantation 2014. [DOI: 10.1097/00007890-201407151-01892] [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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Lim CH, Le L, Shepherd FA, Feld R, Burkes RL, Liu G, Kamel-Reid S, Tsao MS, Leighl NB. Biomarker testing and time-to-treatment decision in patients with advanced non-small cell lung cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.6595] [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)
| | - Lisa Le
- Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | | | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Ming Sound Tsao
- Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Korpanty G, Kamel-Reid S, Tsao MS, Zer A, Liu G, Leighl NB, Feld R, Pintilie M, Shepherd FA. Lung cancer in never-smokers from the Princess Margaret Cancer Centre. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.8099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | - Suzanne Kamel-Reid
- Department of Pathology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Ming Sound Tsao
- Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alona Zer
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ronald Feld
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Melania Pintilie
- Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Azad AK, Qiu X, Boyd K, Kuang Q, Emami M, Perera N, Palepu P, Patel D, Chen Z, Cheng D, Feld R, Leighl NB, Shepherd FA, Tsao MS, Xu W, Liu G, Cuffe S. A genetic sequence variant (GSV) at susceptibility loci of 5p15.33 (TERT-CLPTM1L) is associated with survival outcome in locally advanced and metastatic non-small-cell lung cancer (NSCLC). Lung Cancer 2014; 84:289-94. [PMID: 24679952 DOI: 10.1016/j.lungcan.2014.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/13/2014] [Accepted: 03/03/2014] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Lung cancer is a leading cause of cancer-related mortality in North America. In addition to tobacco smoking, inherited genetic factors can also influence the development of lung cancer. These genetic factors may lead to biologically distinct subsets of cancers that have different outcomes. We evaluated whether genetic sequence variants (GSVs) associated with lung cancer risk are associated with overall survival (OS) and progression-free survival (PFS) in stage-III-IV non-small-cell lung cancer (NSCLC) patients. METHODS A total of 20 candidate GSVs in 12 genes previously reported to be associated with lung cancer risk were genotyped in 564 patients with stage-III or IV NSCLC. Multivariate Cox proportional hazard models adjusted for potential clinical prognostic factors were generated for OS and PFS. RESULTS After taking into account multiple comparisons, one GSV remained significant: rs4975616 on chromosome 5p15.33, located near the TERT-CLPTM1L gene. The adjusted hazard ratio (aHR) for OS was 0.75 (0.69-0.91), p = 0.002; for PFS aHR was 0.74 (0.62-0.89), p < 0.001 for each protective variant allele. Results were similar in both Stage III (OS: aHR = 0.70; PFS: aHR = 0.71) and Stage IV patients (OS: aHR = 0.81; PFS: aHR = 0.77). CONCLUSION A GSV on 5p15.33 is not only a risk factor for lung cancer but may also be associated with survival in patients with late stage NSCLC. If validated, GSVs may define subsets of patients with different risk and prognosis of NSCLC.
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Affiliation(s)
- Abul Kalam Azad
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Xin Qiu
- Department of Biostatistics, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Boyd
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Qin Kuang
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marjan Emami
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Perera
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Prakruthi Palepu
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Devalben Patel
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zhuo Chen
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dangxiao Cheng
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ronald Feld
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Natasha B Leighl
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frances A Shepherd
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Department of Pathology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, Toronto, Ontario, Canada.
| | - Sinead Cuffe
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center/University Health Network, University of Toronto, Toronto, Ontario, Canada
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Ghiam A, Al Zahrani A, Feld R. A case of recurrent metastatic ameloblastoma and hypercalcaemia successfully treated with carboplatin and paclitaxel: long survival and prolonged stable disease. Ecancermedicalscience 2013; 7:323. [PMID: 23781278 PMCID: PMC3680230 DOI: 10.3332/ecancer.2013.323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 02/18/2013] [Indexed: 11/20/2022] Open
Abstract
We describe a case of recurrent metastatic malignant ameloblastoma to the lungs with hypercalcaemia in a 47-year-old man. The first lung metastasis was resected nine years after the initial primary, and the tumour recurred with extensive pulmonary metastases 21 years after the primary tumour was resected. This case presented with malignancy-associated hypercalcaemia, likely due to paraneoplastic syndrome, which is exceedingly unusual in association with malignant ameloblastoma. He was successfully treated with carboplatin/paclitaxel and showed the longest survival and stable disease, from the diagnosis of recurrent metastasis, recorded as a case report. This regimen is reasonably well tolerated and can be repeated safely.
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Affiliation(s)
- Af Ghiam
- Princess Margaret Hospital, University Health Network, Toronto, Canada ; Department of Radiation Oncology, University of Toronto, Canada
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