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Meng Y, Li X, Zhang L, Ye M. The novel EGFR mutations (p.E746_S752delinsI, p.T751_I759delinsG, p.L747_S752delinsAA) in patients with non-small cell lung cancer and the clinical treatment strategy: three case reports. Front Oncol 2023; 13:1129629. [PMID: 37795433 PMCID: PMC10546178 DOI: 10.3389/fonc.2023.1129629] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/18/2023] [Indexed: 10/06/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) is an established driver gene in non-small cell lung cancer (NSCLC) and the common Exon 19 del mutation (p.E746_A750 del) has exhibited remarkable responses for EGFR tyrosine kinase inhibitors (TKIs). However, there is even less comprehension of the treatment strategy in NSCLC patients harboring uncommon Exon 19 delins mutation. Here, we identified three novel EGFR Exon 19 mutations (p.E746_S752delinsI, p.T751_I759delinsG, p.L747_S752delinsAA), and described the clinical treatment process. To our knowledge, the EGFR p.E746_S752delinsI mutation of the patient with advanced NSCLC could benefit from the treatment with Icotinib. Otherwise, for the NSCLC patients with early-stage, one harboring p.T751_I759delinsG mutation had an excellent recovery and the other harboring p.L747_S752delinsAA experienced a relapse after receiving horacoscopic radical resection, which means the patients with different Exon 19 delins mutation might have different prognosis. Our study also demonstrated that next-generation sequencing (NGS) is a crucial tool in guiding clinical treatment decisions in NSCLC. Furthermore, the real incidence of these mutation is not known, the routinely use of NGS surely will increase the detection of EGFR del-ins respect to the old tools used to screen for EGFR mutations.
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Affiliation(s)
- Yamin Meng
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiaodong Li
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Lei Zhang
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Minhua Ye
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
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2
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Adamo A, Frusteri C, Pilotto S, Caligola S, Belluomini L, Poffe O, Giacobazzi L, Dusi S, Musiu C, Hu Y, Wang T, Rizzini D, Vella A, Canè S, Sartori G, Insolda J, Sposito M, Incani UC, Carbone C, Piro G, Pettinella F, Qi F, Wang D, Sartoris S, De Sanctis F, Scapini P, Dusi S, Cassatella MA, Bria E, Milella M, Bronte V, Ugel S. Immune checkpoint blockade therapy mitigates systemic inflammation and affects cellular FLIP-expressing monocytic myeloid-derived suppressor cells in non-progressor non-small cell lung cancer patients. Oncoimmunology 2023; 12:2253644. [PMID: 37720688 PMCID: PMC10503454 DOI: 10.1080/2162402x.2023.2253644] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/10/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023] Open
Abstract
Cancer cells favor the generation of myeloid cells with immunosuppressive and inflammatory features, including myeloid-derived suppressor cells (MDSCs), which support tumor progression. The anti-apoptotic molecule, cellular FLICE (FADD-like interleukin-1β-converting enzyme)-inhibitory protein (c-FLIP), which acts as an important modulator of caspase-8, is required for the development and function of monocytic (M)-MDSCs. Here, we assessed the effect of immune checkpoint inhibitor (ICI) therapy on systemic immunological landscape, including FLIP-expressing MDSCs, in non-small cell lung cancer (NSCLC) patients. Longitudinal changes in peripheral immunological parameters were correlated with patients' outcome. In detail, 34 NSCLC patients were enrolled and classified as progressors (P) or non-progressors (NP), according to the RECIST evaluation. We demonstrated a reduction in pro-inflammatory cytokines such as IL-8, IL-6, and IL-1β in only NP patients after ICI treatment. Moreover, using t-distributed stochastic neighbor embedding (t-SNE) and cluster analysis, we characterized in NP patients a significant increase in the amount of lymphocytes and a slight contraction of myeloid cells such as neutrophils and monocytes. Despite this moderate ICI-associated alteration in myeloid cells, we identified a distinctive reduction of c-FLIP expression in M-MDSCs from NP patients concurrently with the first clinical evaluation (T1), even though NP and P patients showed the same level of expression at baseline (T0). In agreement with the c-FLIP expression, monocytes isolated from both P and NP patients displayed similar immunosuppressive functions at T0; however, this pro-tumor activity was negatively influenced at T1 in the NP patient cohort exclusively. Hence, ICI therapy can mitigate systemic inflammation and impair MDSC-dependent immunosuppression.
