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Szentkereszty M, Ladányi A, Gálffy G, Tóvári J, Losonczy G. Density of tumor-infiltrating NK and Treg cells is associated with 5 years progression-free and overall survival in resected lung adenocarcinoma. Lung Cancer 2024; 192:107824. [PMID: 38761665 DOI: 10.1016/j.lungcan.2024.107824] [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: 01/08/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
Surgical resection of pulmonary adenocarcinoma is considered to be curative but progression-free survival (PFS) has remained highly variable. Antitumor immune response may be important, however, the prognostic significance of tumor-infiltrating natural killer (NK) and regulatory T (Treg) lymphocytes is uncertain. Resected pulmonary adenocarcinoma tissues (n = 115) were studied by immunohistochemical detection of NKp46 and FoxP3 positivity to identify NK and Treg cells, respectively. Association of cell densities with clinicopathological features and progression-free survival (PFS) as well as overall survival (OS) were analyzed with a follow-up time of 60 months. Both types of immune cells were accumulated predominantly in tumor stroma. NK cell density showed association with female gender, non-smoking and KRAS wild-type status. According to Kaplan-Meier analysis, PFS and OS proved to be longer in patients with high NK or Treg cell densities (p = 0.0293 and p = 0.0375 for PFS, p = 0.0310 and p = 0.0448 for OS, respectively). Evaluating the prognostic effect of the combination of NK and Treg cell density values revealed that PFS and OS were significantly longer in NKhigh/Treghigh cases compared to the other groups combined (p = 0.0223 and p = 0.0325, respectively). Multivariate Cox regression analysis indicated that high NK cell density was independent predictor of longer PFS while high NK and high Treg cell densities both proved significant predictors of longer OS. The NKhigh/Treghigh combination also proved to be an independent prognostic factor for both PFS and OS. In conclusion, NK and Treg cells can be components of the innate and adaptive immune response at action against progression of pulmonary adenocarcinoma.
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Affiliation(s)
- Márton Szentkereszty
- Department of Pulmonology, Semmelweis University Clinical Center, Budapest, Hungary; Tumor Pathology Center, National Institute of Oncology, Budapest, Hungary
| | - Andrea Ladányi
- Tumor Pathology Center, National Institute of Oncology, Budapest, Hungary; National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University Clinical Center, Budapest, Hungary; Pulmonology Hospital of Törökbálint, Törökbálint, Hungary
| | - József Tóvári
- National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary; Department of Experimental Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - György Losonczy
- Department of Pulmonology, Semmelweis University Clinical Center, Budapest, Hungary.
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Farkas Á, Horváth A, Réti I, Ilyés N, Havadtői B, Kovács T, Sánta B, Tomisa G, Czaun P, Gálffy G. Comparative study of the inhalation parameters of COPD patients through NEXThaler® and Ellipta® dry powder inhalers. Respir Med 2024; 224:107576. [PMID: 38403127 DOI: 10.1016/j.rmed.2024.107576] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
The deposition of dry powder aerosol drugs depends on the inhalation parameters of the patients through the inhaler. These data are not directly measured in clinical practice. Their prediction based on the routinely measured spirometric data could help in choosing the appropriate device and optimizing the therapy. The aim of this study was to perform inhalation experiments to find correlations between inhalation parameters of COPD patients through two DPI devices and their native spirometric data, gender, age and disease severity. Another goal was to establish relationships between peak inspiratory flows through NEXThaler® and Ellipta® inhalers and their statistical determinants. Breathing parameters of 113 COPD patients were measured by normal spirometry and while inhaling through the two DPIs. Statistical analysis of the measured data was performed. The average values of peak inspiratory flow through the devices (PIFdev) were 68.4 L/min and 78.0 L/min for NEXThaler® and Ellipta®, respectively. PIFdev values were significantly higher for males than for females, but differences upon age, BMI and disease severity group were not significant. PIFdev values correlated best with their native spirometric counterparts (PIF) and linear relationships between them were revealed. Current results may be used in the future to predict the success of inhalation of COPD patients through DPI devices, which may help in the inhaler choice. By choosing the appropriate device-drug pair for each patient the lung dose can be increased and the efficiency of the therapy improved. Further results of the clinical study will be the subject of a next publication.
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Affiliation(s)
- Árpád Farkas
- HUN-REN Centre for Energy Research, Konkoly-Thege Miklós út 29-33, 1121, Budapest, Hungary.
