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Sawa K, Ihara Y, Imai T, Sugimoto A, Nagamine H, Ogawa K, Nakahama K, Matsumoto Y, Tani Y, Kaneda H, Mitsuoka S, Kawaguchi T, Shintani A. Lack of Association Between Immunotherapy and Improvement of Survival for Non-small Cell Lung Cancer Patients With Hemodialysis: A Nationwide Retrospective Cohort Study. Clin Lung Cancer 2024; 25:144-150.e3. [PMID: 38042690 DOI: 10.1016/j.cllc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND The number of patients undergoing hemodialysis continues to increase globally, and the incidence of cancer is high among these patients. Immune checkpoint inhibitors are widely used in patients with advanced cancer, especially non-small cell lung cancer (NSCLC); however, their effectiveness in hemodialysis patients is poorly documented. METHODS This retrospective cohort study used data from a nationwide database. Patients diagnosed with NSCLC, undergoing hemodialysis, and who started chemotherapy between September 2008 and January 2023 were included. In the intention to treat (ITT) analysis, patients were divided into immune checkpoint inhibitor (ICI) and conventional chemotherapy group, and in the chronological analysis, patients were divided into 2 groups before and after ICI approval. Overall survival (OS) was analyzed using the Kaplan-Meier method with log-rank tests and Cox proportional hazards analyses. A propensity score approach was applied to address confounding factors, and analyses were performed by weighting each patient with the inverse of the estimated propensity score. RESULTS We identified 322 and 389 patients in the ITT and chronological analyses respectively. In both analyses, there were no notable difference of OS between 2 groups (P values by log-rank test 0.933 and 0.248, respectively). The hazard ratios for OS were 0.980 (95% confidence interval [CI]: 0.678-1.415) in the ITT analysis and 0.805 (95% CI: 0.531-1.219) in the chronological analysis. CONCLUSION The ICI treatment and approval were not significantly associated with improvement of survival in patients with NSCLC undergoing hemodialysis.
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Affiliation(s)
- Kenji Sawa
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Yasutaka Ihara
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takumi Imai
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | | | - Kenji Nakahama
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Respiratory Medicine, Osaka Hospital, Japan Community of Healthcare Organization (JCHO), Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan; Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Nakahama K, Izumi M, Yoshimoto N, Fukui M, Sugimoto A, Nagamine H, Ogawa K, Sawa K, Tani Y, Kaneda H, Mitsuoka S, Watanabe T, Asai K, Kawaguchi T. Clinical significance of KL-6 in immune-checkpoint inhibitor treatment for non-small cell lung cancer. Cancer Chemother Pharmacol 2023; 92:381-390. [PMID: 37606723 DOI: 10.1007/s00280-023-04573-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Krebs von den Lungen-6 (KL-6) functions as a tumor marker, as well as a diagnostic tool for interstitial pneumonia (IP). However, the significance of KL-6 in the immune-checkpoint inhibitor (ICI) treatment of non-small cell lung cancer (NSCLC), especially in patients without IP, is unknown. METHODS This multicenter, retrospective study, which included patients with advanced NSCLC who received ICI therapy, analyzed the association between serum KL-6 values and ICI efficacy and the association between serum KL-6 values and ICI-induced interstitial lung disease (ILD) occurrence, focusing primarily on patients without IP. RESULTS In total, 322 patients had available KL-6 values before ICI therapy. Among 202 patients without IP who received ICI monotherapy, the high-KL-6 group (≥ 500 U/mL) showed significantly shorter progression-free survival (PFS) and overall survival (OS) than the low-KL-6 group (< 500 U/mL) (median: 2.1 vs. 3.6 months, p = 0.048; median: 9.2 vs. 14.5 months, p = 0.035). There was no significant difference in response rate between the KL-6 high and low groups (19% vs. 29%, p = 0.14). In the multivariate analysis, high KL-6 was a significant predictor of poor PFS (hazard ratio [HR], 1.52; 95% confidence interval [CI] 1.10-2.11, p = 0.012) and OS (HR, 1.51; 95% CI 1.07 - 2.13, p = 0.019) for patients treated with ICI monotherapy. There was no significant difference in the occurrence rate of ILD between the high KL-6 and low KL-6 groups in patients with (20% vs. 15%, p = 1.00) or without IP (12% vs. 12%, p = 1.00). CONCLUSION In ICI monotherapy for NSCLC without IP, elevated serum KL-6 levels were associated with poorer outcomes.
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Affiliation(s)
- Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
| | - Motohiro Izumi
- Department of Pulmonary Medicine, Bell Land General Hospital, Sakai, Japan
| | - Naoki Yoshimoto
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Mitsuru Fukui
- Department of Laboratory of Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Asahimachi 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Haratani K, Nakamura A, Mamesaya N, Mitsuoka S, Yoneshima Y, Saito R, Tanizaki J, Fujisaka Y, Hata A, Tsuruno K, Sakamoto T, Teraoka S, Oki M, Watanabe H, Sato Y, Nakano Y, Otani T, Sakai K, Tomida S, Chiba Y, Ito A, Nishio K, Yamamoto N, Nakagawa K, Hayashi H. Tumor Microenvironment Landscape of NSCLC Reveals Resistance Mechanisms for Programmed Death-Ligand 1 Blockade After Chemoradiotherapy: A Multicenter Prospective Biomarker Study (WJOG11518L:SUBMARINE). J Thorac Oncol 2023; 18:1334-1350. [PMID: 37364849 DOI: 10.1016/j.jtho.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION The PACIFIC regimen of consolidation therapy with the programmed cell death-ligand 1 inhibitor durvalumab after definitive concurrent chemoradiation therapy has become a standard of care for individuals with unresectable stage III NSCLC. Nevertheless, approximately half of the treated patients experience disease progression within 1 year, with the mechanisms of treatment resistance being poorly understood. We here performed a nationwide prospective biomarker study to explore the resistance mechanisms (WJOG11518L:SUBMARINE). METHODS A total of 135 patients with unresectable stage III NSCLC who received the PACIFIC regimen were included for comprehensive profiling of the tumor microenvironment by immunohistochemistry, transcriptome analysis, and genomic sequencing of pretreatment tumor tissue and flow cytometric analysis of circulating immune cells. Progression-free survival was compared on the basis of these biomarkers. RESULTS The importance of preexisting effective adaptive immunity in tumors was revealed for treatment benefit regardless of genomic features. We also identified CD73 expression by cancer cells as a mechanism of resistance to the PACIFIC regimen. Multivariable analysis of immunohistochemistry data with key clinical factors as covariables indicated that low CD8+ tumor-infiltrating lymphocyte density and the high CD73+ cancer cells were independently associated with poor durvalumab outcome (hazard ratios = 4.05 [95% confidence interval: 1.17-14.04] for CD8+ tumor-infiltrating lymphocytes; 4.79 [95% confidence interval: 1.12-20.58] for CD73). In addition, whole-exome sequencing of paired tumor samples suggested that cancer cells eventually escaped immune pressure as a result of neoantigen plasticity. CONCLUSIONS Our study emphasizes the importance of functional adaptive immunity in stage III NSCLC and implicates CD73 as a promising treatment target, thus providing insight forming a basis for development of a new treatment approach in NSCLC.
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Affiliation(s)
- Koji Haratani
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Miyagi, Japan
| | - Nobuaki Mamesaya
- Division of Thoracic Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
| | - Yasuto Yoneshima
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Junko Tanizaki
- Division of Medical Oncology, Kishiwada City Hospital, Kishiwada, Osaka, Japan
| | - Yasuhito Fujisaka
- Medical Oncology, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akito Hata
- Division of Thoracic Oncology, Kobe Minimally Invasive Cancer Center, Kobe, Hyogo, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Tomohiro Sakamoto
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Shunsuke Teraoka
- Internal Medicine III, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Hiroshi Watanabe
- Department of Respiratory Medicine, Saka General Hospital, Shiogama, Miyagi, Japan
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Yusuke Nakano
- Department of Medical Oncology, Izumi City General Hospital, Izumi, Osaka, Japan
| | - Tomoyuki Otani
- Department of Pathology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kazuko Sakai
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Shuta Tomida
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Okayama, Japan
| | - Yasutaka Chiba
- Clinical Research Center, Kindai University Hospital, Osaka-Sayama, Osaka, Japan
| | - Akihiko Ito
- Department of Pathology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Nobuyuki Yamamoto
- Internal Medicine III, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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Nagamine H, Yashiro M, Yoshimoto N, Izumi M, Sugimoto A, Nakahama K, Ogawa K, Matsumoto Y, Sawa K, Tani Y, Kaneda H, Mitsuoka S, Yamada K, Watanabe T, Aasai K, Fukumura K, Mayeda A, Kawaguchi T. RBM17 Expression Is Associated With the Efficacy of ICI Monotherapy in NSCLC With Low PD-L1 Expression. Anticancer Res 2023; 43:4663-4672. [PMID: 37772582 DOI: 10.21873/anticanres.16662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND/AIM Immune checkpoint inhibitors (ICIs) are currently a standard treatment tool for non-small cell lung cancer (NSCLC). RNA-binding motif protein 17 (RBM17), a splicing factor, is frequently over-expressed in NSCLC, but little is known about the role of RBM17 in the efficacy of ICIs for NSCLC. Thus, we investigated the correlation between RBM17 expression and ICI efficacy in NSCLC. PATIENTS AND METHODS Biopsy or surgical specimens were collected from patients with advanced or recurrent NSCLC who received ICI monotherapy or chemo-immunotherapy in a first-line setting. RBM17 expression was examined using immunohistochemistry. The correlation between the efficacy of ICI monotherapy or chemo-immunotherapy and RBM17 expression was evaluated. RESULTS Among the 218 cases, 115 (52.8%) cases were positive for RBM17 expression. RBM17 expression was not associated with the objective response rate (ORR) or progression-free survival (PFS) in either of the ICI monotherapy or chemo-immunotherapy groups. However, among those with a low PD-L1 expression level (PD-L1 <50%; n=86), RBM17 expression was significantly associated with a better ORR (p=0.045) and a better PFS (p<0.001) in the ICI monotherapy group, and was significantly associated with a poor ORR in the chemo-immunotherapy group (p=0.041). CONCLUSION RBM17 might be a useful predictive marker for a higher efficacy of ICI monotherapy in NSCLC patients with a low PD-L1 expression level.
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Affiliation(s)
- Hiroaki Nagamine
- Department of Respiratory Medicine, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Masakazu Yashiro
- Molecular Oncology and Therapeutics, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan;
| | - Naoki Yoshimoto
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Motohiro Izumi
- Department of Pulmonary Medicine, Bell land General Hospital, Sakai, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Kenji Nakahama
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Kazuhiro Yamada
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Kazuhisa Aasai
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Kazuhiro Fukumura
- Division of Gene Expression Mechanism, Center for Medical Science, Fujita Health University, Toyoake, Japan
| | - Akila Mayeda
- Division of Gene Expression Mechanism, Center for Medical Science, Fujita Health University, Toyoake, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
- Department of Clinical Oncology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
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Nakahama K, Izumi M, Yoshimoto N, Fukui M, Sugimoto A, Nagamine H, Ogawa K, Sawa K, Tani Y, Kaneda H, Mitsuoka S, Watanabe T, Asai K, Kawaguchi T. Influence of Smoking History on the Effectiveness of Immune-checkpoint Inhibitor Therapy for Non-small Cell Lung Cancer: Analysis of Real-world Data. Anticancer Res 2023; 43:2185-2197. [PMID: 37097681 DOI: 10.21873/anticanres.16381] [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: 02/20/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/AIM There is no real-world data in an Asian population to investigate the difference between the outcome of immune-checkpoint inhibitor (ICI) monotherapy and combination therapy for non-small cell lung cancer (NSCLC) based on smoking status. In this study, we investigated the correlation between smoking status and the efficacy of ICI therapy for NSCLC patients. PATIENTS AND METHODS This multicentre retrospective study enrolled patients with recurrent or metastatic NSCLC who were treated using ICI therapy between December 2015 and July 2020. We analysed the objective response rate (ORR) of patients who received ICI monotherapy or combination therapy, based on smoking status using Fisher's exact test, and progression-free survival (PFS) and overall survival (OS) based on smoking status using the Kaplan-Meier method, the log-rank test, and Cox proportional hazards model. RESULTS A total of 487 patients were included in the study. In the ICI monotherapy group, non-smokers showed significantly lower ORR and shorter PFS and OS than smokers (10% vs. 26%, p=0.002; median: 1.8 vs. 3.8 months, p<0.001; median: 8.0 vs. 15.4 months, p=0.026). In the ICI combination therapy group, non-smokers showed significantly longer OS than smokers (median: not reached vs. 26.3 months, p=0.045), and there was no significant difference in ORR and PFS between non-smokers and smokers (63% vs. 51%, p=0.43; median: 10.2 vs. 9.2 months, p=0.81). In the multivariate analysis of patients who received ICI combination therapy, the "non-smoker" status was not significantly associated with PFS [hazard ratio (HR)=1.31; 95% confidence interval (CI)=0.70-2.45, p=0.40] and OS (HR=0.40; 95% CI=0.14-1.13, p=0.083). CONCLUSION Non-smokers showed worse outcomes than smokers with ICI monotherapy, but not with ICI combination therapy.