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Affiliation(s)
- Annalisa Adamo
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Cristina Frusteri
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Sara Pilotto
- Oncology section, Department of Engineering for Innovative Medicine and Hospital Trust of Verona, Verona, Italy
| | - Simone Caligola
- Veneto Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IOV-IRCCS), Padova, Italy
| | - Lorenzo Belluomini
- Oncology section, Department of Engineering for Innovative Medicine and Hospital Trust of Verona, Verona, Italy
| | - Ornella Poffe
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Luca Giacobazzi
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Silvia Dusi
- Veneto Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IOV-IRCCS), Padova, Italy
| | - Chiara Musiu
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Yushu Hu
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Tian Wang
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Davide Rizzini
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Antonio Vella
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Stefania Canè
- Veneto Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IOV-IRCCS), Padova, Italy
| | - Giulia Sartori
- Oncology section, Department of Engineering for Innovative Medicine and Hospital Trust of Verona, Verona, Italy
| | - Jessica Insolda
- Oncology section, Department of Engineering for Innovative Medicine and Hospital Trust of Verona, Verona, Italy
| | - Marco Sposito
- Oncology section, Department of Engineering for Innovative Medicine and Hospital Trust of Verona, Verona, Italy
| | - Ursula Cesta Incani
- Oncology section, Department of Engineering for Innovative Medicine and Hospital Trust of Verona, Verona, Italy
| | - Carmine Carbone
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Geny Piro
- Medical Oncology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesca Pettinella
- General Pathology section, Department of Medicine University of Verona, Verona, Italy
| | - Fang Qi
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Dali Wang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, P.R. China
| | - Silvia Sartoris
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Francesco De Sanctis
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
| | - Patrizia Scapini
- General Pathology section, Department of Medicine University of Verona, Verona, Italy
| | - Stefano Dusi
- General Pathology section, Department of Medicine University of Verona, Verona, Italy
| | | | - Emilio Bria
- Veneto Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IOV-IRCCS), Padova, Italy
| | - Michele Milella
- Oncology section, Department of Engineering for Innovative Medicine and Hospital Trust of Verona, Verona, Italy
| | - Vincenzo Bronte
- Veneto Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IOV-IRCCS), Padova, Italy
| | - Stefano Ugel
- Immunology section, Department of Medicine University and Hospital Trust of Verona, Verona, Italy
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3
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Zhou S, Zhai Y, Zhao K, Men Y, Meng X, Hui Z. Real world practice of postoperative radiotherapy for patients with completely resected pIIIA-N2 non-small cell lung cancer: a national survey of radiation oncologists in China. Radiat Oncol 2023; 18:17. [PMID: 36698150 PMCID: PMC9875489 DOI: 10.1186/s13014-023-02208-5] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Results from Lung ART and PORT-C trials suggest that postoperative radiotherapy (PORT) cannot routinely be recommended as standard treatment in completely resected pIIIA-N2 NSCLC patients, but their effects on the real-world practice of PORT in China remain unclear. METHODS A national cross-section survey was conducted by using an online survey service. Participants were voluntarily recruited using a river sampling strategy. A link to the survey was posted on websites of radiation oncologist associations and tweets from public WeChat accounts. The survey collected the real names of participants to ensure that they were board-certified radiation oncologists. RESULTS A total of 484 radiation oncologists were included with a median age of 40 years (IQR, 35-47). A total of 377 (77.9%) participants were male, and 282 (58.1%) had more than 10 years of clinical experience practicing thoracic radiotherapy. Before Lung ART and PORT-C trials were published, 313 (64.7%) respondents recommended PORT, 11 (2.3%) did not recommend it, and 160 (33.1%) reported that they made decisions based on risk factors. After the presentation of two trials, only 42 (8.7%) did not recommend PORT, while 108 (22.3%) recommended it, and 334 (69.0%) made decisions based on risk factors. The five most commonly considered risk factors among these 334 respondents were as follows: nodal extracapsular extension, the highest lymph node (LN) station involved, the number of dissected mediastinal LN stations, the number of positive mediastinal LN stations, and surgical approaches. In addition, the majority of all 484 respondents recommended a total dose of 50 Gy, lung stump + ipsilateral hilus + regions containing positive LNs as the targeted region, lung V20 < 25%, and heart V30 < 40% as dose constraints for PORT. CONCLUSION Most Chinese radiation oncologists recommended PORT for completely resected IIIA-N2 NSCLC patients based on risk factors, especially status of LN station.
