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Amorelli F, Martinez A, Liu F, Foro P, Algara M, Sanz J, Membrive I, Taus A, Arriola E, Masfarré L, Navarro N, De Dios NR. Impact of Lymphopenia on Treatment Outcomes in Unresectable Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e2-e3. [PMID: 37784847 DOI: 10.1016/j.ijrobp.2023.06.652] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The purpose of this study was to investigate associations between lymphopenia and radiotherapy (RT) parameters. Moreover, to investigate the prognostic role of lymphopenia, and treatment and patient-related factors. Definitive chemoradiation (CRT) with consolidative durvalumab offers the best chance for cure in patients with unresectable, locally advanced non-small cell lung cancer. However, treatment-related lymphopenia (TRL) may negatively impact outcomes. MATERIALS/METHODS Fifty-four patients treated with CRT and durvalumab from 2017 to 2021 at a single academic center were prospectively included. Absolute lymphocyte counts (ALC), absolute neutrophil counts (ANC), and neutrophil-to lymphocyte ratio (NLR) were analyzed before (TLR1), and after CRT (TRL2), before durvalumab initiation (TRL3), and 3 months after CRT (TRL4). Patients were prospectively enrolled in the study. Categorical variables were analyzed using Pearson's chi-squared or Fisher's Exact tests. Nonparametric continuous variables were analyzed using Wilcoxon Rank-Sum test. Association of continuous clinical and dosimetric variables with hematologic toxicity was performed with Spearman's correlation. Kaplan-Meier analysis and the log-rank test were used to assess the probability of PFS and OS Cox proportional hazard models were used to estimate the effect of covariates on disease control rate. Variables that were strongly associated in univariate Cox regression analyses were entered into a multivariable Cox model. All statistical tests were two-sided, and statistical significance was set at p < 0.05. All analyses were performed using STATA version 15.1. RESULTS The median follow-up was 28.4 months (m). N2-3 disease showed worse TRL2 compared to N0-1 (p = 0.013). Table 1 shows RT parameters related to TLR2. Median time to durvalumab initiation after CRT was 47 days. Patients who started durvalumab later than 42 days had a greater decrease in lymphocytes at the end of CRT compared to those who started earlier. (70.1 vs 58.8%, p = 0.025). Median overall survival (OS) and progression-free survival (PFS) were 39.4 and 22.4m, respectively. Disease control rate (DCR) with durvalumab consolidation was 70.8%. Patients with NLR >4 prior to durvalumab initiation achieved a lower DCR compared to those with a NLR ≤4 (85.7 vs 14.3%, p = 0.005). CONCLUSION CRT-related immunosuppression is associated with delayed durvalumab initiation and worse DCR. Larger PTV and higher lung and heart doses are associated with TRL. Median real-world OS and PFS are similar to those in the PACIFIC trial.
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Affiliation(s)
- F Amorelli
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - A Martinez
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - F Liu
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - P Foro
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - M Algara
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - J Sanz
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - I Membrive
- Hospital Del Mar, Radiation Oncology department, Barcelona, Spain
| | - A Taus
- Hospital Del Mar, Medical Oncology department, Barcelona, Spain
| | - E Arriola
- Hospital Del Mar, Medical Oncology department, Barcelona, Spain
| | - L Masfarré
- Hospital Del Mar, Medical Oncology department, Barcelona, Spain
| | - N Navarro
- Hospital Del Mar, Medical Oncology department, Barcelona, Spain
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Masfarré L, Rocha P, Clavé S, Moliner L, Navarro-Gorro N, Ríos-Hoyo A, Sánchez I, Giner M, Corbera A, Taus A, Bellosillo B, Arriola E. 167P KRAS G12C lung adenocarcinoma represents a distinct group of patients with different response to immunotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Palmero R, Taus A, Viteri S, Majem M, Carcereny E, Garde-Noguera J, Felip E, Sampayo M, Gomez L, Lopez N, Olsen S, Jackson M, Faull I, Dix D, Karachaliou N, Rosell R. P2.03-02 Cell-Free DNA (cfDNA) Testing in Lung Adenocarcinoma (LUAC) Patients: Spanish Lung Liquid Versus Invasive Biopsy Program (SLLIP). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1189] [Citation(s) in RCA: 3] [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: 12/01/2022]
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Rodríguez-Vida A, Pérez-Gracia J, Taus A, Bonfill T, Vázquez-Mazón F, Galtes S, Pons B, Cano L, Macia S, Maroto P, Bellmunt J. Phase II study of paclitaxel and TAK-228 in metastatic urothelial carcinoma and the impact of PI3K-mTOR pathway genomic alterations. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Karachaliou N, Lefterova M, Draper J, Molina MA, Chaib I, Palmero R, Taus A, Viteri S, González Cao M, Majem Tarruella M, Carcereny Costa E, Moran T, Garde Noguera J, Felip Font E, Olsen S, Jackson M, Sampayo M, Faull I, Dix D, Rosell R. Homology-directed repair (HDR)-defective lung adenocarcinomas (LUACs) in circulating tumor DNA (ctDNA). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy304.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hardy-Werbin M, Arpí O, Taus A, Rocha P, Joseph-Pietras D, Nolan L, Danson S, Griffiths R, Lopez-Botet M, Rovira A, Albanell J, Ottensmeier CH, Arriola E. Assessment of neuronal autoantibodies in patients with small cell lung cancer treated with chemotherapy with or without ipilimumab. Oncoimmunology 2017; 7:e1395125. [PMID: 29308329 PMCID: PMC5749672 DOI: 10.1080/2162402x.2017.1395125] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/17/2017] [Indexed: 12/17/2022] Open
Abstract
Small-cell lung cancer (SCLC) is often associated with paraneoplastic syndromes. To assess the role of anti-neuronal autoantibodies (NAAs) as biomarkers of treatment outcome, we assessed NAAs in serial samples from SCLC patients treated with chemoimmunotherapy compared to chemotherapy alone. We evaluated 2 cohorts: in cohort 1 (C1), 47 patients received standard platinum/etoposide, and in cohort 2 (C2), 38 patients received ipilimumab, carboplatin and etoposide. Serum samples at baseline and subsequent time points were analyzed for the presence of NAAs. NAAs were detected at baseline in 25 patients (53.2%) in C1 and in 20 patients (52.6%) in C2 (most frequently anti-Sox1). NAA at baseline was associated with limited disease (75% vs 50%; p: 0.096) and better overall survival (15.1 m vs 11.7 m; p: 0.032) in C1. Thirteen patients (28.9%) showed 2 or more reactivities before treatment; this was associated with worse PFS (5.5 m vs 7.3 m; p: 0.005) in patients treated with chemoimmunotherapy. NAA titers decreased after therapy in 68.9% patients, with no differential patterns of change between cohorts. Patients whose NAA titer decreased after treatment, showed longer OS [18.5 m (95% CI: 15.8 - 21.2)] compared with those whose NAA increased [12.3 m (95% CI: 8.1 - 16.5; p 0.049)], suggesting that antibody levels correlate to tumor load. Our findings reinforce the role of NAAs as prognostic markers and tumor activity/burden in SCLC, warrant further investigation in their predictive role for immunotherapy and raise concern over the use of immunotherapy in patients with more than one anti-NAA reactivity.