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Affiliation(s)
- Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan;
| | - Motohiro Izumi
- Department of Pulmonary Medicine, Bell Land General Hospital, Sakai, Japan
| | - Naoki Yoshimoto
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Mitsuru Fukui
- Department of Laboratory of Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Nakahama K, Izumi M, Yoshimoto N, Fukui M, Sugimoto A, Nagamine H, Ogawa K, Sawa K, Tani Y, Kaneda H, Mitsuoka S, Watanabe T, Asai K, Kawaguchi T. Vimentin expression correlates with immune-checkpoint inhibitor efficacy in non-small cell lung cancer. Cancer 2023. [PMID: 37021822 DOI: 10.1002/cncr.34782] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/20/2023] [Accepted: 03/09/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Although vimentin is often expressed in non-small cell lung cancer (NSCLC), the association between vimentin expression and immune-checkpoint inhibitor (ICI) efficacy remains unclear. METHODS This retrospective multicenter study enrolled patients with NSCLC who received ICI treatment between December 2015 and July 2020. The authors constructed tissue microarrays and performed immunohistochemical staining with vimentin. They analyzed the relationship between vimentin expression rate and objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). RESULTS Immunohistochemically evaluable specimens on microarray blocks were available for 397 patients, of whom 343 (86%) were negative (<10%), 30 (8%) were positive (10%-49%), and 24 (6%) were highly positive (≥50%) for vimentin expression. Both rates of programmed death-ligand 1 (PD-L1) tumor proportion score ≥1% and ≥50% were significantly higher in the vimentin-positive group (≥10%) than the vimentin-negative group (<10%) (96% vs. 78%, p = .004; 64% vs. 42%, p = .006, respectively). In patients treated with ICI monotherapy, ORR, PFS, and OS were significantly better in the vimentin-positive group (10%-49%) than in the vimentin-negative group (<10%) (54% vs. 25%, p = .003, median = 7.9 vs. 3.2 months, p = .011; median = 27.0 vs. 13.6 months, p = .015, respectively), whereas there was no significant difference in PFS and OS between the vimentin highly positive group (≥50%) and the vimentin-negative group (<10%) (median = 3.4 vs. 3.2 months, p = .57; median = 7.2 vs. 13.6 months, p = .086, respectively). CONCLUSIONS Vimentin expression correlated with PD-L1 expression and ICI efficacy. PLAIN LANGUAGE SUMMARY We constructed tissue microarrays and performed immunohistochemical staining with vimentin on 397 patients with advanced non-small cell lung cancer who were treated with immune-checkpoint inhibitor (ICI). The vimentin-positive group who were treated with ICI monotherapy showed significantly better objective response rate, progression-free survival, and overall survival than the vimentin negative group. The measurement of vimentin expression will aid in determining appropriate immunotherapy strategies.
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Affiliation(s)
- Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Motohiro Izumi
- Department of Pulmonary Medicine, Bell Land General Hospital, Sakai, Japan
| | - Naoki Yoshimoto
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Mitsuru Fukui
- Department of Laboratory of Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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7
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Tani Y, Kaneda H, Koh Y, Tamiya A, Isa S, Kubo A, Ogawa K, Matsumoto Y, Sawa K, Yoshimoto N, Mitsuoka S, Kawaguchi T. The Impact of Estrogen Receptor Expression on Mutational Status in the Evolution of Non-Small Cell Lung Cancer. Clin Lung Cancer 2023; 24:165-174. [PMID: 36646585 DOI: 10.1016/j.cllc.2022.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/15/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The role of estrogen receptor (ER) status in the carcinogenesis of lung cancer and its impact on prognosis remain unclear. MATERIALS AND METHODS We previously reported a prospective, multicenter, molecular epidemiology study (Japan Molecular Epidemiology for Lung Cancer Study [JME]). We examined the relationship of ER status with reproductive and hormonal factors, mutational profile, and survival using JME study data. Patients were enrolled between July 2012 and December 2013, with follow-up until November, 2017. RESULTS Among 441 ever- and 435 never-smokers, ER expression was observed in 46.4% and 53.5%, respectively (P = .022). Hormone use and reproductive history of female patients were not associated with ER status. Mutations in EGFR (P = .003), TP53 (P = .007), and CTNNB1 (P = .027) were significantly associated with ER expression. Multivariate analysis showed that mutations in EGFR (P = .032) and CTNNB1 (P = .026) were significantly associated with ER expression, whereas TP53 mutations exhibited a trend toward significance (P = .059). Relapse-free survival (RFS) was longer in all the patients with ER-positive tumors than those with ER-negative tumors (P = .021). RFS and overall survival were longer (P = .024, P = .011, respectively) in the stage I patients with ER-positive tumors than those with ER-negative tumors. CONCLUSION ERβ expression is positively associated with EGFR mutations and negatively with TP53 and CTNNB1 mutations. ER-positive tumors can be associated with better prognosis of the patients, suggesting that ER expression with coexisting EGFR mutations and wild-type TP53 contribute to the biology of non-small cell lung cancer.
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Affiliation(s)
- Yoko Tani
- Department of Clinical Oncology, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan.
| | - Yasuhiro Koh
- Center for Biomedical Sciences, Wakayama Medical University, Wakayama City, Wakayama Prefecture, Japan; Department of Internal Medicine III, Wakayama Medical University, Wakayama City, Wakayama Prefecture, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka Prefecture, Japan
| | - Shunichi Isa
- Department of Thoracic Oncology, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka Prefecture, Japan
| | - Akihito Kubo
- Department of Medical Oncology, Oncology Center, Aichi Medical University Hospital, Nagakute City, Aichi Prefecture, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan
| | - Naoki Yoshimoto
- Department of Clinical Oncology, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan; Department of Respiratory Medicine, Ishikiri Seiki Hospital, Osaka City, Osaka Prefecture, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan
| | - Tomoya Kawaguchi
- Department of Clinical Oncology, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan; Department of Respiratory Medicine, Osaka Metropolitan University, Graduate School of Medicine, Osaka City, Osaka Prefecture, Japan
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8
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Nakahama K, Osawa M, Izumi M, Yoshimoto N, Sugimoto A, Nagamine H, Ogawa K, Matsumoto Y, Sawa K, Tani Y, Kaneda H, Mitsuoka S, Watanabe T, Asai K, Kawaguchi T. SP142 evaluation contributes to the prediction of immune checkpoint inhibitor efficacy in non-small cell lung cancer with high PD-L1 expression assessed by 22C3. Transl Lung Cancer Res 2022; 11:2438-2451. [PMID: 36636414 PMCID: PMC9830255 DOI: 10.21037/tlcr-22-496] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/23/2022] [Indexed: 12/03/2022]
Abstract
Background It remains unclear whether assessing programmed death-ligand 1 (PD-L1) expression by SP142 plus 22C3 adds value for predicting the response to immunotherapy in non-small cell lung cancer (NSCLC). Methods This retrospective multicenter study included patients with advanced NSCLC treated with immune-checkpoint inhibitors. We constructed tissue microarrays (TMAs) and performed immunohistochemical staining with 22C3 and SP142 assays. We denoted the PD-L1 tumor proportion score (TPS) obtained from clinical medical records based on 22C3 staining as "22C3 (C)" and that obtained with 22C3 staining using our TMA as "22C3 (TMA)". SP142 staining was evaluated in both tumor cells and immune cells. We assessed the concordance between each PD-L1 assessment method and analyzed the objective response rate (ORR), progression-free survival (PFS) and overall survival (OS) based on the PD-L1 expression level determined using the 22C3 and SP142 assays. Results In total, 288 patients were included. Among those with 22C3 (TMA) ≥50%, 60% of patients showed SP142 TC3 or IC3; among patients with 22C3 (C) <1%, 9% and 18% exhibited 22C3 (TMA) ≥1% and SP142 TC1/2/3 or IC1/2/3, respectively. Among patients with 22C3 (C) ≥50% treated with immune-checkpoint inhibitor monotherapy, the SP142 TC1/2/3 or IC1/2/3 group showed significantly better ORR, PFS and OS than the SP142 TC0 and IC0 group (54% vs. 29%, P=0.040, median =11.0 vs. 3.2 months, P=0.002, median =27.9 vs. 12.6 months, P=0.030, respectively). Multivariate analysis revealed that SP142 TC0 and IC0 was an independent unfavorable prognostic factor for PFS and OS in patients with 22C3 (C) ≥50% treated with immune-checkpoint inhibitor monotherapy. For those with 22C3 (C) ≥50% and SP142 TC0 and IC0, immune-checkpoint inhibitor concurrent with chemotherapy tended to result in a longer PFS and OS than immune-checkpoint inhibitor monotherapy (median =13.7 vs. 2.3 months, P=0.054, median = not estimable vs. 12.0 months, P=0.064, respectively). Conclusions SP142 evaluation contributes to the prediction of immune-checkpoint inhibitor efficacy in NSCLC with high PD-L1 expression assessed by 22C3.
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Affiliation(s)
- Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masahiko Osawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Motohiro Izumi
- Department of Pulmonary Medicine, Bell land General Hospital, Sakai, Japan
| | - Naoki Yoshimoto
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan;,Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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9
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Nakahama K, Kaneda H, Osawa M, Izumi M, Yoshimoto N, Sugimoto A, Nagamine H, Ogawa K, Matsumoto Y, Sawa K, Tani Y, Mitsuoka S, Watanabe T, Asai K, Kawaguchi T. Association of thyroid transcription factor-1 with the efficacy of immune-checkpoint inhibitors in patients with advanced lung adenocarcinoma. Thorac Cancer 2022; 13:2309-2317. [PMID: 35808895 PMCID: PMC9376174 DOI: 10.1111/1759-7714.14560] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background We aimed to identify the relationship between thyroid transcription factor‐1 (TTF‐1) expression of lung adenocarcinoma and the efficacy of immune‐checkpoint inhibitor (ICI) therapy. Methods This retrospective multicenter study comprised patients with advanced lung adenocarcinoma treated with ICI monotherapy. We collected clinical medical records including data on TTF‐1 expression and analyzed the relationship between TTF‐1 expression and programmed death‐ligand 1 tumor proportion score (PD‐L1 TPS), objective response rate (ORR), progression‐free survival (PFS), and overall survival (OS). Results In total, 108 patients with lung adenocarcinoma were analyzed. The rate of TPS ≥1% and ≥50% in patients with positive TTF‐1 expression was significantly higher than that in patients with negative TTF‐1 expression (88% vs. 60%, p < 0.001; 65% vs. 24%, p < 0.001). The ORR was significantly higher in TTF‐1 positive patients than in TTF‐1‐negative patients (38% vs. 8%, p = 0.003). Among patients with TPS ≥50% and 1%–49%, the ORR in TTF‐1 positive and negative patients was 48% (26/54) versus 17% (1/6) (p = 0.21), and 32% (6/19) versus 11% (1/9) (p = 0.37), respectively. The ORR for patients with TPS <1% was 0% in both the TTF‐1 negative and positive cases. The median PFS and OS was significantly longer in TTF‐1‐positive patients than in TTF‐1‐negative patients (5.4 vs. 1.6 months, p < 0.001; 18.2 vs. 8.0 months, p = 0.041). Multivariate analysis revealed that TTF‐1‐negative status was an independent unfavorable prognostic factor for PFS. Conclusion Patients with TTF‐1‐positive status receiving ICI monotherapy showed better outcomes than those with TTF‐1‐negative lung adenocarcinoma.