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Affiliation(s)
- Shujie Zhou
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 250117 Shandong China
| | - Yirui Zhai
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Kaikai Zhao
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yu Men
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China ,grid.506261.60000 0001 0706 7839Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xiangjiao Meng
- grid.440144.10000 0004 1803 8437Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Zhouguang Hui
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China ,grid.506261.60000 0001 0706 7839Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
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4
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Gupta K, Uchel T, Karamian G, Loschner A. Pulmonary complications of tyrosine kinase inhibitors and immune checkpoint inhibitors in patients with non-small cell lung cancer. Cancer Treat Res Commun 2021; 28:100439. [PMID: 34333246 DOI: 10.1016/j.ctarc.2021.100439] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
The understanding of cancer biology and the identification of various molecular pathways and targeted oncogenic drivers have led to a paradigm shift in treatment of non-small cell lung cancer. In the last two decades, the therapeutic approach for non-small cell lung cancer (NSCLC) has gradually transitioned from empiric treatment with chemotherapeutic regimens to personalized medicine with precision targets. The major key players in these novel approaches involve targeted therapy, such as tyrosine kinase inhibitors (TKI) and immunotherapy, such as immune checkpoint inhibitors (ICI) blocking intrinsic down regulators of immunity, to achieve anti-cancer effects. These novel agents are generally better tolerated than chemotherapeutics and it is essential to be cognizant of the various drug related adverse effects. Regular follow up of patients with NSCLC by chest computed tomography (CT) surveillance to monitor for disease progression or recurrence is a prerequisite. It is becoming increasingly challenging to identify pulmonary complications related to the use of novel TKI and ICI. Our review focuses on various pulmonary complications of TKI and ICI in patients undergoing treatment for NSCLC, chest CT manifestations, management strategies, and treatment outcomes described in various case reports and case series.