| | - Alpár Horváth
- Chiesi Hungary Ltd., Dunavirág u. 2, 1138, Budapest, Hungary; Pulmonology Institute of Törökbálint, Munkácsy M. u.70, 2045, Törökbálint, Hungary
| | - Izolda Réti
- Pulmonology Institute of Törökbálint, Munkácsy M. u.70, 2045, Törökbálint, Hungary
| | - Norbert Ilyés
- Pulmonology Institute of Törökbálint, Munkácsy M. u.70, 2045, Törökbálint, Hungary
| | - Botond Havadtői
- Pulmonology Institute of Törökbálint, Munkácsy M. u.70, 2045, Törökbálint, Hungary
| | - Tamás Kovács
- Pulmonology Clinic, University of Debrecen, Nagyerdei krt. 98, 4032, Debrecen, Hungary
| | - Balázs Sánta
- Chiesi Hungary Ltd., Dunavirág u. 2, 1138, Budapest, Hungary
| | - Gábor Tomisa
- Chiesi Hungary Ltd., Dunavirág u. 2, 1138, Budapest, Hungary
| | - Péter Czaun
- Bremotech Ltd., Ezred u. 7, 1044, Budapest, Hungary
| | - Gabriella Gálffy
- Pulmonology Institute of Törökbálint, Munkácsy M. u.70, 2045, Törökbálint, Hungary
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Gálffy G, Morócz É, Korompay R, Hécz R, Bujdosó R, Puskás R, Lovas T, Gáspár E, Yahya K, Király P, Lohinai Z. Targeted therapeutic options in early and metastatic NSCLC-overview. Pathol Oncol Res 2024; 30:1611715. [PMID: 38605928 PMCID: PMC11006988 DOI: 10.3389/pore.2024.1611715] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 04/13/2024]
Abstract
The complex therapeutic strategy of non-small cell lung cancer (NSCLC) has changed significantly in recent years. Disease-free survival increased significantly with immunotherapy and chemotherapy registered in perioperative treatments, as well as adjuvant registered immunotherapy and targeted therapy (osimertinib) in case of EGFR mutation. In oncogenic-addictive metastatic NSCLC, primarily in adenocarcinoma, the range of targeted therapies is expanding, with which the expected overall survival increases significantly, measured in years. By 2021, the FDA and EMA have approved targeted agents to inhibit EGFR activating mutations, T790 M resistance mutation, BRAF V600E mutation, ALK, ROS1, NTRK and RET fusion. In 2022, the range of authorized target therapies was expanded. With therapies that inhibit KRASG12C, EGFR exon 20, HER2 and MET. Until now, there was no registered targeted therapy for the KRAS mutations, which affect 30% of adenocarcinomas. Thus, the greatest expectation surrounded the inhibition of the KRAS G12C mutation, which occurs in ∼15% of NSCLC, mainly in smokers and is characterized by a poor prognosis. Sotorasib and adagrasib are approved as second-line agents after at least one prior course of chemotherapy and/or immunotherapy. Adagrasib in first-line combination with pembrolizumab immunotherapy proved more beneficial, especially in patients with high expression of PD-L1. In EGFR exon 20 insertion mutation of lung adenocarcinoma, amivantanab was registered for progression after platinum-based chemotherapy. Lung adenocarcinoma carries an EGFR exon 20, HER2 insertion mutation in 2%, for which the first targeted therapy is trastuzumab deruxtecan, in patients already treated with platinum-based chemotherapy. Two orally administered selective c-MET inhibitors, capmatinib and tepotinib, were also approved after chemotherapy in adenocarcinoma carrying MET exon 14 skipping mutations of about 3%. Incorporating reflex testing with next-generation sequencing (NGS) expands personalized therapies by identifying guideline-recommended molecular alterations.
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Tomisa G, Sánta B, Horváth A, Németh L, Tamás B, Gálffy G, Tamási L, Eszes N. Risk of exacerbation and mortality in asthma: a 10-year retrospective financial database analysis of the Hungarian Health Insurance Fund. BMJ Open Respir Res 2024; 11:e002006. [PMID: 38413122 PMCID: PMC10900350 DOI: 10.1136/bmjresp-2023-002006] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Asthma is the most prevalent obstructive pulmonary disease, with drastically improved treatment options over the past decades. However, there is still a proportion of patients with suboptimal level of asthma control, leading to multiple hospitalisation due to severe acute exacerbation (SAE) and earlier death. In our study, we aimed to assess the risk of SAEs and mortality in patients who suffered an SAE. METHODS The database of the National Health Insurance Fund was used to retrospectively analyse the data of all asthmatic patients who had been hospitalised for an SAE between 2009 and 2019. We used a competing risk model to analyse the effect of each exacerbation on the risk of further SAEs with age, sex, Charlson index and the number of severe and moderate exacerbations included as covariates. RESULT Altogether, 9257 asthmatic patients suffered at least one exacerbation leading to hospitalisation during the study time. The majority (75.8%) were women, and the average age was 58.24 years. Most patients had at least one comorbidity. 3492 patients suffered at least one further exacerbation and 1193 patients died of any cause. In the competing risk model, each SAE increased the risk of further exacerbations (HR=2.078-7.026; p<0.0001 for each case) but not death. The risk of SAEs was also increased by age (HR=1.008) female sex (HR=1.102) and with the number of days of the first SAE (HR=1.007). CONCLUSIONS Even though asthma is generally a well-manageable disease, there still are many patients who suffer SAEs that significantly increase the risk of further similar SAEs.