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Affiliation(s)
- Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masahiko Osawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Motohiro Izumi
- Department of Pulmonary Medicine, Bell land General Hospital, Sakai, Japan
| | - Naoki Yoshimoto
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.,Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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10
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Nagamine H, Sawa K, Kaneda H, Ogawa K, Nakahama K, Matsumoto Y, Tani Y, Mitsuoka S, Kimura T, Kawaguchi T. P28-11 The therapeutic efficacy of osimertinib in non-small cell lung cancer with malignant pleural effusion. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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11
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Nakahama K, Kaneda H, Osawa M, Fukui M, Izumi M, Yoshimoto N, Sugimoto A, Nagamine H, Ogawa K, Matsumoto Y, Sawa K, Tani Y, Mitsuoka S, Watanabe T, Asai K, Kawaguchi T. Vascular endothelial growth factor receptor 2 expression and immunotherapy efficacy in non-small cell lung cancer. Cancer Sci 2022; 113:3148-3160. [PMID: 35722982 PMCID: PMC9459341 DOI: 10.1111/cas.15464] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022] Open
Abstract
It is unclear whether tumor vascular endothelial growth factor receptor 2 expression affects the therapeutic efficacy of immune‐checkpoint inhibitors and antiangiogenic agents. This retrospective, multicenter study included patients with advanced non–small cell lung cancer who were treated with immune‐checkpoint inhibitors. We constructed tissue microarrays and performed immunohistochemistry with an anti‐vascular endothelial growth factor receptor 2 antibody. We analyzed immune and tumor cell staining separately in order to determine their correlation with the objective response rate, progression‐free survival, and overall survival in patients receiving immune‐checkpoint inhibitors. Of 364 patients, 37 (10%) expressed vascular endothelial growth factor receptor 2 in immune cells and 165 (45%) in tumor cells. The objective response rate, progression‐free survival, and overall survival were significantly worse in patients treated with immune checkpoint inhibitor monotherapy who expressed vascular endothelial growth factor receptor 2 in immune cells than those who did not (10% vs 30%, p = 0.028; median = 2.2 vs 3.6 months, p = 0.012; median = 7.9 vs 17.0 months, p = 0.049, respectively), while there was no significant difference based on tumor cell expression (24% vs 30%, p = 0.33; median = 3.1 vs 3.5 months, p = 0.55; median = 13.6 vs 16.8 months, p = 0.31). There was no significant difference in overall survival between patients treated with and without antiangiogenic agents in any treatment period based on vascular endothelial growth factor receptor 2 expression. Immune checkpoint inhibitor efficacy was limited in patients expressing vascular endothelial growth factor receptor 2 in immune cells.
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Affiliation(s)
- Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Japan
| | - Masahiko Osawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Osaka Metropolitan University, Japan
| | - Mitsuru Fukui
- Department of Laboratory of Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Motohiro Izumi
- Department of Pulmonary Medicine, Bell land General Hospital, Sakai, Japan
| | - Naoki Yoshimoto
- Department of Pulmonary Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan
| | - Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Japan.,Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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12
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Nakahama K, Kaneda H, Ogawa K, Matsumoto Y, Tani Y, Suzumura T, Mitsuoka S, Watanabe T, Asai K, Kawaguchi T. Safe Concurrent Use of Anti-tuberculosis Drugs and Pembrolizumab in a Patient with Non-small-cell Lung Cancer Who Was Infected with Mycobacterium tuberculosis. Intern Med 2022; 61:1039-1042. [PMID: 35370247 PMCID: PMC9038460 DOI: 10.2169/internalmedicine.6811-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A 68-year-old Japanese man was diagnosed with lung adenocarcinoma stage IVB. We introduced a first-line chemotherapy of four cycles of carboplatin and pemetrexed and pembrolizumab, followed by pemetrexed and pembrolizumab maintenance therapy. Approximately four months after anticancer therapy, a small nodule appeared in the right peripheral S3 lesion. After five months, the nodule was confirmed as a Mycobacterium tuberculosis (TB) nodule. We initiated anti-TB therapy without stopping pembrolizumab, and the right S3 nodule shrank immediately. This report supports the concurrent use of anti-TB treatment with an immune checkpoint inhibitor when the TB infection area is limited.
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Affiliation(s)
- Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
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13
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Kaneda H, Sawa K, Daga H, Okada A, Nakatani Y, Atagi S, Okishio K, Tani Y, Matsumoto Y, Ogawa K, Nakahama K, Izumi M, Mitsuoka S, Kawaguchi T. Phase 1b study of ramucirumab in combination with erlotinib or osimertinib for untreated EGFR-mutated non-small cell lung cancer patients with asymptomatic brain metastases. Invest New Drugs 2021; 39:1598-1603. [PMID: 34215931 DOI: 10.1007/s10637-021-01147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study was designed to investigate the safety of ramucirumab administered in combination with erlotinib or osimertinib for patients with untreated EGFR-mutated non-small cell lung cancer (NSCLC) and asymptomatic brain metastases, a patient subgroup in which these regimens have remained untested. MATERIALS AND METHODS This phase 1b study (RELAY-Brain) consisted of two cohorts with three patients each. Patients with asymptomatic brain metastases received ramucirumab every 2 weeks plus either daily oral erlotinib or osimertinib until disease progression or intolerable toxicity. The primary objective was to assess dose-limiting toxicity (DLT), defined as central nervous system (CNS) hemorrhage of grade ≥ 2. RESULTS Six patients were enrolled. Neither DLT nor serious or unexpected adverse events were observed. One treatment-related adverse event of grade ≥ 3 (hypertension of grade 3) was apparent. Common adverse events were generally manageable. The median number of ramucirumab administrations was 18.5 (range, 13 to 31), and there were no detected episodes of CNS hemorrhage. Five of the six patients showed an objective systemic response. Although only one patient had a measurable CNS lesion at baseline, a confirmed intracranial partial response was observed. CONCLUSION Ramucirumab in combination with erlotinib or osimertinib showed safety for EGFR-mutated NSCLC with brain metastases.
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Affiliation(s)
- Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Haruko Daga
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Asuka Okada
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Yuki Nakatani
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
| | - Shinji Atagi
- Department of Thoracic Oncology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Kyoichi Okishio
- Department of Thoracic Oncology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Motohiro Izumi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tomoya Kawaguchi
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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14
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Oku A, Nakai K, Ikenaga T, Sato K, Mitsuoka S, Takahashi S, Tanoue K, Sawada A, Nagami Y, Tsuruta D. Case of afatinib-induced severe purpuric drug eruption with gastrointestinal bleeding. J Dermatol 2021; 48:e534-e535. [PMID: 34390023 DOI: 10.1111/1346-8138.16088] [Citation(s) in RCA: 1] [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] [Received: 05/20/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Aoi Oku
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kozo Nakai
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuhiko Ikenaga
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kanako Sato
- Department of Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Respiratory Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shunsuke Takahashi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kojiro Tanoue
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akinari Sawada
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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15
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Katayama H, Mizusawa J, Fukuda H, Nakamura S, Nakamura K, Saijo N, Yokoyama A, Ohe Y, Shinkai T, Nakagawa K, Abe T, Mitsuoka S, Okamoto H, Yamamoto N, Yoshioka H, Ando M, Tamura T, Takeda K. Prognostic impact of geriatric assessment in elderly patients with non-small cell lung cancer: an integrated analysis of two randomized phase III trials (JCOG1115-A). Jpn J Clin Oncol 2021; 51:685-692. [PMID: 33479759 DOI: 10.1093/jjco/hyaa257] [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: 09/18/2020] [Accepted: 12/13/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Patients' actual age and performance status do not always accurately identify the 'fit elderly' for chemotherapy. This study aimed to determine whether four geriatric assessment tools could predict prognosis. METHODS This study were analyzed using the data of two randomized phase III trials (JCOG0207 and JCOG0803/WJOG4307L) for elderly patients with advanced non-small cell lung cancer and included all eligible patients who were assessed before treatment with four geriatric assessment tools: the Barthel activities of daily living index, Lawton instrumental activities of daily living scale, Mini-Mental State Examination, and Geriatric Depression Scale-15. Univariable and multivariable analyses for overall survival, adjusted for baseline factors, were performed using a stratified Cox regression model with treatment regimen as strata. RESULTS This analysis included 330 patients aged 70-74, 75-79 or 80 or more (n = 95/181/54), with a performance status of 0 or 1 (n = 119/211). Patients were divided into three groups based on Mini-Mental State Examination and two groups based on Geriatric Depression Scale, but over 80% of patients had perfect scores for both activities of daily living and instrumental activities of daily living. In overall survival subgroup analyses by GA tool, only Mini-Mental State Examination scores were associated with substantial outcome differences (median survival times: 21.2, 13.5 and 12.2 months for scores 30, 29-24 and ≤23). After adjusting for baseline factors, the Mini-Mental State Examination, sex and performance status were tended to be worse overall survival. CONCLUSION MMSE scores, performance status and sex, but not chronological age, effectively predicted the prognosis of elderly patients. Further studies should confirm that the Mini-Mental State Examination is useful for determining the indication of chemotherapy in elderly patients with advanced non-small cell lung cancer.
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Affiliation(s)
- Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kenich Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Nagahiro Saijo
- Department of Medical Oncology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Akira Yokoyama
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yuichro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsu Shinkai
- Department of Medicine and Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Tetsuya Abe
- Department of Respiratory Medicine, Niigata City General Hospital, Niigata, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Japan
| | - Nobuyuki Yamamoto
- Internal Medicine III, Wakayama Medical University Hospital, Wakayama, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, Hirakata, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Tomohide Tamura
- Thoracic Center, St. Luke's International Hospital, Tokyo, Japan
| | - Koji Takeda
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan
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16
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Izumi M, Sawa K, Oyanagi J, Noura I, Fukui M, Ogawa K, Matsumoto Y, Tani Y, Suzumura T, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Nishiyama N, Ohsawa M, Yamamoto N, Koh Y, Kawaguchi T. Tumor microenvironment disparity in multiple primary lung cancers: Impact of non-intrinsic factors, histological subtypes, and genetic aberrations. Transl Oncol 2021; 14:101102. [PMID: 33930847 PMCID: PMC8102176 DOI: 10.1016/j.tranon.2021.101102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/01/2021] [Revised: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 12/11/2022] Open
Abstract
Tumor microenvironment (TME) was compared among multiple primary lung cancers (MPLCs). Sex and smoking status concomitantly impacted PD-L1 expression in paired tumors. EGFR mutations were independently associated with PD-L1 expression. KRAS mutations altered the TMEs according to the types of co-mutations. The number of FOXP3-positive t cells reflected histological subtypes.
Introduction Multiple primary lung cancers (MPLCs) occur in common carcinogenetic risks such as lifestyle, biological aging, immune responses, hormones, and metabolism. Although MPLCs harbor various genetic profiles within the same individuals, differences in the tumor microenvironment (TME) are unclear. We investigated the impact of genetic aberrations, non-intrinsic factors, and pathological subtypes on tumor immunity. Materials and Methods In total, 73 surgically resected specimens from 32 patients with MPLC were analyzed. PD-L1 expression in tumor cells (TCs) and immune cells (ICs), CD3-positive tumor-infiltrating lymphocytes (TILs), CD8/CD3 ratios, and FOXP3-positive TILs that compose TMEs were evaluated by immunohistochemistry and classified on a score of 0–2. 38 tumors were sequenced for somatic mutations in 409 cancer-associated genes. Results Females and never or light smokers had a higher incidence of PD-L1-negative tumors and a higher concordance rate. PD-L1 positivity in TCs and ICs was significantly less frequent in EGFR-mutated than in wild-type tumors. Differences in the score of TMEs were observed between the KRAS-mutated-only tumor and the KRAS and TP53-co-mutated tumors, and between the KRAS-mutated-only tumor and the KRAS and STK11-co-mutated tumors. Significantly more FOXP3-high TILs were observed in invasive pathological subtypes than in non-invasive ones. Conclusion Comparing TMEs among MPLCs revealed that non-smokers or light smokers and females were unlikely to express PD-L1 regardless of tumor site and confirmed that the EGFR mutations and co-occurring KRAS and STK11 or TP53 mutations were associated with TME. Pathological subtypes may impact the efficacy of immune therapy due to their potential correlations with regulatory T cells.
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Affiliation(s)
- Motohiro Izumi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan; Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama 641-8509, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Jun Oyanagi
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama 641-8509, Japan
| | - Ikue Noura
- Department of Pathology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Noritoshi Nishiyama
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Nobuyuki Yamamoto
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama 641-8509, Japan
| | - Yasuhiro Koh
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama 641-8509, Japan.