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Affiliation(s)
- Kushagra Gupta
- Department of Pulmonary and Critical Care Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
| | - Toribiong Uchel
- Department of Pulmonary and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Gregory Karamian
- Department of Pulmonary and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Anthony Loschner
- Department of Pulmonary and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
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5
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Chang SC, Zhang BX, Su ECY, Wu WC, Hsieh TH, Salazar AM, Lin YK, Ding JL. Hiltonol Cocktail Kills Lung Cancer Cells by Activating Cancer-Suppressors, PKR/OAS, and Restraining the Tumor Microenvironment. Int J Mol Sci 2021; 22:ijms22041626. [PMID: 33562773 PMCID: PMC7915988 DOI: 10.3390/ijms22041626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
NSCLC (non-small cell lung cancer) is a leading cause of cancer-related deaths worldwide. Clinical trials showed that Hiltonol, a stable dsRNA representing an advanced form of polyI:C (polyinosinic-polycytidilic acid), is an adjuvant cancer-immunomodulator. However, its mechanisms of action and effect on lung cancer have not been explored pre-clinically. Here, we examined, for the first time, how a novel Hiltonol cocktail kills NSCLC cells. By retrospective analysis of NSCLC patient tissues obtained from the tumor biobank; pre-clinical studies with Hiltonol alone or Hiltonol+++ cocktail [Hiltonol+anti-IL6+AG490 (JAK2 inhibitor)+Stattic (STAT3 inhibitor)]; cytokine analysis; gene knockdown and gain/loss-of-function studies, we uncovered the mechanisms of action of Hiltonol+++. We demonstrated that Hiltonol+++ kills the cancer cells and suppresses the metastatic potential of NSCLC through: (i) upregulation of pro-apoptotic Caspase-9 and Caspase-3, (ii) induction of cytosolic cytochrome c, (iii) modulation of pro-inflammatory cytokines (GRO, MCP-1, IL-8, and IL-6) and anticancer IL-24 in NSCLC subtypes, and (iv) upregulation of tumor suppressors, PKR (protein kinase R) and OAS (2′5′ oligoadenylate synthetase). In silico analysis showed that Lys296 of PKR and Lys66 of OAS interact with Hiltonol. These Lys residues are purportedly involved in the catalytic/signaling activity of the tumor suppressors. Furthermore, knockdown of PKR/OAS abrogated the anticancer action of Hiltonol, provoking survival of cancer cells. Ex vivo analysis of NSCLC patient tissues corroborated that loss of PKR and OAS is associated with cancer advancement. Altogether, our findings unraveled the significance of studying tumor biobank tissues, which suggests PKR and OAS as precision oncological suppressor candidates to be targeted by this novel Hiltonol+++ cocktail which represents a prospective drug for development into a potent and tailored therapy for NSCLC subtypes.
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MESH Headings
- 2',5'-Oligoadenylate Synthetase/chemistry
- 2',5'-Oligoadenylate Synthetase/genetics
- 2',5'-Oligoadenylate Synthetase/metabolism
- A549 Cells
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Binding Sites
- Carboxymethylcellulose Sodium/analogs & derivatives
- Carboxymethylcellulose Sodium/pharmacology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/metabolism
- Cell Line, Tumor
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cell Survival/drug effects
- Cyclic S-Oxides/pharmacology
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Interleukin-6/antagonists & inhibitors
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Models, Molecular
- Poly I-C/pharmacology
- Polylysine/analogs & derivatives
- Polylysine/pharmacology
- Tumor Microenvironment/drug effects
- Tyrphostins/pharmacology
- eIF-2 Kinase/chemistry
- eIF-2 Kinase/genetics
- eIF-2 Kinase/metabolism
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Affiliation(s)
- Shu-Chun Chang
- The PhD Program for Translational Medicine, College for Medical Science and Technology, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan;
- International Ph.D. Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan
- Correspondence: (S.-C.C.); (J.L.D.)
| | - Bo-Xiang Zhang
- The PhD Program for Translational Medicine, College for Medical Science and Technology, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan;
- International Ph.D. Program for Translational Science, College of Medical Science and Technology, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University Hospital, 252 Wusing Street, Taipei 110, Taiwan;
- Clinical Big Data Research Center, Taipei Medical University Hospital, 252 Wusing Street, Taipei 110, Taiwan
| | - Wei-Ciao Wu
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan;
- Department of Thoracic Surgery, Department of Surgery, Taipei Medical University Shuang Ho Hospital, Taipei 110, Taiwan
| | - Tsung-Han Hsieh
- Joint Biobank, Office of Human Research, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan;
| | - Andres M. Salazar
- Oncovir, Inc., 3203 Cleveland Avenue Northwest, Washington, DC 20008, USA;
| | - Yen-Kuang Lin
- Big Data Research Center, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan;
- Biostatistics Center, Office of Data Science, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan
- Graduate Institute of Data Science, College of Management, Taipei Medical University, 250 Wusing Street, Taipei 110, Taiwan
| | - Jeak Ling Ding
- Department of Biological Sciences, National University of Singapore, Singapore 117543, Singapore
- Correspondence: (S.-C.C.); (J.L.D.)