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Affiliation(s)
- Gábor Tomisa
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Balázs Sánta
- Department of Pulmonology, Szent Borbala Korhaz, Tatabanya, Hungary
- Chiesi Hungary Ltd, Budapest, Hungary
| | - Alpár Horváth
- Chiesi Hungary Ltd, Budapest, Hungary
- Pulmonology Institute of Törökbálint, Törökbálint, Hungary
| | | | | | | | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Noémi Eszes
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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Kerpel-Fronius A, Megyesfalvi Z, Markóczy Z, Solymosi D, Csányi P, Tisza J, Kecskés A, Baranyi B, Csánky E, Dóka A, Gálffy G, Göcző K, Győry C, Horváth Z, Juhász T, Kállai Á, Kincses ZT, Király Z, Király-Incze E, Kostyál L, Kovács A, Kovács A, Kuczkó É, Makra Z, Maurovich Horvát P, Merth G, Moldoványi I, Müller V, Pápai-Székely Z, Papp D, Polgár C, Rózsa P, Sárosi V, Szalai Z, Székely A, Szuhács M, Tárnoki D, Tavaszi G, Turóczi-Kirizs R, Tóth L, Urbán L, Vaskó A, Vigh É, Dome B, Bogos K. HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program. Eur Radiol 2023:10.1007/s00330-023-10379-8. [PMID: 37921926 DOI: 10.1007/s00330-023-10379-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases. METHODS A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients. RESULTS The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology's archive or the Hungarian Cancer Registry (p < 0.001). CONCLUSIONS HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary. CLINICAL RELEVANCE STATEMENT HUNCHEST-II is the so-far largest population-based low-dose CT screening program in Hungary. A positive test's overall positive predictive value was 58%, and most screen-detected malignancies were early-stage lesions. These results pave the way for expansive systematic screening in the region. KEY POINTS • Conducted in 18 medical facilities, HUNCHEST-II is the so far largest population-based low-dose CT screening program in Hungary. • The vast majority of screen-detected malignancies were early-stage lung cancers, and the overall positive predictive value of a positive test was 58%. • HUNCHEST-II facilitates early diagnosis, thus arguing in favor of introducing systematic lung cancer screening in Hungary.
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Affiliation(s)
| | - Zsolt Megyesfalvi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Zsolt Markóczy
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Diana Solymosi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Péter Csányi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Tisza
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Anita Kecskés
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | | | - Eszter Csánky
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Adrienn Dóka
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | | | - Katalin Göcző
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Csilla Győry
- Petz Aladár University Teaching Hospital, Győr, Hungary
| | - Zsolt Horváth
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Tünde Juhász
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | - Árpád Kállai
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | - Zsigmond T Kincses
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zsolt Király
- Pulmonological Institute of Veszprém County, Farkasgyepű, Hungary
| | - Enikő Király-Incze
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - László Kostyál
- Borsod-Abaúj-Zemplén County Hospital and University Teaching Hospital - Semmelweis Member State Hospital, Miskolc, Hungary
| | - Anita Kovács
- Department of Radiology, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - András Kovács
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | - Éva Kuczkó
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Zsuzsanna Makra
- Hódmezővásárhely- Makó Healthcare Services Center, Hódmezővásárhely, Hungary
| | | | | | | | | | - Zsolt Pápai-Székely
- Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| | - Dávid Papp
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary
| | - Csaba Polgár
- National Institute of Oncology, Budapest, Hungary
| | - Péter Rózsa
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
- MediConcept, Budapest, Hungary
| | - Veronika Sárosi
- Medical School and Clinical Centre, University of Pecs, Pecs, Hungary
| | | | | | - Marianna Szuhács
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching, Nyíregyháza, Hungary
| | | | - Gábor Tavaszi
- Törökbálint Institute of Pulmonology, Törökbálint, Hungary
| | | | | | | | | | - Éva Vigh
- Vas County Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Balazs Dome
- National Koranyi Institute of Pulmonology, Budapest, Hungary.
- Department of Thoracic Surgery, Semmelweis University and National Institute of Oncology, Budapest, Hungary.
- Department of Thoracic Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
- Department of Translational Medicine, Lund University, Lund, Sweden.
| | - Krisztina Bogos
- National Koranyi Institute of Pulmonology, Budapest, Hungary
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Ahn MJ, Bondarenko I, Kalinka E, Cho BC, Sugawara S, Gálffy G, Shim BY, Kislov N, Nagarkar R, Demedts I, Gans SJM, Mendoza Oliva D, Stewart R, Lai Z, Mann H, Shi X, Hussein M. Durvalumab in Combination With Olaparib Versus Durvalumab Alone as Maintenance Therapy in Metastatic NSCLC: The Phase 2 ORION Study. J Thorac Oncol 2023; 18:1594-1606. [PMID: 37390980 DOI: 10.1016/j.jtho.2023.06.013] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION Increased DNA damage triggered through poly (ADP-ribose) polymerase inhibition may modify tumor immunogenicity, sensitizing tumors to immunotherapy. ORION (NCT03775486) evaluated the combination of olaparib with durvalumab as maintenance therapy in patients with metastatic NSCLC. METHODS ORION is a phase 2, randomized, multicenter, double-blind, international study. Patients with metastatic NSCLC (without activating EGFR or ALK aberrations) and Eastern Cooperative Oncology Group performance status of 0 or 1 were enrolled to receive initial therapy with durvalumab (1500 mg intravenously; every 3 wk) plus platinum-based chemotherapy for four cycles. Patients without disease progression were then randomized (1:1) to maintenance durvalumab (1500 mg; every 4 wk) plus either olaparib (300 mg orally) or placebo (both twice daily); randomization was stratified by objective response during initial therapy and tumor histologic type. The primary end point was investigator-assessed progression-free survival (PFS) (Response Evaluation Criteria in Solid Tumors version 1.1). RESULTS Between January 2019 and February 2020, 269 of 401 patients who received initial therapy were randomized. As of January 11, 2021 (median follow-up: 9.6 mo), median PFS was 7.2 months (95% confidence interval: 5.3-7.9) with durvalumab plus olaparib versus 5.3 months (3.7-5.8) with durvalumab plus placebo (hazard ratio = 0.76, 95% confidence interval: 0.57-1.02, p = 0.074). Safety findings were consistent with the known profiles of durvalumab and olaparib. Anemia was the most common adverse event (AE) with durvalumab plus olaparib (26.1% versus 8.2% with durvalumab plus placebo). The incidence of grade 3 or 4 AEs (34.3% versus 17.9%) and AEs leading to treatment discontinuation (10.4% versus 4.5%) was numerically higher with durvalumab plus olaparib versus durvalumab plus placebo. CONCLUSIONS Maintenance therapy with durvalumab in combination with olaparib was not associated with a statistically significant improvement in PFS versus durvalumab alone, although numerical improvement was observed.