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan; Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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17
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Izumi M, Oyanagi J, Sawa K, Fukui M, Ogawa K, Matsumoto Y, Tani Y, Suzumura T, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Ohsawa M, Yamamoto N, Koh Y, Kawaguchi T. Mutational landscape of multiple primary lung cancers and its correlation with non-intrinsic risk factors. Sci Rep 2021; 11:5680. [PMID: 33707471 PMCID: PMC7952588 DOI: 10.1038/s41598-021-83609-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/01/2020] [Indexed: 12/31/2022] Open
Abstract
Multiple primary lung cancers (MPLCs) harbour various genetic profiles among the tumours, even from individuals with same non-intrinsic risk factors. Paired mutational analyses were performed to obtain a census of mutational events in MPLC and assess their relationship with non-intrinsic risk factors. Thirty-eight surgical specimens from 17 patients diagnosed as MPLC were used. Extracted DNAs were sequenced for somatic mutations in 409 cancer-associated genes from a comprehensive cancer panel. We statistically analysed the correlation between each driver mutation frequency and non-intrinsic risk factors using Fisher's exact test, and whether genetic mutations occurred concomitantly or randomly in MPLC using an exact test. Comprehensive genetic analyses suggested different mutation profiles in tumours within the same individuals, with some exceptions. EGFR, KRAS, TP53, or PARP1 mutations were concomitantly detected in some MPLC cases. EGFR mutations were significantly more frequent in never or light smokers and females. Concomitant EGFR or KRAS mutations in MPLCs were significantly more frequent than expected by chance (P = .0023 and .0049, respectively) suggesting a more prominent role of non-intrinsic risk factors in EGFR and KRAS mutations than other mutations, which occurred more randomly. Concomitant EGFR or KRAS mutations were particularly prominent in never or light smokers and males.
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Affiliation(s)
- Motohiro Izumi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Jun Oyanagi
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan
| | - Masahiko Ohsawa
- Department of Pathology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Nobuyuki Yamamoto
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
| | - Yasuhiro Koh
- Internal Medicine III, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan.
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-cho, Abeno-ku, Osaka, 545-8585, Japan.
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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18
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Izumi M, Sawa K, Oyanagi J, Noura I, Fukui M, Ogawa K, Matsumoto Y, Tani Y, Suzumura T, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Ohsawa M, Yamamoto N, Kawaguchi T, Koh Y. P72.03 Tumor Microenvironment Disparity in Multiple Primary Lung Cancers. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Izumi M, Suzumura T, Ogawa K, Matsumoto Y, Sawa K, Yoshimoto N, Tani Y, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Kawaguchi T. Differences in molecular epidemiology of lung cancer among ethnicities (Asian vs. Caucasian). J Thorac Dis 2020; 12:3776-3784. [PMID: 32802457 PMCID: PMC7399397 DOI: 10.21037/jtd.2019.08.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Differences in carcinogenesis and therapeutic efficacy according to ethnicity have been reported for lung cancer, and understanding differences in genetic mutation profiles among ethnicities is important for interpreting the results of clinical trials, preventing carcinogenesis, and individualizing treatment. However, no studies have focused on differences in mutation profiles among different ethnicities using large-scale genomic analysis data with detailed information on smoking history, the main cause of lung cancer. Methods To clarify the differences in genetic mutation profiles between Caucasian and Japanese subjects, we compared data from The Cancer Genome Atlas, which mainly included Caucasians, with results from the Japan Molecular Epidemiology for lung cancer study, which is an epidemiological study only involving Japanese subjects. We divided the participants into four groups according to smoking status and performed comparative analysis by tissue type (lung adenocarcinoma and squamous cell lung cancer). Results In patients with lung adenocarcinoma, the frequency of EGFR mutations was lower in Caucasian subjects than in Japanese subjects (14.6% vs. 51.1%), whereas the frequencies of mutations in other genes, namely KRAS (32.9% vs. 9.3%), TP53 (45.2% vs. 20.7%), BRAF (9.6% vs. 1.3%), PIK3CA (5.9% vs. 2.6%), KEAP1 (17.8% vs. 0.5%), NF1 (10.9% vs. 0.5%), STK11 (17.8% vs. 0.7%), RBM10 (8.7% vs. 0.1%), and MET (7.8% vs. 0.1%), were higher in Caucasian subjects. Among patients with squamous cell carcinoma, TP53 (81.2% vs. 49.1%), PIK3CA (14.5% vs. 6.8%), KEAP1 (12.7% vs. 0.9%), and NFE2L2 mutations (15.8% vs. 13.6%) were more common in Caucasian subjects. Conclusions Ethnicity is an important and complex characteristic that must be recognized and considered, even in the era of precision medicine. We should collaborate to share data for different ethnicities and incorporate them into clinical practice and the design of global clinical studies. Carefully designed molecular epidemiological studies focusing on ethnic differences are warranted.
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Affiliation(s)
- Motohiro Izumi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Naoki Yoshimoto
- Department of Respiratory Medicine, Ishikiriseiki Hosipital, Higashiosaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.,Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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20
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Tani Y, Koh Y, Tamiya A, Isa SI, Kubo A, Ando M, Saka H, Izumi M, Ogawa K, Matsumoto Y, Sawa K, Yoshimoto N, Suzumura T, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Kawaguchi T. The impact of estrogen receptor status on EGFR/TP53/ CTNNB1 axis in the evolution of non-small cell lung cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21035] [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
e21035 Background: The role of estrogen receptor status in the carcinogenesis of lung cancer remains elusive. A census of clonal and sub-clonal mutations has been defined through the analyses of evolutionary histories of cancers. We previously reported a prospective multicenter molecular epidemiology study (JME study; Kawaguchi T, J Clin Oncol 2016), which included the expression levels of estrogen receptors β (ER) using immunohistochemistry(IHC) and the mutational profile using next generation sequencing as well as solid smoking information and reproductive/ hormonal risk factors from the detailed questionnaire. Methods: Utilizing the data of the JME study, the impact of ER in lung cancer development was explored. All the patients underwent surgery. In 441 ever- and 435 never-smokers, ER were observed in 46.4% and 53.5%, respectively. The cancer-associated 72 gene mutations and 5 gene amplifications examined in this study included EGFR, SMAD4, APC, FBXW7, BRAF, STK11, PIK3CA, TP53, PTEN, KRAS, CTNNB1, NFE2L2, NF1, and MET. ALK fusion was detected by IHC. Patients were enrolled between July 2012 and December 2013, with follow up until November 30th, 2017.Cox proportional hazards models were used to assess the ER expression on relapse free survival (RFS) and overall survival (OS). A logistic regression model was applied to assess the impact of ER (positive vs. negative) on gene alterations, using sex, smoking history, age and stage as independent variables. Results: ER expression was significantly higher in never smokers (vs. ever smokers; p = 0.022) and earlier stage (stage I vs. II-IV; p = 0.002). Patients with ER positive tumors had a longer RFS than those with negative tumors (RFS rate at 4 years: 33.7 vs. 26.5%; p = 0.021), however, there was no significant difference in OS between the two groups (p = 0.108). In the impact of ER status on the gene alterations, mutations in EGFR (p = 0.003), TP53 (p = 0.007) and CTNNB1 (p = 0.027) were significantly associated with ER expression. Multivariate analysis showed that EGFR mutations (OR = 1.394, 95%CI: 1.029-1.890, p = 0.032) and CTNNB1 mutations (OR = 0.272, 95%CI: 0.087-0.853, p = 0.026) were significantly associated with ER expression, while there was a trend for significance with TP53 mutations (OR = 0.737, 95%CI: 0.537-1.011, p = 0.059). Conclusions: ER positive status triggered the clonal EGFR mutations and suppressed the sub-clonal mutations of TP53 and CTNNB1. It is suggested that ER plays a critical role in the alterations of EGFR/TP53/ CTNNB1 axis in lung cancer evolution.
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Affiliation(s)
- Yoko Tani
- Department of Clinical Oncology, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Koh
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Akihiro Tamiya
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Shun-ichi Isa
- Department of Thoracic Oncology, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Akihito Kubo
- Division of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Nagakute, Japan
| | | | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Motohiro Izumi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Naoki Yoshimoto
- Department of Clinical Oncology, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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21
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Ogawa K, Kaneda H, Kawamoto T, Tani Y, Izumi M, Matsumoto Y, Sawa K, Suzumura T, Watanabe T, Mitsuoka S, Asai K, Kawaguchi T. Early-onset meningitis associated with atezolizumab treatment for non-small cell lung cancer: case report and literature review. Invest New Drugs 2020; 38:1901-1905. [PMID: 32399862 DOI: 10.1007/s10637-020-00947-w] [Citation(s) in RCA: 3] [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: 03/13/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have improved the overall survival of many patients with advanced cancers. However, unlike cytotoxic and targeted drugs, ICIs may cause various immune-related adverse events (irAEs). Among these irAEs, autoimmune meningitis is very rare. Here, we report a case of early-onset, atezolizumab-induced meningitis after administration of one dose of atezolizumab. A 56-year-old man with lung adenocarcinoma had received seventh-line treatment with atezolizumab when he experienced dysarthria. Blood examinations, including the measurement of electrolytes, glucose, and organ functions, were unremarkable, but enhanced head magnetic resonance imaging T1-weighted images showed meningeal enhancement. Although cerebral spinal fluid (CSF) examinations revealed elevated lymphocyte and protein levels, no cancer cells were detected in the CSF. CSF cultures and serological tests, including polymerase chain reaction for herpes simplex virus, were negative. The patient was therefore diagnosed with atezolizumab-triggered autoimmune meningitis. With steroid treatment, the patient's clinical and neurological state improved immediately and he recovered to baseline conditions. Prompt diagnosis and therapeutic intervention are essential for the effective treatment of autoimmune meningitis.
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Affiliation(s)
- Koichi Ogawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan.
| | - Tamaki Kawamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Motohiro Izumi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan.,Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, 545-8585, Osaka, Japan
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22
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Seto T, Azuma K, Yamanaka T, Sugawara S, Yoshioka H, Wakuda K, Atagi S, Iwamoto Y, Hayashi H, Okamoto I, Saka H, Mitsuoka S, Fujimoto D, Nishino K, Horiike A, Daga H, Sone T, Yamamoto N, Nakagawa K, Nakanishi Y. Randomized Phase III Study of Continuation Maintenance Bevacizumab With or Without Pemetrexed in Advanced Nonsquamous Non-Small-Cell Lung Cancer: COMPASS (WJOG5610L). J Clin Oncol 2019; 38:793-803. [PMID: 31880966 DOI: 10.1200/jco.19.01494] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Patients with non-small-cell lung cancer (NSCLC) have been shown to benefit from maintenance therapy. COMPASS evaluated the efficacy and safety of bevacizumab with or without pemetrexed as continuation maintenance therapy after carboplatin, pemetrexed, and bevacizumab induction therapy. PATIENTS AND METHODS Patients with untreated advanced nonsquamous NSCLC without confirmed EGFR 19 deletion or L858R mutation received first-line therapy with carboplatin area under the curve 6, pemetrexed 500 mg/m2, and bevacizumab 15 mg/kg once every 3 weeks for 4 cycles. Patients without disease progression during the induction therapy were randomly assigned 1:1 for maintenance therapy with pemetrexed 500 mg/m2 plus bevacizumab 15 mg/kg or bevacizumab 15 mg/kg once every 3 weeks until disease progression or unacceptable toxicity. The primary end point was overall survival (OS) after random assignment. RESULTS Between September 2010 and September 2015, 907 patients received induction therapy. Of those, 599 were randomly assigned: 298 received pemetrexed plus bevacizumab, and 301 received bevacizumab. The median OS was 23.3 v 19.6 months (hazard ratio [HR], 0.87; 95% CI, 0.73 to 1.05; 1-sided stratified log-rank P = .069). In the wild-type EGFR subset, the OS HR was 0.82 (95% CI, 0.68 to 0.99; 1-sided unstratified log-rank P = .020). The median progression-free survival (PFS) was 5.7 v 4.0 months (HR, 0.67; 95% CI, 0.57 to 0.79; 2-sided log-rank P < .001). The safety data were consistent with previous reports of treatment regimens. CONCLUSION In terms of the primary end point of OS, no statistically significant benefit was observed; however, PFS in the total patient population and OS in patients with wild-type EGFR was prolonged with the addition of pemetrexed to bevacizumab maintenance therapy.