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6
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Robinson SD, Tahir BA, Absalom KAR, Lankathilake A, Das T, Lee C, Fisher PM, Bates E, Hatton MQF. Radical accelerated radiotherapy for non-small cell lung cancer (NSCLC): A 5-year retrospective review of two dose fractionation schedules. Radiother Oncol 2019; 143:37-43. [PMID: 31563408 DOI: 10.1016/j.radonc.2019.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Numerous fractionation regimes are used for inoperable NSCLC patients not suitable for stereotactic ablative radiotherapy. Continuous hyperfractionated accelerated radiotherapy (CHART, 54 Gy, 36 fractions over 12 days) and hypofractionated accelerated radiotherapy (55 Gy, 20 fractions over 4 weeks) are recommended UK schedules. In this single-centre retrospective analysis, we compare both fractionation schemes for patients treated at our institution from 2010 to 15. MATERIALS AND METHODS Clinical demographic, tumour and survival data were collected alongside radiotherapy dosimetric data from the Varian Eclipse Scripting application programming interface. Differences were assessed using independent samples t-tests. Multivariate survival analysis was performed using Cox regression. RESULTS We identified 563 eligible patients; 43% received CHART and 57% hypofractionated radiotherapy. Median age was 71 years, 56% were male, 95% PET staged with 53% WHO performance status 0-1. 30%, 14%, 50% and 6% were stage I, II, III and IV, respectively. 38% of patients underwent induction chemotherapy. 99% completed their prescribed radiotherapy treatment. Overall response rate was 50% with a 6.5% 90-day mortality rate. Median disease-free survival was 19 months, 50% recurred locally. Median overall survival was 22.5 months with 48% alive at 2 years. Multivariate analysis identified histology, stage, performance status, chemotherapy and radiotherapy response as independent predictors of survival; no significant differences between radiotherapy regimes were observed. CONCLUSION In our centre, CHART and hypofractionated accelerated radiotherapy produce similar outcomes. Dose escalation studies are in progress to develop these schedules to match outcomes reported in concurrent chemo-radiation studies.
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Affiliation(s)
- Stephen D Robinson
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Bilal A Tahir
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Katherine A R Absalom
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Amila Lankathilake
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Tathagata Das
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Caroline Lee
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Patricia M Fisher
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Emma Bates
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Matthew Q F Hatton
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom.
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7
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Kim S, Park AK, Cho J. Early emergence of de novo EGFR T790M gatekeeper mutations during erlotinib treatment in PC9 non-small cell lung cancer cells. Biochem Biophys Res Commun 2018; 503:710-714. [PMID: 29909007 DOI: 10.1016/j.bbrc.2018.06.065] [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: 06/01/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
The emergence of the T790M gatekeeper mutation in the Epidermal Growth Factor Receptor (EGFR) gene is an important mechanism that can lead to the acquired resistance to EGFR-targeted tyrosine kinase inhibitors such as erlotinib or gefitinib. These drugs have been used in treating a subset of non-small cell lung cancer (NSCLC) patients harboring EGFR activating mutations. Here we investigated the paths leading to the acquisition of the T790M mutation by establishing an erlotinib resistant PC9 cell model harboring ectopically introduced EGFR cDNA. We detected the emergence of T790M mutation within the EGFR cDNA in a subset of erlotinib resistant PC9 cell models through Sanger sequencing and droplet digital PCR-based methods, demonstrating that T790M mutation can emerge via de novo events following treatment with erlotinib. In addition, we show that the de novo T790M bearing erlotinib resistant PC9 cells are sensitive to the 3rd generation EGFR-targeted drug, WZ4002. Furthermore, GFP-based competition cell proliferation assays reveal that PC9 cells ectopically expressing EGFR mutant become more rapidly resistant to erlotinib than parental PC9 cells through the acquisition of the T790M mutation. Taken together, we believe that our findings expand upon the previous notion of evolutionary paths of T790M development, providing an important clue to designing a therapeutic strategy to overcome drug resistance.