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Affiliation(s)
- Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | | | - Ewa Kalinka
- Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Byoung Chul Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Byoung Yong Shim
- Department of Medical Oncology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Nikolay Kislov
- State Budget Institution of Health Yaroslavl Region "Regional Clinical Oncology Hospital," Yaroslavl, Russia
| | | | | | | | | | | | | | | | | | - Maen Hussein
- Florida Cancer Specialists-Sarah Cannon Research Institute, Leesburg, Florida
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Kiss Z, Gálffy G, Müller V, Moldvay J, Sárosi V, Pápai-Székely Z, Csada E, Kerpel-Fronius A, Király Z, Szász Z, Hódi G, Polányi Z, Kovács K, Karamousouli E, Knollmajer K, Szabó TG, Berta A, Vokó Z, Rokszin G, Abonyi-Tóth Z, Barcza Z, Tamási L, Bogos K. Significant changes in advanced lung cancer survival during the past decade in Hungary: impact of modern immunotherapy and the COVID-19 pandemic. Front Oncol 2023; 13:1207295. [PMID: 37860193 PMCID: PMC10584310 DOI: 10.3389/fonc.2023.1207295] [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: 04/17/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
Objective The approval of immunotherapy (I-O) for the treatment of late-stage non-small cell lung cancer (NSCLC) opened new perspectives in improving survival outcomes. However, survival data have not yet been provided from the period of the Covid-19 pandemic. The aims of our study were to assess and compare survival outcomes of patients with advanced LC receiving systemic anticancer treatment (SACT) before and after the approval of immunotherapy in Hungary, and to examine the impact of pandemic on survival outcomes using data from the Hungarian National Health Insurance Fund (NHIF) database. Methods This retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with advanced stage lung cancer (LC) (ICD-10 C34) between 1 January 2011 and 31 December 2021 and received SACT treatment without LC-related surgery. Survival rates were evaluated by year of diagnosis, sex, age, and LC histology. Results In total, 35,416 patients were newly diagnosed with advanced LC and received SACT during the study period (mean age at diagnosis: 62.1-66.3 years). In patients with non-squamous cell carcinoma, 3-year survival was significantly higher among those diagnosed in 2019 vs. 2011-2012 (28.7% [95% CI: 26.4%-30.9%] vs. 14.45% [95% CI: 13.21%-15.69%], respectively). In patients with squamous cell carcinoma, 3-year survival rates were 22.3% (95% CI: 19.4%-25.2%) and 13.37% (95% CI: 11.8%-15.0%) in 2019 and 2011-2012, respectively, the change was statistically significant. Compared to 2011-2012, the hazard ratio of survival change for non-squamous cell carcinoma patients was 0.91, 0.82, and 0.62 in 2015-2016, 2017-2018, and 2019, respectively (p<0.001 for all cases). In the squamous cell carcinoma group, corresponding hazard ratios were 0.93, 0.87, and 0.78, respectively (p<0.001 for all cases). Survival improvements remained significant in both patient populations during the Covid-19 pandemic (2020-2021). No significant improvements were found in the survival of patients with small cell carcinoma. Platinum-based chemotherapy was the most common first-line treatment in all diagnostic periods, however, the proportion of patients receiving first- or second-line immunotherapy significantly increased during the study period. Conclusion 3-year survival rates of NSCLC almost doubled among patients with non-squamous cell carcinoma and significantly improved at squamous cell carcinoma over the past decade in Hungary. Improvements could potentially be attributable by the introduction of immunotherapy and were not offset by the Covid-19 pandemic.
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Affiliation(s)
- Zoltán Kiss
- MSD Pharma Hungary Ltd, Budapest, Hungary
- Second Department of Medicine and Nephrology-Diabetes Center, University of Pécs Medical School, Pécs, Hungary
| | - Gabriella Gálffy
- Pulmonology Hospital Törökbálint, Department of Pulmonology, Törökbálin, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Judit Moldvay
- 1st Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
- 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | | | - Zsolt Pápai-Székely
- Fejér County Szent György, University Teaching Hospital, Székesfehérvár, Hungary
| | - Edit Csada
- Csongrád-Csanád County Hospital for Chest Diseases, Deszk, Hungary
| | - Anna Kerpel-Fronius
- National Korányi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | - Zsolt Király
- Veszprém County Pulmonary Hospital, Farkasgyepű, Hungary
| | - Zoltán Szász
- Department of Pulmonology, Petz Aladár University Teaching Hospital, Győr, Hungary
| | - Gábor Hódi
- MSD Pharma Hungary Ltd, Budapest, Hungary
| | | | | | | | | | | | | | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary
| | | | - Lilla Tamási
- Pulmonology Hospital Törökbálint, Department of Pulmonology, Törökbálin, Hungary
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
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Groma V, Kugler S, Farkas Á, Füri P, Madas B, Nagy A, Erdélyi T, Horváth A, Müller V, Szántó-Egész R, Micsinai A, Gálffy G, Osán J. Size distribution and relationship of airborne SARS-CoV-2 RNA to indoor aerosol in hospital ward environments. Sci Rep 2023; 13:3566. [PMID: 36864124 PMCID: PMC9980870 DOI: 10.1038/s41598-023-30702-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/28/2023] [Indexed: 03/04/2023] Open
Abstract
Aerosol particles proved to play a key role in airborne transmission of SARS-CoV-2 viruses. Therefore, their size-fractionated collection and analysis is invaluable. However, aerosol sampling in COVID departments is not straightforward, especially in the sub-500-nm size range. In this study, particle number concentrations were measured with high temporal resolution using an optical particle counter, and several 8 h daytime sample sets were collected simultaneously on gelatin filters with cascade impactors in two different hospital wards during both alpha and delta variants of concern periods. Due to the large number (152) of size-fractionated samples, SARS-CoV-2 RNA copies could be statistically analyzed over a wide range of aerosol particle diameters (70-10 µm). Our results revealed that SARS-CoV-2 RNA is most likely to exist in particles with 0.5-4 µm aerodynamic diameter, but also in ultrafine particles. Correlation analysis of particulate matter (PM) and RNA copies highlighted the importance of indoor medical activity. It was found that the daily maximum increment of PM mass concentration correlated the most with the number concentration of SARS-CoV-2 RNA in the corresponding size fractions. Our results suggest that particle resuspension from surrounding surfaces is an important source of SARS-CoV-2 RNA present in the air of hospital rooms.