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Affiliation(s)
- Takashi Seto
- National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Koichi Azuma
- Kurume University School of Medicine, Kurume, Japan
| | | | | | | | | | - Shinji Atagi
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | | | | | - Isamu Okamoto
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideo Saka
- National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | | | | | | | - Atsushi Horiike
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Tsuboi M, Zenke Y, Chiba Y, Satouchi M, Mitsuoka S, Shimizu J, Daga H, Fujimoto D, Mori M, Aoki T, Sawa T, Omori S, Saka H, Iwamoto Y, Okuno M, Hirashima T, Kashiwabara K, Tachihara M, Yamamoto N, Nakagawa K. Histological type analysis of 10-year follow-up of WJTOG0105: A phase III study comparing second- and third-generation regimens with concurrent thoracic radiotherapy in unresectable stage III non-small cell lung cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz436.004] [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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24
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Zenke Y, Tsuboi M, Chiba Y, Satouchi M, Mitsuoka S, Shimizu J, Daga H, Fujimoto D, Mori M, Aoki T, Sawa T, Omori S, Saka H, Iwamoto Y, Okuno M, Hirashima T, Kshiwabara K, Tachihara M, Yamamoto N, Nakagawa K. Phase III study comparing second- and third-generation regimens with concurrent thoracic radiotherapy in patients with unresectable stage III non-small cell lung cancer: 10-year follow-up of West Japan thoracic oncology group WJTOG0105. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259.001] [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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25
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Matsumoto Y, Sawa K, Fukui M, Oyanagi J, Izumi M, Ogawa K, Suzumura T, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Kimura T, Yamamoto N, Koh Y, Kawaguchi T. Impact of tumor microenvironment on the efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors in patients with EGFR-mutant non-small cell lung cancer. Cancer Sci 2019; 110:3244-3254. [PMID: 31368625 PMCID: PMC6778652 DOI: 10.1111/cas.14156] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022] Open
Abstract
We retrospectively investigated the impact of the tumor microenvironment (TME) on the efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) as first-line treatment in 70 patients with advanced EGFR-mutant non-small cell lung cancer and who were seen at Osaka City University Hospital (Osaka, Japan) between August 2013 and December 2017. Using immunohistochemical staining with 28-8 and D7U8C Abs, the tumor proportion score was assessed for programmed cell death-1 ligand-1 (PD-L1), as high (50% or more) or low (less than 50%), and ligand-2 (PD-L2) expression, respectively. The extent of CD8+ tumor-infiltrating lymphocytes was evaluated on a scale of 0-3, with 0-1 as low and 2-3 as high. The TME of the 52 evaluable pretreatment specimens was categorized into 4 subtypes, according to the respective PD-L1 tumor proportion and CD8+ scores, as follows: (a) high/high (13.5%, n = 7); (b) low/low (42.3%, n = 22); (c) high/low (17.3%, n = 9); and (d) low/high (26.9%, n = 14). Expression of PD-L2 was significantly the highest in type 1 (57.1% vs 4.5% vs 11.1% vs 7.1%, respectively; P = .0090). Response rate was significantly the lowest in type 1 (14.3% vs 81.8% vs 66.7% vs 78.6%, respectively; P = .0085). Progression-free survival was the shortest in type 1 and the longest in type 4 (median, 2.4 vs 11.3 vs 8.4 vs 17.5 months, respectively; P = .00000077). The efficacy of EGFR-TKIs differed according to the TME, and the phenotype with high PD-L1 and CD8+ expression might be the subset that would poorly benefit from such treatment.
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Affiliation(s)
- Yoshiya Matsumoto
- Department of Respiratory MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
- Internal Medicine IIIWakayama Medical UniversityWakayamaJapan
| | - Kenji Sawa
- Department of Respiratory MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Mitsuru Fukui
- Laboratory of StatisticsGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Jun Oyanagi
- Internal Medicine IIIWakayama Medical UniversityWakayamaJapan
| | - Motohiro Izumi
- Department of Respiratory MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Koichi Ogawa
- Department of Respiratory MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Tomohiro Suzumura
- Department of Clinical OncologyGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Tetsuya Watanabe
- Department of Respiratory MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Hiroyasu Kaneda
- Department of Clinical OncologyGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Shigeki Mitsuoka
- Department of Clinical OncologyGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Kazuhisa Asai
- Department of Respiratory MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
| | - Tatsuo Kimura
- Department of Premier Preventive MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
| | | | - Yasuhiro Koh
- Internal Medicine IIIWakayama Medical UniversityWakayamaJapan
| | - Tomoya Kawaguchi
- Department of Respiratory MedicineGraduate School of MedicineOsaka City UniversityOsakaJapan
- Department of Clinical OncologyGraduate School of MedicineOsaka City UniversityOsakaJapan
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26
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Yamamoto N, Watanabe T, Yamada K, Nakai T, Suzumura T, Sakagami K, Yoshimoto N, Sato K, Tanaka H, Mitsuoka S, Asai K, Kimura T, Kanazawa H, Hirata K, Kawaguchi T. Efficacy and safety of ultrasound (US) guided percutaneous needle biopsy for peripheral lung or pleural lesion: comparison with computed tomography (CT) guided needle biopsy. J Thorac Dis 2019; 11:936-943. [PMID: 31019783 DOI: 10.21037/jtd.2019.01.88] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Ultrasound (US)-guided percutaneous needle biopsy is a useful diagnostic technique with short examination time and real-time monitoring at the bedside. However, there are only a few studies that report on thoracic lesions, whereas the computed tomography (CT)-guided biopsy is well established. There is also limited data comparing US- and CT-guided biopsy. We aimed to clarify the efficacy and safety of US-guided biopsy for thoracic lesions adjacent to the chest wall. Methods We retrospectively enrolled consecutive patients who underwent US- or CT-guided percutaneous biopsies for thoracic lesions adjacent to the chest wall between April 2012 and December 2017. Clinical characteristics, lesion size, lesion-pleura contact arc length (LPCAL), diagnostic rate, and complications were compared between the 2 groups. Results This study enrolled 61 US-guided and 70 CT-guided biopsies. No significant difference was found in age or sex. The lesion size and LPCAL in the US-guided group were significantly larger than those in the CT-guided group (P<0.0001). The diagnostic rate was marginally higher in the US-guided group (93.4%) than in the CT-guided group (84.3%) (P=0.101). When the median cut-off of the LPCAL was defined as 40 mm in all cases, the diagnostic rate for lesion size >40 mm was significantly higher in the US-guided group than in the CT-guided group (P=0.009). Complication rates were significantly lower in the US-guided group (3.3%) than in the CT-guided group (24.3%) (P<0.001). Conclusions US-guided percutaneous needle biopsy for thoracic lesions adjacent to the chest wall is a feasible technique compared with CT-guided biopsy because of its higher diagnostic rate with a longer LPCAL and reduced complications.
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Affiliation(s)
- Norio Yamamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuhiro Yamada
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Toshiyuki Nakai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuki Sakagami
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Naoki Yoshimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kanako Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hidenori Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tatsuo Kimura
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Matsumoto Y, Sawa K, Oyanagi J, Fukui M, Yoshimoto N, Suzumura T, Mitsuoka S, Asai K, Kimura T, Yamamoto N, Kawaguchi T, Hirata K, Koh Y. Abstract 2613: Predictive impact of low-frequency pretreatment T790M mutation in patients with EGFR-mutated non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-2613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: T790M mutation in EGFR accounts for nearly 50% of the acquired mechanism of resistance to EGFR-tyrosine kinase inhibitors (TKIs). Previous studies suggested that EGFR T790M mutation was also detected in a considerable number of EGFR-TKI-naïve non-small-cell lung cancer (NSCLC) patients utilizing ultrasensitive detection methods such as droplet digital PCR (ddPCR). Here we investigated the significance of low-frequency pretreatment EGFR T790M mutation (preT790M) and its association with cancer molecular heterogeneity in the efficacy of EGFR-TKIs.
Materials and methods: Fifty-two advanced NSCLC patients harboring activating EGFR mutations treated with first-line EGFR-TKIs at Osaka City University Hospital between August 2013 and July 2016 were enrolled in the study. DNAs from tumor biopsies at diagnosis were available from 44 patients for detecting preT790M by the cobas® EGFR Mutation Test v2 (cobas) and ddPCR (RainDance Technologies) and those from 33 were available for assessing the actionable mutations in 50 genes by next-generation sequencing (NGS). NGS was performed on the Ion PGM using Ion AmpliSeq Cancer Hotspot Panel v2 (Life Technologies). Paired biopsies before EGFR-TKIs treatment and at disease progression (PD) were obtained from 15 patients to assess the T790M mutation by cobas.
Results: The overall detection rate of preT790M by ddPCR was 40.9% (18/44), while not detected in any case by cobas. The median progression free survival (mPFS) was 10.0 months for the patients with preT790M and 13.5 months for those without preT790M (p=0.288), respectively. When divided into 3 categories based on the frequency of preT790M such as high with T790M allele frequency (AF) >0.3%, low with AF ≤0.3% and undetected, 12 patients with high AF had a relatively shorter mPFS than 6 with low AF (p=0.090) and 26 without detectable preT790M (p=0.046) (7.7 vs 17.1 vs 13.5 months, respectively). NGS revealed 18 additional coexisting actionable mutations in 15 out of 33 patients: TP53 (n=7), PIK3CA (n=5), CTNNB1 (n=3) and uncommon EGFR (n=3). There was a trend for patients with higher preT790M AF to harbor less additional coexisting mutations (27% with high AF, 60% with low AF and 53% without preT790M, p=0.320). In 15 paired biopsies, T790M mutation was detected in 60% (9/15) at PD by cobas in the clinical setting; 67% (2/3) with high AF, 50% (1/2) with low AF and 60% (6/10) without detectable preT790M, suggesting T790M mutation after first-line EGFR-TKIs developed from both clonal selection and secondary acquisition models.
Conclusion: Results of our study indicated that EGFR-mutated NSCLCs with higher AF preT790M >0.3% had significantly shorter duration of response to EGFR-TKIs. In addition, the AF of preT790M in EGFR-mutated NSCLC may be associated with coexisting actionable mutation load potentially affecting the efficacy of EGFR-TKIs.
Citation Format: Yoshiya Matsumoto, Kenji Sawa, Jun Oyanagi, Mitsuru Fukui, Naoki Yoshimoto, Tomohiro Suzumura, Shigeki Mitsuoka, Kazuhisa Asai, Tatsuo Kimura, Nobuyuki Yamamoto, Tomoya Kawaguchi, Kazuto Hirata, Yasuhiro Koh. Predictive impact of low-frequency pretreatment T790M mutation in patients with EGFR-mutated non-small cell lung cancer treated with EGFR tyrosine kinase inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2613.
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Affiliation(s)
| | | | - Jun Oyanagi
- 2Wakayama Medical University, Wakayama, Japan
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28
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Matsumoto Y, Kawaguchi T, Yamamoto N, Sawa K, Yoshimoto N, Suzumura T, Watanabe T, Mitsuoka S, Asai K, Kimura T, Yoshimura N, Kuwae Y, Hirata K. Interstitial Lung Disease Induced by Osimertinib for Epidermal Growth Factor Receptor (EGFR) T790M-positive Non-small Cell Lung Cancer. Intern Med 2017; 56:2325-2328. [PMID: 28794368 PMCID: PMC5635308 DOI: 10.2169/internalmedicine.8467-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/15/2017] [Indexed: 01/23/2023] Open
Abstract
A 75-year-old man with stage IV lung adenocarcinoma was treated with osimertinib due to disease progression despite having been administered erlotinib. Both an epidermal growth factor receptor (EGFR) L858R mutation on exon 21 and a T790M mutation on exon 20 were detected in a specimen from a recurrent primary tumor. Five weeks after osimertinib initiation, he developed general fatigue and dyspnea. Chest computed tomography scan revealed diffuse ground glass opacities and consolidation on both lungs. An analysis of the bronchoalveolar lavage fluid revealed marked lymphocytosis, and a transbronchial lung biopsy specimen showed a thickened interstitium with fibrosis and prominent lymphocytic infiltration. We diagnosed the patient to have interstitial lung disease induced by osimertinib.