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Affiliation(s)
- Sujin Kim
- Department of Nanobiomedical Science, Dankook University, Cheonan, 31116, Republic of Korea
| | - Angela Kj Park
- Department of Nanobiomedical Science, Dankook University, Cheonan, 31116, Republic of Korea
| | - Jeonghee Cho
- Department of Nanobiomedical Science, Dankook University, Cheonan, 31116, Republic of Korea.
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8
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Sanganalmath P, Lester JE, Bradshaw AG, Das T, Esler C, Roy AEF, Toy E, Lester JF, Button M, Wilson P, Comins C, Atherton P, Pickles R, Foweraker K, Walker GA, Keni M, Hatton MQ. Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres. Clin Oncol (R Coll Radiol) 2018; 30:144-150. [PMID: 29336865 DOI: 10.1016/j.clon.2017.12.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 08/27/2017] [Accepted: 11/06/2017] [Indexed: 01/15/2023]
Abstract
AIM Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009. MATERIALS AND METHODS UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance. RESULTS In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity. CONCLUSION In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.
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Affiliation(s)
| | | | - A G Bradshaw
- Weston Park Hospital, Sheffield, UK; Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - T Das
- Weston Park Hospital, Sheffield, UK
| | - C Esler
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A E F Roy
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - M Button
- Velindre Cancer Centre, Cardiff, UK
| | - P Wilson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - C Comins
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - P Atherton
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - R Pickles
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - K Foweraker
- Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - G A Walker
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
| | - M Keni
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
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9
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Jiang L, Zhang W, Li W, Ling C, Jiang M. Anti-inflammatory drug, leflunomide and its metabolite teriflunomide inhibit NSCLC proliferation in vivo and in vitro. Toxicol Lett 2017; 282:154-165. [PMID: 29050931 DOI: 10.1016/j.toxlet.2017.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/06/2017] [Accepted: 10/12/2017] [Indexed: 01/03/2023]
Abstract
Lung cancer causes more than 150000 deaths annually in the United States alone, of which non-small cell lung cancer (NSCLC) accounts for 80%. Our studies demonstrated that NSCLC cells were sensitive to leflunomide and its metabolite teriflunomide, a FDA approved drug, which was a well-known immunomodulatory drug for relapsing multiple sclerosis (MS). In the present studies, we found first time that they displayed anti-tumor activity of NSCLC in vitro and in vivo. Potent anti-cancer effects in NSCLC in vitro, including inhibiting NSCLC cells viability, arresting cell cycle at the G0/G1 phase, inducing cell apoptosis, delaying and suppressing NSCLC cells colony-forming ability and cell motility, could be achieved with this agent. Meanwhile, we provided evidence that these effects were applicable in vivo by using H460 cells xenograft model in nude mice. In addition, to comprehensively clarify the mechanisms of teriflunomide in NSCLC, we explored a genome-wide transcriptomic analysis, and found that teriflunomide was involved in multiple signaling pathways and cellular processes, such as cell cycle, apoptosis, MAPK and p53 signaling pathway. Taken together, the results of our studies provided insights into a novel anti-cancer effect of leflunomide and teriflunomide on NSCLC and might open new therapeutic avenues for the treatment of NSCLC.
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Affiliation(s)
- Liyang Jiang
- Department of Respiratory Diseases, The First Affiliated Hospital of Soochow University, 215006, China
| | - Weili Zhang
- Department of Gastroenterology, Xiangcheng People's Hospital, Suzhou, 215131, China
| | - Wei Li
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Chunhua Ling
- Department of Respiratory Diseases, The First Affiliated Hospital of Soochow University, 215006, China.
| | - Min Jiang
- Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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