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Affiliation(s)
- M. Hardy-Werbin
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - O. Arpí
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - A. Taus
- Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - P. Rocha
- Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - D. Joseph-Pietras
- NIHR Experimental Cancer Medicine Centre, Southampton, United Kingdom
| | - L. Nolan
- Medical Oncology Department, University Hospital Southampton, Southampton, United Kingdom
| | - S. Danson
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - R. Griffiths
- Medical Oncology Department, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - M. Lopez-Botet
- Immunology unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - A. Rovira
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - J. Albanell
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
| | - C. H. Ottensmeier
- Cancer Science Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Experimental Cancer Medicine Centre, Southampton, United Kingdom
| | - E. Arriola
- Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain
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Aguilar DC, Pijuan L, Clave S, Taus A, Hernández A, Lorenzo M, Mojal S, Menéndez S, Albanell J, Salido M, Arriola E. Evaluation of tumor- and stromal immune marker heterogeneity in non-small cell lung cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.65] [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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Meulendijks D, Lassen U, Cervantes A, Han JY, Calles A, Felip E, Kim SW, Schellens J, Taus A, Sorensen M, Fleitas T, Bossenmaier B, Michielin F, Adessi C, Meneses-Lorente G, Ceppi M, James I, Jacob W, Weisser M, Martinez-Garcia M. Impact of tumor heregulin mRNA expression on outcome of patients with advanced/metastatic squamous NSCLC treated with lumretuzumab, a glycoengineered monoclonal antibody targeting HER3, in combination with erlotinib. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw368.12] [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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Cejalvo J, Fleitas T, Felip E, Mendivil AN, Martinez-Garcia M, Taus A, Leighl N, Lassen U, Soerensen MM, Adessi C, Michielin F, Jacob W, James I, Ceppi M, Weisser M, Cervantes A. A phase Ib study of lumretuzumab, a glycoengineered monoclonal antibody targeting HER3, in combination with carboplatin and paclitaxel as 1st-line treatment in patients with squamous non-small cell lung cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw368.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Nayak T, Massard C, Martinez Garcia M, Le Tourneau C, Boni V, Garralda E, Taus A, Albanell J, Lahr A, Krieter O, Hidalgo M. 304 Vanucizumab reduces vessel permeability, perfusion and cellular density of tumor lesions in cancer patients as measured by DCE-MRI and DW-MRI. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30170-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Clavé S, Gimeno J, De Muga S, Pijuan L, Vidal J, Lorenzo M, Menendez S, Taus A, Muñoz-Mármol A, Carcereny E, Reguart N, Mate J, Serrano S, Albanell J, Espinet B, Arriola E, Salido M. Ros1 Rearrangements and Copy Number Alterations in Nsclc Patients: High Frequency of Ros1 Deletions. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu359.8] [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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Lassen U, Ruiperez AC, Fleitas T, Meulendijks D, Schellens J, Lolkemar M, De Jonge M, Sleijfer S, Mau-Soerensen M, Taus A, Adessi C, Keelara A, Michielin F, Bossenmaier B, Meneses-Lorente G, James I, Jacob W, Weisser M, Martinez-Garcia M. Phase Ib Trial Trial of Rg7116, a Glycoengineered Monoclonal Antibody Targeting Her3, in Combination with Cetuximab or Erlotinib in Patients with Advanced/Metastatic Tumors of Epithelial Cell Origin Expressing Her3 Protein. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu331.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Casadevall D, Gimeno J, Clavé S, Taus A, Pijuan L, Luque A, Lorenzo M, Menendez S, Espinet B, Albanell J, Arriola E. Heterogeneity of Met Assessed By Immunohistochemistry (Ihc) and Fluorescence-In-Situ Hybridization (Fish) in Nonsquamous Non-Small Cell Lung Cancer (Nsnsclc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu326.27] [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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Gimeno E, Sorli L, Abella E, Alvarez-Larran A, Horcajada JP, Garrigos L, Taus A, Salar A, Sanchez B, Pedro C, Besses C, Salvado M. Molecular diagnosis of bacteriemia in patients with neutropenic febrile oncohematologic. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9033] [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: 11/20/2022] Open
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