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Affiliation(s)
- Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Norio Yamamoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Naoki Yoshimoto
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Tomohiro Suzumura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Tetsuya Watanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Tatsuo Kimura
- Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka City University, Japan
| | - Naruo Yoshimura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Japan
| | - Yuko Kuwae
- Department of Pathology, Graduate School of Medicine, Osaka City University, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Japan
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29
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Sawa K, Koh Y, Kawaguchi T, Kambayashi S, Asai K, Mitsuoka S, Kimura T, Yoshimura N, Yoshimoto N, Kubo A, Saka H, Matsumura A, Wanibuchi H, Yamamoto N, Nishiyama N, Hirata K. PIK3CA mutation as a distinctive genetic feature of non-small cell lung cancer with chronic obstructive pulmonary disease: A comprehensive mutational analysis from a multi-institutional cohort. Lung Cancer 2017; 112:96-101. [PMID: 29191607 DOI: 10.1016/j.lungcan.2017.07.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/30/2017] [Revised: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD) have been proposed to have a mutual developmental mechanism, but their association has not been fully understood. We aimed to examine the association of the mutational landscape of NSCLC with co-morbid COPD. MATERIALS AND METHODS A total of 197 surgical specimens of early stage NSCLC were retrospectively collected from two independent sources, namely, the Japan Molecular Epidemiology for Lung Cancer Study and the Osaka City University Hospital cohort from 2010 to 2013. COPD and its severity were defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines and grading system. For molecular profiling of NSCLC patients with COPD, the extracted DNAs were deep-sequenced using next generation sequence technologies for somatic mutations in a maximum 72 cancer-associated genes. Logistic regression analysis was performed to evaluate the impact of COPD on the somatic mutations. RESULTS The COPD group (n=77), including 56 GOLD 1 and 21 GOLD 2 or 3 patients, had 58 squamous cell lung carcinoma (SCC) cases and 19 adenocarcinoma cases. The non-COPD group (n=120) had 53 SCC cases, 64 adenocarcinoma cases, and three cases with other histology. The frequency of PIK3CA mutation was significantly higher in the COPD group than in the non-COPD group (10.4% vs. 1.7%, p=0.015). Meanwhile, NFE2L2 mutation was observed only in SCC cases, with no difference in the frequency between the two groups (17.2% vs. 17.0%). In the multivariate logistic regression model with consideration for COPD status, age, smoking dose, pathological stage, and histology, significantly more PIK3CA mutation was observed in the presence of COPD (odds ratio=5.31, 95% CI: 1.03-27.29, p=0.046). CONCLUSIONS PIK3CA mutation is a distinctive genetic feature of NSCLC with COPD, regardless of age, smoking dose, pathological stage, and histology.
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Affiliation(s)
- Kenji Sawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasuhiro Koh
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Satoshi Kambayashi
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazuhisa Asai
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tatsuo Kimura
- Department of Premier Preventive Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Naruo Yoshimura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Naoki Yoshimoto
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Akihito Kubo
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi, Japan
| | - Hideo Saka
- Department of Respiratory Medicine and Medical Oncology, Japanese National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Akihide Matsumura
- Department of Surgery, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Hideki Wanibuchi
- Department of Molecular Pathology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Nobuyuki Yamamoto
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Noritoshi Nishiyama
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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30
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Sawa K, Kawaguchi T, Koh Y, Kambayashi S, Asai K, Mitsuoka S, Kimura T, Yoshimura N, Kubo A, Saka H, Matsumura A, Nishiyama N, Hirata K. PIK3CA mutations are distinctive genetic features in non-small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD): A comprehensive mutational analysis from multi-institutional cohort. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20060] [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
e20060 Background: A mutual developmental mechanism has been proposed between NSCLC and COPD; however, the association is not fully understood. We previously reported that the mutations in PI3K/AKT/mTOR pathway and NFE2L2 were frequently observed and co-existed in NSCLC patients with COPD (Kawaguchi T, J Clin Oncol 34, 2016 [suppl; abstr 8526]). To further validate this finding, a new cohort was added and merged into the original cohort’s study. Methods: A total of 197 surgical specimens of early stage NSCLC including 90 newly added from Osaka City University hospital were collected between 2010 and 2013. Extracted DNAs were deep-sequenced using NGS technologies for somatic mutations in 72 cancer-associated genes for a molecular profiling in NSCLC patients with COPD. We defined COPD as presence of FEV1/FEV < 0.7 and classified the severity based on the Global Initiative for Chronic Obstructive Lung Disease. Results: The COPD group (N = 77) including 56 mild, 21 moderate/severe diseases, had 58 squamous cell carcinoma (SQ) and 19 adenocarcinoma (AD), with 70 smokers. The non-COPD group (N = 120) had 53 SQ, 64 AD and three others, with 78 smokers. The frequency of PIK3CA mutations was higher in COPD (10.4 %) than non-COPD (1.7 %), while in AD KRAS mutations were more frequent in COPD (21.1%) than non-COPD (9.4%). Notably, the frequency of PIK3CA mutations increased parallel to the COPD severity (p < 0.001). Meanwhile, NFE2L2 mutations were observed only in SQ, and no difference in the frequency was observed between the two groups (17.2% vs. 17.0%) unlike our previous analysis. In the multivariate logistic regression model, significantly more PIK3CA mutations were observed in the presence of COPD (Odds ratio = 5.47, 95%CI: 1.04-28.85, p = 0.045) with consideration of age, smoking dose, histology and pathological stage. The most frequent base substitution pattern in PIK3CA mutations was C > T change, suggesting the association with APOBEC-mediated mutagenesis. Conclusions: PIK3CA mutations are distinctive genetic features in NSCLC with COPD, regardless of age, smoking dose, histology and pathological stage.
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Affiliation(s)
- Kenji Sawa
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Yasuhiro Koh
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Satoshi Kambayashi
- Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazuhisa Asai
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigeki Mitsuoka
- Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | - Naruo Yoshimura
- Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Akihito Kubo
- Division of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Akihide Matsumura
- National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | | | - Kazuto Hirata
- Osaka City University Graduate School of Medicine, Osaka, Japan
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31
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Mitsuoka S, Kawaguchi T, Kubo A, Isa SI, Asai K, Uji M, Watanabe T, Sawa K, Yoshimoto N, Oka T, Nakai T, Suzumura T, Tanaka H, Matsuura K, Kimura T, Yoshimura N, Kudoh S, Hirata K. Epidermal growth factor receptor tyrosine kinase inhibitors in previously treated advanced non-small-cell lung cancer with wild-type EGFR. Expert Opin Pharmacother 2016; 17:193-203. [PMID: 26781399 DOI: 10.1517/14656566.2016.1109635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While epidermal growth factor receptor (EGFR) - tyrosine kinase inhibitors (TKIs) lead to longer progression-free survival (PFS) when compared with conventional chemotherapy in non-small-cell lung cancer (NSCLC) harboring activating EGFR mutations, the role of EGFR-TKI remains unclear in EGFR-wild-type (WT) NSCLC. AREAS COVERED This article reviews selected data from randomized trials regarding the use of TKIs in EGFR-WT NSCLC. Nine randomized phase III trials have compared EGFR-TKI with chemotherapy in NSCLC patients in a second or later line setting. Two of these trials, TAILOR and DELTA, which were designed to investigate treatment benefits according to EGFR genotype, demonstrated that docetaxel chemotherapy displayed significantly better in progression-free survival (PFS) when compared with the EGFR-TKI erlotinib. Biomarkers to predict clinical benefits of the drug against EGFR WT tumor, and the efficacy of combination regimens using erlotinib or single-use afatinib against tumors are also covered in this article. EXPERT OPINION Considering the modest benefits of erlotinib for EGFR-WT tumors, future studies are warranted, including the exploration of useful biomarkers and new treatment strategies for EGFT-TKI use, as well as the development of more sensitive EGFR mutation tests.
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Affiliation(s)
- Shigeki Mitsuoka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tomoya Kawaguchi
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Akihito Kubo
- b Department of Respiratory Medicine , Aichi Medical University School of Medicine , Aichi , Japan
| | - Shun-ichi Isa
- c Clinical Research Center , National Hospital Organization Kinki-chuo Chest Medical Center , Osaka , Japan
| | - Kazuhisa Asai
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Masato Uji
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tetsuya Watanabe
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kenji Sawa
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Naoki Yoshimoto
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Takako Oka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Toshiyuki Nakai
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tomohiro Suzumura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Hidenori Tanaka
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kuniomi Matsuura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Tatsuo Kimura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Naruo Yoshimura
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Shinzoh Kudoh
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
| | - Kazuto Hirata
- a Department of Respiratory Medicine, Graduate School of Medicine , Osaka City University , Osaka , Japan
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Toshiyuki N, Kimura T, Suzumura T, Yoshimoto N, Oka T, Yamamoto N, Matsuura K, Mitsuoka S, Asai K, Tochino Y, Yoshimura N, Kawaguchi T, Kudoh S, Matsuoka T, Ohsawa M, Hirata K. The Macroscopic Appearance of Computed Tomography-guided Needle Biopsy Specimens Correlates with Tumor Metastasis in Non-small Cell Lung Cancer. Osaka City Med J 2015; 61:105-112. [PMID: 26995854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Computed tomography (CT)-guided needle biopsy is a well-established and dependable procedure for the diagnosis of pulmonary lesions. Some tissue biopsy samples have loose cohesion and disintegrate into tiny pieces before formalin fixation. The purpose of this study was to assess the association between the fresh macroscopic appearance of samples obtained using CT-guided needle biopsy and the clinicopathological features of non-small cell lung cancer (NSCLC). METHODS A total of 111 patients who underwent CT-guided lung needle biopsy at Osaka City University Hospital between May 2009 and May 2013 were enrolled. Macroscopic appearance was categorized as either loose or tight cohesion. Samples were evaluated using Azan staining to detect collagen fibers. The staining intensity was multiplied by the percentage of positive cells, and the specimen was categorized as having either low (<100) or high expression ( ≥100). Univariate and multivariate logistic regression models were used to evaluate significant covariates for tumor metastasis. RESULTS In the cohort of 111 patients, the diagnostic rates in loose and tight cohesions were 82.6% and 87.5%, respectively (p=0.509). In 60 patients diagnosed with NSCLC, Azan staining of collagen fibers was positive in 93.5% of the samples with tight cohesion and 28.6% of the samples with loose cohesion (p<0.001). In the multivariate logistic regression models, distant metastasis was significantly associated with loose cohesion (p=0.026). CONCLUSIONS These results suggest that the macroscopic appearance of CT-guided biopsy samples correlates with tumor metastasis in NSCLC.
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Yoshimura N, Kudoh S, Mitsuoka S, Yoshimoto N, Oka T, Nakai T, Suzumira T, Matusura K, Tochino Y, Asai K, Kimura T, Kawaguchi T, Hirata K. Phase II study of a combination regimen of gefitinib and pemetrexed as first-line treatment in patients with advanced non-small cell lung cancer harboring a sensitive EGFR mutation. Lung Cancer 2015; 90:65-70. [DOI: 10.1016/j.lungcan.2015.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
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Oka T, Kimura T, Suzumura T, Yoshimoto N, Nakai T, Yamamoto N, Matsuura K, Mitsuoka S, Yoshimura N, Kudoh S, Hirata K. Magnesium supplementation and high volume hydration reduce the renal toxicity caused by cisplatin-based chemotherapy in patients with lung cancer: a toxicity study. BMC Pharmacol Toxicol 2014; 15:70. [PMID: 25472655 PMCID: PMC4272804 DOI: 10.1186/2050-6511-15-70] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 11/19/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Renal toxicity is a clinical problem that affects 28-42% of patients undergoing treatment with cisplatin. Renal toxicity can be minimized by high volume hydration with mannitol diuresis. Recent reports have shown that cisplatin induces depletion of Mg and that Mg supplementation can reduce renal toxicity. We hypothesized that Mg infusion combined with low volume hydration may not be sufficient to overcome cisplatin-induced renal toxicity. METHODS In total, 85 patients with lung cancer receiving their first cycle of cisplatin-based chemotherapy at the Osaka City University Hospital were classified into three groups: those administered high volume hydration without Mg infusion (high-volume Mg-), high volume hydration with Mg infusion (high-volume Mg+), and with low volume hydration with Mg infusion (low-volume Mg+). Serum creatinine (sCr) and creatinine clearance (CrCl) were examined before and after treatment with cisplatin. Multivariable analysis was carried out to identify the most important contributing factors. RESULTS There were no significant differences in pre-treatment sCr levels or CrCl between groups. In the high-volume Mg- group, post-treatment sCr significantly increased compared with pre-treatment levels, while post-CrCl significantly decreased compared with pre-treatment CrCl (p < 0.001 and p < 0.001, respectively). In the high-volume Mg+ group, there was no significant difference between pre- and post-treatment levels of sCr, or between pre- and post-treatment CrCl (p = 0.118 and p = 0.254, respectively). In the low-volume Mg+ group, there was a trend towards increased sCr levels and decreased CrCl after treatment (p = 0.068 and p = 0.055, respectively). Multivariate analysis revealed that the absence of Mg infusion and low-volume hydration were both independent factors for decreased CrCl (p < 0.001 and p = 0.001, respectively). CONCLUSIONS High-volume hydration and Mg infusion reduces the renal toxicity induced by cisplatin. A low-volume Mg+ regimen may be considered for patients with adequate renal function. TRIAL REGISTRATION Observational Study UMIN000013950; Registered 13 May 2014.