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Affiliation(s)
- V Groma
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - Sz Kugler
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - Á Farkas
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - P Füri
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - B Madas
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary
| | - A Nagy
- Department of Applied and Nonlinear Optics, Wigner Research Centre for Physics, Budapest, 1121, Hungary
| | - T Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
| | - A Horváth
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
- Pest County Pulmonology Hospital, Törökbálint, 2045, Hungary
| | - V Müller
- Department of Pulmonology, Semmelweis University, Budapest, 1085, Hungary
| | | | | | - G Gálffy
- Pest County Pulmonology Hospital, Törökbálint, 2045, Hungary
| | - J Osán
- Environmental Physics Department, Centre for Energy Research, Budapest, 1121, Hungary.
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Farkas Á, Tomisa G, Kugler S, Nagy A, Vaskó A, Kis E, Szénási G, Gálffy G, Horváth A. The effect of exhalation before the inhalation of dry powder aerosol drugs on the breathing parameters, emitted doses and aerosol size distributions. Int J Pharm X 2023; 5:100167. [PMID: 36824288 PMCID: PMC9941374 DOI: 10.1016/j.ijpx.2023.100167] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/06/2023] Open
Abstract
Airway deposition of aerosol drugs is highly dependent on the breathing manoeuvre of the patients. Though incorrect exhalation before the inhalation of the drug is one of the most common mistakes, its effect on the rest of the manoeuvre and on the airway deposition distribution of aerosol drugs is not explored in the open literature. The aim of the present work was to conduct inhalation experiments using six dry powder inhalers in order to quantify the effect of the degree of lung emptying on the inhalation time, inhaled volume and peak inhalation flow. Another goal of the research was to determine the effect of the exhalation on the aerodynamic properties of the drugs emitted by the same inhalers. According to the measurements, deep exhalation before drug inhalation increased the volume of the inhaled air and the average and maximum values of the inhalation flow rate, but the extent of the increase was patient and inhaler specific. For different inhalers, the mean value of the relative increase in peak inhalation flow due to forceful exhalation was between 15.3 and 38.4% (min: Easyhaler®, max: Breezhaler®), compared to the case of normal (tidal) exhalation before the drug inhalation. The relative increase in the inhaled volume was between 36.4 and 57.1% (min: NEXThaler®, max: Turbuhaler®). By the same token, forceful exhalation resulted in higher emitted doses and smaller emitted particles, depending on the individual breathing ability of the patient, the inhalation device and the drug metered in it. The relative increase in the emitted dose varied between 0.2 and 8.0% (min: Foster® NEXThaler®, max: Bufomix® Easyhaler®), while the relative enhancement of fine particle dose ranged between 1.9 and 30.8% (min: Foster® NEXThaler®, max: Symbicort® Turbuhaler®), depending on the inhaler. All these effects and parameter values point toward higher airway doses due to forceful exhalation before the inhalation of the drug. At the same time, the present findings highlight the necessity of proper patient education on the importance of lung emptying, but also the importance of patient-specific inhaler-drug pair choice in the future.
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Key Words
- AF, aerosolized fraction
- Aerosol drug delivery
- BMI, body mass index
- Breathing parameters
- CAD, computer aided design
- COPD, chronic obstructive pulmonary disease
- CT, computed tomography
- DPI, dry powder inhaler
- Dry powder inhalers
- ED, emitted dose
- FEV1, expiratory volume at the end of the first second of forced exhalation
- FPF, fine particle fraction
- FVC, forced vital capacity
- GSD, geometric standard deviation
- ICS, inhalation cortico-steroid
- IV, inhaled volume
- IVC, inspiratory vital capacity
- IVdev, inhaled volume through an inhalation device
- Inhalation therapy
- LABA, long-acting beta-agonist
- Lung emptying
- MMAD, mass median aerodynamic diameter
- PEF, peak expiratory flow
- PIF, peak inhalation flow
- PIFdev, peak inhalation flow through an inhalation device
- PIL, patient information leaflet
- Q, mean inhalation flow rate
- Qdev, mean inhalation flow rate through an inhalation device
- SPC, summary of product characteristics
- tin, inhalation time
- tin-dev, inhalation time through an inhalation device
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Affiliation(s)
- Árpád Farkas
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary,Corresponding author at: Centre for Energy Research, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary.
| | - Gábor Tomisa
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
| | - Szilvia Kugler
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Nagy
- Wigner Research Centre for Physics, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Vaskó
- Pulmonology Clinic, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary
| | - Erika Kis
- Babes-Bolyai University, Hungarian Department of Biology and Ecology, Cluj-Napoca, Romania
| | | | - Gabriella Gálffy
- County Institute of Pulmonology, Department of Pulmonology, Munkácsy M. u. 70, 2045 Törökbálint, Hungary
| | - Alpár Horváth
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
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10
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Andric Z, Gálffy G, Cobo Dols M, Szima B, Stojanovic G, Petrovic M, Felip E, Vicente Baz D, Ponce Aix S, Juan-Vidal O, Szalai Z, Losonczy G, Calles Blanco A, Bernabe R, García Ledo G, Aguilar Hernández A, Duecker K, Zhou D, Schroeder A, Guezel G, Ciardiello F. Avelumab in Combination With Cetuximab and Chemotherapy as First-Line Treatment for Patients With Advanced Squamous NSCLC. JTO Clin Res Rep 2023; 4:100461. [PMID: 36718142 PMCID: PMC9883276 DOI: 10.1016/j.jtocrr.2022.100461] [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: 10/26/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction We present the results of a phase 2a trial of first-line avelumab (anti-programmed death-ligand 1 antibody) plus cetuximab (anti-EGFR antibody) in patients with advanced squamous NSCLC. Methods Patients with recurrent or metastatic squamous NSCLC received avelumab 800 mg (d 1 and 8), cetuximab 250 mg/m2 (d 1) and 500 mg/m2 (d 8), cisplatin 75 mg/m2 (d 1), and gemcitabine 1250 mg/m2 (d 1 and 8) for four 3-week cycles, followed by avelumab 800 mg and cetuximab 500 mg/m2 every 2 weeks. The primary end point was the best overall response; the secondary end points were progression-free survival, duration of response, overall survival, and safety. Efficacy analyses were reported from an updated data cutoff. Results A total of 43 patients were enrolled. The median follow-up was 6.6 months for the primary analyses and 9.2 months for the efficacy analyses. In the efficacy analyses, 15 patients had a confirmed partial response (objective response rate, 34.9% [95% confidence interval: 21.0%-50.9%]), and the median duration of response was 7.1 months (95% confidence interval: 4.2-12.5 mo). The median progression-free survival and overall survival were 6.1 months and 10.0 months, respectively. In the safety analyses (primary analysis), 38 patients (88.4%) had a treatment-related adverse event, of whom 24 (55.8%) had a grade 3 or higher treatment-related adverse event. Conclusions The combination of avelumab + cetuximab and chemotherapy showed antitumor activity and tolerable safety; however, the ORR was not improved compared with those reported for current standards of care (NCT03717155).
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Affiliation(s)
- Zoran Andric
- Department of Medical Oncology, Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | | | - Manuel Cobo Dols
- Department of Medical Oncology, Hospital Regional Universitario de Málaga, Institute of Biomedical Research of Málaga (IBIMA), Málaga, Spain
| | - Barna Szima
- Department of Pulmonology, Markusovszky Hospital, Szombathely, Hungary
| | - Goran Stojanovic
- Institute of Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Marina Petrovic
- Clinic for Pulmonology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Enriqueta Felip
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Vicente Baz
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Santiago Ponce Aix
- Medical Oncology Department, H120-CNIO Lung Cancer Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Oscar Juan-Vidal
- Department of Medical Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Zsuzsanna Szalai
- Department of Pulmonology, Aladar Petz University Teaching Hospital, Győr, Hungary
| | - Gyorgy Losonczy
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Antonio Calles Blanco
- Medical Oncology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Reyes Bernabe
- Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Gema García Ledo
- Centro Integral Oncológico Clara Campal HM CIOCC, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | | | - Klaus Duecker
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Dongli Zhou
- Merck Serono (Beijing) Pharmaceutical R&D Co., Ltd., Beijing, China
| | | | | | - Fortunato Ciardiello
- Division of Medical Oncology, Department of Precision Medicine, The University of Campania Luigi Vanvitelli, Naples, Italy,Corresponding author. Address for correspondence: Fortunato Ciardiello, MD, PhD, Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
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11
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Sánta B, Tomisa G, Horváth A, Balázs T, Németh L, Gálffy G. Severe exacerbations and mortality in COPD patients: A retrospective analysis of the database of the Hungarian National Health Insurance Fund. Pulmonology 2022:S2531-0437(22)00259-8. [DOI: 10.1016/j.pulmoe.2022.11.001] [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] [Received: 06/07/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/07/2022] Open
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12
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Kiss Z, Bogos K, Tamási L, Ostoros G, Müller V, Bittner N, Sárosi V, Vastag A, Knollmajer K, Várnai M, Kovács K, Berta A, Köveskuti I, Karamousouli E, Rokszin G, Abonyi-Tóth Z, Barcza Z, Kenessey I, Weber A, Nagy P, Freyler-Fadgyas P, Szócska M, Szegner P, Hilbert L, Géczy GB, Surján G, Moldvay J, Vokó Z, Gálffy G, Polányi Z. Underlying reasons for post-mortem diagnosed lung cancer cases - A robust retrospective comparative study from Hungary (HULC study). Front Oncol 2022; 12:1032366. [PMID: 36505881 PMCID: PMC9732724 DOI: 10.3389/fonc.2022.1032366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 11/27/2022] Open