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Affiliation(s)
| | - Tatsuo Kimura
- Department of Respiratory Medicine, Graduate school of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
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Yoshimura N, Mitsuoka S, Yoshimoto N, Nakai T, Oka T, Matsuura K, Kimura T, Kudoh S, Kawaguchi T, Hirata K. Gefitinib and Pemetrexed As a First Line Treatment in Patients with Egfr Mutant Advanced Nsclc: a Phase Ii Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.62] [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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Mitsudomi T, Iwamoto Y, Tomida S, Sakai K, Yamanaka T, Tada H, Yoshioka H, Uchino K, Yoshino I, Sugawara S, Mitsuoka S, Takahashi T, Ohta M, Seto T, Atagi S, Okada M, Saka H, Nakagawa K, Nakanishi Y, Nishio K. Serum biomarker analysis of WJOG4107: A randomized phase II trial of adjuvant chemotherapy with S-1 versus CDDP+S-1 for resected stage II-IIIA non-small cell lung cancer (NSCLC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7550] [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)
| | - Yasuo Iwamoto
- Department of Medical Oncology, Hiroshima City Hospital, Hiroshima, Japan
| | - Shuta Tomida
- Department of Genome Biology, Kinki University Faculty of Medicine, Osakasayama, Japan
| | - Kazuko Sakai
- Kinki University School of Medicine, Osaka, Japan
| | | | - Hirohito Tada
- Department of General Thoracic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroshige Yoshioka
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazuya Uchino
- Department of Thoracic Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Shigeki Mitsuoka
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | | | - Mitsunori Ohta
- Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka, Japan
| | - Shinji Atagi
- National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Hideo Saka
- Department of Medical Oncology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuto Nishio
- Department of Genome Biology, Kinki University Faculty of Medicine, Osaka, Japan
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Nishio K, Ikezoe H, Hofmann S, Heßberger F, Ackermann D, Antalic S, Aritomo Y, Comas V, Düllman C, Gorshkov A, Graeger R, Heinz S, Heredia J, Hirose K, Khuyagbaatar J, Kindler B, Kojouharov I, Lommel B, Makii H, Mann R, Mitsuoka S, Nagame Y, Nishinaka I, Ohtsuki T, Popeko A, Saro S, Schädel M, Türler A, Wakabayashi Y, Watanabe Y, Yakushev A, Yeremin A. Study of heavy-ion induced fission for heavy-element synthesis. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146603065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nagata M, Kudoh S, Mitsuoka S, Suzumura T, Umekawa K, Tanaka H, Matsuura K, Kimura T, Yoshimura N, Hirata K. Skeletal-related events in advanced lung adenocarcinoma patients evaluated EGFR mutations. Osaka City Med J 2013; 59:45-52. [PMID: 23909080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The rate of lung cancer metastasis to the bone is high and skeletal-related events (SREs) decrease the quality of life in many patients. Recently, it was found that a subgroup of patients with non-small cell lung cancer (NSCLC) have specific mutations in the EGFR (epidermal growth factor receptor) gene. We assessed the SREs in advanced lung adenocarcinoma patients that evaluated EGFR mutations in whom bone metastasis was present. METHODS We retrospectively investigated the clinical records of 377 patients with advanced NSCLC. Patients were evaluated for the presence of EGFR mutations, bone metastases, the incidence of SREs, and treatment history before the first SRE. RESULTS A total of 78 patients who were evaluated for EGFR mutations had bone metastasis from lung adenocarcinoma. The most frequent site of bone metastasis was the spine (36.2%). SREs occurred in 37 patients (47.4%), the most common of which was bone radiotherapy (41.0%). Significant differences were not observed in the sites of bone metastases or the patterns of SREs between patients with and without EGFR mutations. The median time from bone metastasis to the first SRE was 5.8 months in all of the subjects, history of EGFR-tyrosine kinase inhibitor (TKI) treatment was significantly associated with longer median time to first SRE (14.2 months vs 1.3 months, p < 0.0001), and the median time to first SRE of patients with PS 0-1 was longer (8.5 months vs 0.9 months, p = 0.0023). CONCLUSIONS We found that SRE patterns have no difference between EGFR mutation positive and negative, and that the time from bone metastasis to the first SRE was longer in advanced lung adenocarcinoma patients with good PS and history of EGFR-TKI treatment.
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Affiliation(s)
- Misato Nagata
- Department of Respiratory Medicine, Osaka City University, Graduate School of Medicine, Japan.
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Umekawa K, Kimura T, Kudoh S, Suzumura T, Nagata M, Mitsuoka S, Matsuura K, Oka T, Yoshimura N, Kira Y, Hirata K. Reaction of plasma adiponectin level in non-small cell lung cancer patients treated with EGFR-TKIs. Osaka City Med J 2013; 59:53-60. [PMID: 23909081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are routinely used to treat advanced non-small cell lung cancer (NSCLC) patients with activated EGFR mutations, and are associated with excellent response and improvement of performance status. Adipose tissue produces and releases substances called adipokines, which include adiponectin, leptin, resistin, and hepatocyte growth factor (HGF), etc. Previously, we reported that high levels of plasma HGF at diagnosis indicated intrinsic resistance to EGFR-TKIs. EGFR-TKIs have been hypothesized to affect these adipokines. METHODS This prospective study, to evaluate the correlation between plasma adiponectin and insulin levels and non-hematological adverse effects in advanced NSCLC following EGFR-TKIs administration, was conducted at the Osaka City University Hospital. Plasma adiponectin and insulin levels were determined at diagnosis and on treatment day 30. RESULTS Overall 33 patients were enrolled. We obtained plasma samples for analyses from all patients at diagnosis and from 26 patients on day 30. Increased adiponectin (13.69 to 14.42 microg/mL, p = 0.0092), and decreased insulin (404.0 to 351.2 pg/mL, p = 0.022) were observed after EGFR-TKI treatments. High levels of adiponectin at diagnosis were associated with severities of skin rash (p = 0.035). CONCLUSIONS The adiponectin was affected by EGFR-TKI treatments for NSCLC. Besides, the adverse events by EGFR-TKIs were influenced by the plasma adipokines at diagnosis. Our study may provide useful information regarding patient outcomes to EGFR-TKI treatments. A prospective large clinical trial is warranted to clarify these results.
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Affiliation(s)
- Kanako Umekawa
- Department of Respiratory Medicine, Osaka City University, Graduate School of Medicine, Japan.
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Yoshimura N, Mitsuoka S, Kimura T, Tanaka H, Suzumura T, Nagata M, Umekawa K, Nakai T, Hosono MH, Tada T, Hirata K, Kudoh S. Dose-escalation study of chemoradiotherapy with use of involved-field conformal radiotherapy and accelerated hyperfractionation for stage III non-small cell lung cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7564] [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
7564 Background: To determine a recommended dose (RD) of chemoradiotherapy with use of involved-field conformal radiotherapy and accelerated hyperfractionation (AHF) for stage III non-small cell lung cancer (NSCLC). Methods: Eligible patients had unresectable stage III NSCLC, age of less than 75 years, PS: 0 or 1, V20 of 35% or less. PET was used for staging. Cisplatin (80mg/m2) was administered on day 1 and vinorelbine (20mg/m2) was administered on days 1 and 8 for two cycle. Twice-daily radiation therapy (1.5 Gy per fraction) without elective nodal irradiation started on day 1. Total doses were 60Gy in 40 fractions and 66Gy in 44 fractions at levels 1 and 2 respectively. After concurrent chemoradiotherapy, consolidation chemotherapy regimen was cisplatin (80mg/m2) on day 1 and vinorelbine (20mg/m2) on days 1 and 8 every 4 week for three cycles. The dose-limiting toxicity (DLT) was defined as grade ≥ 3 esophagitis, grade 3 neutropenic fever, grade ≥ 3 other non-hematologic toxicities and interruption of irradiation for more than 2 weeks. DLT was monitored for 90 days. Results: A total of 12 patients were enrolled (6 patients in Level 1, 6 patients in Levels 2). DLTs were noted in 2 patients at Level 1, which were grade 3 esophagitis and grade 3 febrile neutropenia. Radiation dose was escalated up to 66 Gy in 44 fractions (Level 2), and there was no DLT. In principle, Sixty-six Gy in 44 fractions (Level 2) should be the RD. Major toxicities were leucopenia, neutropenia, and anemia. The response rate, the median progression free survival time, and the median overall survival time was 83.3%, 10.4 months, and 36.3 months for all patients, respectively. Conclusions: The RD was 66 Gy in 44 fractions (Level 2). The toxicity of this chemoradiothrapy regimen was manageable and efficacy is promising. The efficacy and safety of this regimen should be confirmed in a phase II study. Clinical trial information: UMIN000003769.
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Affiliation(s)
- Naruo Yoshimura
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeki Mitsuoka
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Tatsuo Kimura
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hidenori Tanaka
- Department of Respiratory Medicine, JR Osaka railway hospital, Osaka, Japan
| | - Tomohiro Suzumura
- Department of Medical Oncology, Izumi Municipal Hospital, Osaka, Japan
| | - Misato Nagata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kanako Umekawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Toshiyuki Nakai
- Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masako Hosono Hosono
- Department of Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takuhito Tada
- Department of Radiology, Izumi Municipal Hospital, Osaka, Japan
| | - Kazuto Hirata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shinzoh Kudoh
- Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Umekawa K, Kimura T, Kudoh S, Suzumura T, Oka T, Nagata M, Mitsuoka S, Matsuura K, Nakai T, Yoshimura N, Kira Y, Hirata K. Plasma RANTES, IL-10, and IL-8 levels in non-small-cell lung cancer patients treated with EGFR-TKIs. BMC Res Notes 2013; 6:139. [PMID: 23566546 PMCID: PMC3637543 DOI: 10.1186/1756-0500-6-139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), routinely used to treat advanced non-small-cell lung cancer (NSCLC) patients with activated EGFR mutations, are associated with excellent response and improved performance status. Recently, pro-inflammatory cytokines, such as regulated upon activation normal T cell expressed and secreted (RANTES), interleukin (IL)-10 and IL-8 have been proposed as mediators of cancer development. EGFR-TKIs have been found to affect this network of pro-inflammatory cytokines. Methods EGFR-TKIs (erlotinib, 150 mg/day; and gefitinib, 250 mg/day) were administered once per day. Treatment was continued until disease progressed or the patient developed intolerable symptoms of toxicity, or withdrew his/her consent for study participation. The treatment was a part of standard care. We investigated the correlation between plasma pro-inflammatory cytokines (including plasma RANTES, IL-10, and IL-8) levels and clinical outcomes following EGFR-TKI treatment in lung cancer patients. Pro-inflammatory cytokine levels were evaluated at diagnosis and on treatment day 30 after the first administration of EGFR-TKIs. Results Overall, 33 patients were enrolled. Plasma pro-inflammatory cytokine levels were determined for all patients at diagnosis. Plasma samples from 26 patients were obtained on treatment day 30. High level of RANTES at diagnosis was associated with severe general fatigue (P = .026). Low level of RANTES at diagnosis was significantly associated with long-term survival (P = .0032). Percent decrease change of IL-10 was associated with severity of rash (P = .037). The plasma IL-8 level on treatment day 30 (median, 5.48 pg/mL; range, 0.49–26.13 pg/mL) was significantly lower than the level at diagnosis (median 10.45 pg/mL; 3.04–54.86 pg/mL; P = .021). Conclusions These results suggest that EGFR-TKIs may suppress systemic inflammation and promote tumor shrinkage. The network of pro-inflammatory cytokines was affected by EGFR-TKI treatment for NSCLC. In addition, the clinical outcomes of EGFR-TKI treatment were influenced by the status of the plasma pro-inflammatory cytokines at diagnosis.