Abstract
Objective The Hungarian Undiagnosed Lung Cancer (HULC) study aimed to explore the potential reasons for missed LC (lung cancer) diagnosis by comparing healthcare and socio-economic data among patients with post-mortem diagnosed LC with those who were diagnosed with LC during their lives. Methods This nationwide, retrospective study used the databases of the Hungarian Central Statistical Office (HCSO) and National Health Insurance Fund (NHIF) to identify patients who died between January 1, 2019 and December 31, 2019 and were diagnosed with lung cancer post-mortem (population A) or during their lifetime (population B). Patient characteristics, socio-economic factors, and healthcare resource utilization (HCRU) data were compared between the diagnosed and undiagnosed patient population. Results During the study period, 8,435 patients were identified from the HCSO database with LC as the cause of death, of whom 1,203 (14.24%) had no LC-related ICD (International Classification of Diseases) code records in the NHIF database during their lives (post-mortem diagnosed LC population). Post-mortem diagnosed LC patients were significantly older than patients diagnosed while still alive (mean age 71.20 vs. 68.69 years, p<0.001), with a more pronounced age difference among female patients (difference: 4.57 years, p<0.001), and had significantly fewer GP (General Practitioner) and specialist visits, X-ray and CT scans within 7 to 24 months and 6 months before death, although the differences in GP and specialist visits within 7-24 months did not seem clinically relevant. Patients diagnosed with LC while still alive were more likely to be married (47.62% vs. 33.49%), had higher educational attainment, and had more children, than patients diagnosed with LC post-mortem. Conclusions Post-mortem diagnosed lung cancer accounts for 14.24% of total lung cancer mortality in Hungary. This study provides valuable insights into patient characteristics, socio-economic factors, and HCRU data potentially associated with a high risk of lung cancer misdiagnosis.
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Affiliation(s)
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Directorate of Institution, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Directorate of Institution, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Nóra Bittner
- Department of Pulmonology, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- University of Veterinary Medicine Budapest, Department of Biostatistics, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd, Budapest, Hungary
| | - István Kenessey
- 1 Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - András Weber
- National Institute of Oncology, National Tumorbiology Laboratory project (NLP-17), Budapest, Hungary
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Péter Nagy
- National Institute of Oncology, National Tumorbiology Laboratory project (NLP-17), Budapest, Hungary
- Department of Anatomy and Histology, University of Veterinary Medicine, Budapest, Hungary
- Institute of Oncochemistry, University of Debrecen, Debrecen, Hungary
| | - Petra Freyler-Fadgyas
- National Health Insurance Fund, Department of Project Management and Data Services, Budapest, Hungary
| | - Miklós Szócska
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Péter Szegner
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Lászlóné Hilbert
- Hungarian Central Statistical Office, Department of Population Statistics, Budapest, Hungary
| | | | - György Surján
- Institute of Digital Health Sciences, Semmelweis University, Budapest, Hungary
| | - Judit Moldvay
- 2 Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Gabriella Gálffy
- Pulmonology Hospital Törökbálint, 6th Department, Törökbálint, Hungary
- Department of Thoracic Surgery, Semmelweis University, Budapest, Hungary
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13
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Reinmuth N, Juan-Vidal O, Horváth Z, Kowalski D, Kryzhanivska A, Csánky E, Gálffy G, Bryl M, Vicente D, Vynnychenko I, Pápai-Székely Z, Armstrong J, Dalvi T, Shrestha Y, Xie M, Jiang H, Bondarenko I. Abstract CT533: Durvalumab (D) plus tremelimumab (T) in platinum-refractory/resistant extensive-stage small cell lung cancer (ES-SCLC): Efficacy, safety and ctDNA dynamics from Arm A of the phase 2 BALTIC study. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-ct533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Molecular response based on ctDNA dynamics may be predictive of benefit from immunotherapy in NSCLC, complementing radiologic disease assessment and potentially enabling early clinical decision-making, but data in SCLC are lacking. The phase 2, multi-arm, signal-searching BALTIC study (NCT02937818) assessed novel treatment combinations in platinum-refractory/resistant ES-SCLC; we report efficacy, safety, and exploratory ctDNA and PD-L1 analyses from pts who received D + T in Arm A.
Methods: Eligible pts had ES-SCLC, progressive disease (PD) during or within 90 days of completing 1L platinum-based CT, WHO PS 0-1, and life expectancy ≥8 weeks. In Arm A, pts received D 1500 mg + T 75 mg q4w for 4 cycles, followed by maintenance D 1500 mg q4w until PD. The primary endpoint was ORR (investigator assessment, RECIST v1.1). Secondary endpoints included DCR, PFS, OS, and safety and tolerability. Prespecified exploratory analyses included assessment of baseline/on-treatment ctDNA levels measured by maximum variant allele frequency (MaxVAF), and PD-L1 expression on tumor cells (TC) and immune cells (IC) (VENTANA PD-L1 [SP263] Assay).