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Affiliation(s)
- Kanako Umekawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
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Nagata M, Kimura T, Suzumura T, Kira Y, Nakai T, Umekawa K, Tanaka H, Matsuura K, Mitsuoka S, Yoshimura N, Oka T, Kudoh S, Hirata K. C609T Polymorphism of NADPH Quinone Oxidoreductase 1 Correlates Clinical Hematological Toxicities in Lung Cancer Patients Treated with Amrubicin. Clin Med Insights Oncol 2013; 7:31-9. [PMID: 23467445 PMCID: PMC3576865 DOI: 10.4137/cmo.s10839] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Amrubicin hydrochloride (AMR) is a key agent for lung cancer. NADPH quinone oxidoreductase 1 (NQO1) metabolizes the quinone structures contained in both amrubicin (AMR) and amrubicinol (AMR-OH). We hypothesized that NQO1 C609T polymorphism may affect AMR-related pharmacokinetics and clinical outcomes. Methods: Patients received AMR doses of 30 or 40 mg/m2/day on days 1–3. Plasma sampling was performed 24 hours after the first and third AMR injections. Concentrations of AMR and AMR-OH were determined by HPLC and the NQO1 C609T polymorphism was assayed by RT-PCR. Results: A total of 35 patients were enrolled. At a dose of 40 mg/m2, the T/T genotype exhibited a tendency toward a relationship with decrease concentrations of AMR-OH on days 2 and 4. The genotype also showed a significant decrease of hematological toxicities (P < 0.05). Conclusions: NQO1 C609T polymorphism had a tendency of correlation with the plasma concentrations of AMR-OH, and thereby had significant correlations with hematologic toxicities.
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Affiliation(s)
- Misato Nagata
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University
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Suzumura T, Kimura T, Kudoh S, Umekawa K, Nagata M, Matsuura K, Tanaka H, Mitsuoka S, Yoshimura N, Kira Y, Nakai T, Hirata K. Reduced CYP2D6 function is associated with gefitinib-induced rash in patients with non-small cell lung cancer. BMC Cancer 2012. [PMID: 23207012 PMCID: PMC3536666 DOI: 10.1186/1471-2407-12-568] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Rash, liver dysfunction, and diarrhea are known major adverse events associated with erlotinib and gefitinib. However, clinical trials with gefitinib have reported different proportions of adverse events compared to trials with erlotinib. In an in vitro study, cytochrome P450 (CYP) 2D6 was shown to be involved in the metabolism of gefitinib but not erlotinib. It has been hypothesized that CYP2D6 phenotypes may be implicated in different adverse events associated with gefitinib and erlotinib therapies. Methods The frequency of each adverse event was evaluated during the period in which the patients received gefitinib or erlotinib therapy. CYP2D6 phenotypes were determined by analysis of CYP2D6 genotypes using real-time polymerase chain reaction techniques, which can detect single-nucleotide polymorphisms. The CYP2D6 phenotypes were categorized into 2 groups according to functional or reduced metabolic levels. In addition, we evaluated the odds ratio (OR) of the adverse events associated with each factor, including CYP2D6 activities and treatment types. Results A total of 232 patients received gefitinib therapy, and 86 received erlotinib therapy. Reduced function of CYP2D6 was associated with an increased risk of rash of grade 2 or more (OR, 0.44; 95% confidence interval [CI], 0.21–0.94; *p = 0.03), but not diarrhea ≥ grade 2 (OR, 0.49; 95% CI, 0.17–1.51; *p = 0.20) or liver dysfunction ≥ grade 2 (OR, 1.08; 95% CI, 0.52–2.34; *p = 0.84) in the gefitinib cohort. No associations were observed between any adverse events in the erlotinib cohort and CYP2D6 phenotypes (rash: OR, 1.77; 95% CI, 0.54–6.41; *p = 0.35/diarrhea: OR, 1.08; 95% CI, 0.21–7.43; *p = 0.93/liver dysfunction: OR, 0.93; 95% CI, 0.20–5.07; *p = 0.93). Conclusions The frequency of rash was significantly higher in patients with reduced CYP2D6 activity who treated with gefitinib compared to patients with functional CYP2D6. CYP2D6 phenotypes are a risk factor for the development of rash in response to gefitinib therapy.
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Affiliation(s)
- Tomohiro Suzumura
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Nagata M, Kimura T, Suzumura T, Nakai T, Umekawa K, Tanaka H, Matsuura K, Mitsuoka S, Yoshimura N, Kudoh S, Hirata K. Correlation of C609T Polymorphism of NADPH Quinone Oxidoreductase 1 and Clinical Outcome in Amrubicin-Treated Lung Cancer Patients. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yoshimura N, Matsuura K, Mitsuoka S, Asai K, Tochino Y, Kimura T, Nakai M, Mitsukawa Y, Hirata K, Kudoh S. Gefitinib (G) and Pemetrexed (Pem) as a First Line Treatment in Patients with EGFR Mutant Advanced Non-Small Cell Lung Cancer (NSCLC): A Phase II Study. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33852-7] [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: 10/25/2022] Open
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Umekawa K, Kimura T, Suzumura T, Kudoh S, Nakai T, Nagata M, Matsuura K, Mitsuoka S, Yoshimura N, Hirata K. Increase of Plasma Adiponectin Levels and Decrease of Pro-Inflammatory Cytokines in Non-Small Cell Lung Cancer Patients Treated with EGFR-TKIS. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Suzumura T, Kimura T, Kudoh S, Umekawa K, Nagata M, Tanaka H, Mitsuoka S, Yoshimura N, Kira Y, Hirata K. Comparison of adverse events of erlotinib with those of gefitinib in patients with non-small cell lung cancer: a case-control study in a Japanese population. Osaka City Med J 2012; 58:25-34. [PMID: 23094511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Rash, liver dysfunction, and diarrhea are known as adverse events of erlotinib and gefitinib. However, clinical trials with gefitinib have reported different adverse events compared to those with erlotinib. In an in vitro study, cytochrome P450 (CYP) 2D6 was shown to be involved in the metabolism of gefitinib and not of erlotinib. It has been hypothesized that gefitinib therapy results in different adverse events compared to erlotinib therapy. METHODS The frequency of each adverse event was evaluated in a case-control study on Japanese patients who were treated with gefitinib or erlotinib. The CYP2D6 phenotype was categorized into 2 groups according to functional or reduced metabolic levels. In addition, we evaluated the odds ratio (OR) of adverse events with each factor, including CYP2D6 activities as well as treatment types. RESULTS A total of 112 patients received gefitinib therapy, 74 patients received erlotinib therapy, and 17 patients received erlotinib and gefitinib sequentially. The OR of developing rash with gefitinib versus erlotinib treatment was 0.38 (95% confidence interval [CI], 0.15-0.86). The OR of developing diarrhea with gefitinib versus erlotinib treatment was 0.46 (95% CI, 0.22-0.94). The OR of developing liver dysfunction with gefitinib versus erlotinib treatment was 3.30 (95% CI, 1.59-7.22). Reduced function of CYP2D6 was not associated with an increased risk of any adverse events in both gefitinib and erlotinib cohorts. CONCLUSIONS Erlotinib had higher rate of rash and diarrhea than gefitinib. Liver dysfunction occurred significantly more often in the gefitinib group than in the erlotinib group.
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Affiliation(s)
- Tomohiro Suzumura
- Department of Respiratory Medicine, Osaka City University, Graduate School of Medicine, Japan.
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Katayama H, Takeda K, Fukuda H, Nakamura S, Nakamura K, Mizusawa J, Saijo N, Yokoyama A, Ohe Y, Shinkai T, Nakagawa K, Abe T, Mitsuoka S, Ichinose Y, Okamoto H, Yamamoto N, Yoshioka H, Ando M, Tamura T. An integrated analysis of comprehensive geriatric assessment (CGA) in elderly patients with non-small cell lung cancer (NSCLC) (JCOG1115-A). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.6112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6112 Background: The number of elderly NSCLC patients is increasing all over the world. Actual age and ECOG PS is not always efficient to select "fit-elderly" for chemotherapy. We integrated the data from two phase III trial (JCOG0207, JCOG0803/WJOG4307L) and evaluated 4 CGA items as well as age and PS to determine whether they would predict survival, response and toxicities. Methods: Eligibility criteria of both trials included histologically or cytologically proven NSCLC; stage III/IV; age 70 or more; ECOG PS of 0-1; unfit for bolus cisplatin; no prior treatment; adequate organ function. Patients were randomized to receive either weekly docetaxel (D) or D plus cisplatin (DP) in J0207, and either 3-weekly D or DP in J0803/W4307L. This study included all eligible pts for whom all of 4 CGA items (Activity of Daily Living [ADL], Instrumental Activity of Daily Living [IADL], Mini-Mental State Examination [MMSE], Geriatric Depression Scale [GDS-15]) were assessed before treatment. Primary endpoint was overall survival (OS). Survival curves are estimated by Kaplan-Meier method and multivariate analysis for OS adjusting baseline factors were performed by using stratified Cox regression model. Results: This analysis included 331 pts (J0207/J0803-W4307L: 105/226) in total. The result of multivariate analysis for OS was shown in the table. After adjusting baseline factors, MMSE as well as sex and PS was significantly associated with OS. None of the CGA items were associated with response and toxicities. Conclusions: It is not actual age but MMSE and PS that is useful for predicting prognosis of elderly pts. MMSE should be taken into consideration to determine the indication of chemotherapy for elderly pts. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yuichiro Ohe
- National Cancer Center Hospital East, Chiba, Japan
| | - Tetsu Shinkai
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | | | - Tetsuya Abe
- Niigata Cancer Center Hospital, Niigata, Japan
| | - Shigeki Mitsuoka
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
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Manabe M, Mitsuoka S, Umekawa K, Tanaka H, Kimura T, Yoshimura N, Takeda A, Kudoh S, Hirata K. [Carcinomatous meningitis in a post-operative patient with lung adenocarcinoma for which erlotinib was effective - a case report]. Gan To Kagaku Ryoho 2012; 39:633-635. [PMID: 22504691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 53-year-old female was admitted to our hospital complaining of disturbance of consciousness and hallucinations. About one year and 5 months ago she had adenocarcinoma of the lung, which was treated with surgery and chemotherapy. Computed tomography and magnetic resonance imaging revealed that her lung cancer had relapsed as caricinomatous meningitis and multiple lung metastases. She was treated with erlotinib, which rapidly resulted in disappearance of her symptoms. She still continues to receive erlotinib therapy without suffering from evident relapse 7 months after the initiation of the treatment.
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Mitsuoka S, Kudoh S, Kimura T, Yoshimura N, Tanaka H, Suzumura T, Umekawa K, Nagata M, Ueda T, Hirata K. Clinical outcome of amrubicin therapy according to the prior chemotherapy sensitivities of extensive small cell lung cancer. Osaka City Med J 2011; 57:59-66. [PMID: 22443079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Amrubicin (AMR) is an active agent for relapsed small cell lung cancer (SCLC). However, the activity of AMR in refractory relapsed patients is controversial. The objective of this retrospective analysis was to evaluate the efficacy and safety of AMR as second-line chemotherapy in SCLC, especially refractory relapsed SCLC. METHODS Between July 2003 and February 2009, a total of 27 patients were treated with AMR at a dosage of 40 mg x m(-2) x day(-1) on days 1-3 every 3 weeks. Safety was assessable for all patients. Efficacy was evaluated in 26 patients (one patient was not assessable for response), in 12 patients with chemotherapy-sensitive relapse and 14 patients with chemotherapy-refractory relapse. Sensitive relapse means that a first-line response lasted more than 90 days. Refractory relapse means that either did not respond to first-line chemotherapy or responded initially but relapsed within 90 days. RESULTS Thirteen patients (50%, 95% CI, 31% to 69%) had partial response, including 6 (50%) of the 12 patients with chemotherapy-sensitive relapse and 7 (50%) of 14 patients with chemotherapy-refractory relapse. Median survival times of patients with chemotherapy-sensitive and -refractory relapse were 9.7 months and 8.4 months, respectively, showing significant difference (p = 0.0337). Adverse events were observed in all 27 patients. Grade 3 and 4 neutropenia was seen in 8 patients (29.6%) and 15 patients (55.5%), respectively. Grade 3 and 4 thrombocytopenia occurred in 10 patients (37.0%) and 2 patients (7.4%). Non-hematologic toxicities were generally mild, except for febrile neutropenia. Febrile neutropenia was seen in 6 patients (22.2%). No treatment-related deaths occurred. CONCLUSIONS AMR is an active agent for the treatment of relapsed SCLC, especially chemotherapy-refractory relapse SCLC, with predictable and manageable toxicities.
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Affiliation(s)
- Shigeki Mitsuoka
- Department of Respiratory Medicine, Osaka City University, Graduate School of Medicine, Japan.
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