Results: 41 pts received treatment with D + T (median age 63 years; 76% male; 76% PS 1). At the data cut-off (DCO; Jun 22, 2020), median treatment duration was 12 weeks, with 3 pts ongoing D treatment (these pts had received ≥38, ≥21, and ≥19 doses of D, respectively, at DCO). Confirmed ORR was 7.3% (95% CI 1.54‒19.92; 3 partial responses [PR]). DCR at 12 weeks was 27%. 21 pts (51%) were PD-L1 evaluable. Of 12 pts with PD-L1 expression (TC or IC) ≥1%, 3 (25%) had a best response of PR or stable disease, compared with 1 (11%) of 9 pts with PD-L1 (TC or IC) <1%. Median PFS was 1.84 mo (95% CI 1.77‒1.91) and median OS was 5.36 mo (95% CI 2.89‒7.23). Grade 3/4 treatment-related adverse events (TRAEs) occurred in 8 pts (20%); TRAEs led to treatment discontinuation in 5 pts (12%) and death in 1 pt (hemorrhagic enterocolitis). 26 pts (63%) were evaluable for ctDNA at baseline, and 10 pts (24%) had on-treatment ctDNA data. Pts with baseline MaxVAF in low (n=9), medium (n=8), and high (n=9) tertiles had a median OS of 12.8, 4.5, and 2.3 mo, respectively. Pts with a decrease in on-treatment ctDNA level (delta MaxVAF <0) had a longer median OS (12.0 mo) vs those with an increase (5.6 mo).
Conclusions: Although limited antitumor activity was observed in refractory/resistant ES-SCLC in BALTIC, association of lower baseline ctDNA levels (MaxVAF) with longer OS may reflect the prognostic effect of disease burden. Association of on-treatment reduction in ctDNA level with longer OS suggests potential use of ctDNA as a surrogate of treatment response in ES-SCLC. Further analyses in larger datasets and in a randomized setting are warranted.
Citation Format: Niels Reinmuth, Oscar Juan-Vidal, Zsolt Horváth, Dariusz Kowalski, Anna Kryzhanivska, Eszter Csánky, Gabriella Gálffy, Maciej Bryl, David Vicente, Ihor Vynnychenko, Zsolt Pápai-Székely, Jon Armstrong, Tapashi Dalvi, Yashaswi Shrestha, Mingchao Xie, Haiyi Jiang, Igor Bondarenko. Durvalumab (D) plus tremelimumab (T) in platinum-refractory/resistant extensive-stage small cell lung cancer (ES-SCLC): Efficacy, safety and ctDNA dynamics from Arm A of the phase 2 BALTIC study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT533.
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Affiliation(s)
| | | | - Zsolt Horváth
- 3Bacs-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Dariusz Kowalski
- 4Department of Lung Cancer and Chest Tumours, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Anna Kryzhanivska
- 5Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Eszter Csánky
- 6Department of Pulmonology, Semmelweis Hospital, Miskolc, Hungary
| | | | - Maciej Bryl
- 8Oncology Department, E.J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - David Vicente
- 9Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | | | | - Igor Bondarenko
- 14Dnipropetrovsk State Medical Academy, Dnipropetrovsk, Ukraine
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14
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Gálffy G, Molnár A, Blasszauer C, Komka I, Reibl D, Lövey J. [Not Available]. Magy Onkol 2022; 66:55-63. [PMID: 35343976] [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] [Received: 11/18/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
During oncological treatments, body mass index (BMI) and weight loss (WL) are important prognostic factors, but can be influenced by nutrition therapy. The aim of the study was to collect data on BMI and WL of patients with lung cancer and on the nutritional therapy influencing malnutrition. In our multicenter, retrospective study involving 1616 patients, data were collected using a questionnaire with 51 questions, and statistical analysis was performed with descriptive, and multivariate analysis methods with IBM SPSS 20 software. According to the method of Martin, based on BMI and WL, patients were ranked on a scale of 0 to 4 (grade 0 24.9%; grade 1 20.7%; grade 2 14.9%; grade 3 22.4%; grade 4 17.0%). Based on this data low BMI and WL may affect survival in 75.1%. In contrast, only 37.6% of patients received nutritional therapy, based on 47 different strategies. The data substituted into the prognostic matrix highlights that weight loss may shorten patients' survival. The 47 strategies indicate that the use of nutritional therapy is inconsistent throughout this patient cohort.
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Affiliation(s)
| | - Andrea Molnár
- Magyar Dietetikusok Országos Szövetsége, Budapest, Hungary
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15
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Kiss Z, Bogos K, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Knollmajer K, Várnai M, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Barcza Z, Moldvay J, Gálffy G, Vokó Z. Increase in the Length of Lung Cancer Patient Pathway Before First-Line Therapy: A 6-Year Nationwide Analysis From Hungary. Pathol Oncol Res 2021; 27:1610041. [PMID: 35002544 PMCID: PMC8734146 DOI: 10.3389/pore.2021.1610041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
Objective: This study aimed to examine the characteristics of the lung cancer (LC) patient pathway in Hungary during a 6-years period. Methods: This nationwide, retrospective study included patients newly diagnosed with LC (ICD-10 C34) between January 1, 2011, and December 31, 2016, using data from the National Health Insurance Fund (NHIF) of Hungary. The following patient pathway intervals were examined: system, diagnostic and treatment interval by age, gender, tumor type, study year and first-line LC therapy. Results: During the 6-years study period, 17,386 patients had at least one type of imaging (X-ray or CT/MRI) prior to diagnosis, and 12,063 had records of both X-ray and CT/MRI. The median system interval was 64.5 days, and it was 5 days longer among women, than in men (68.0 vs. 63.0 days). The median system interval was significantly longer in patients with adenocarcinoma compared to those with squamous cell carcinoma or small cell lung cancer (70.4 vs. 64.0 vs. 48.0 days, respectively). Patients who received surgery as first-line treatment had significantly longer median system intervals compared to those receiving chemotherapy (81.4 vs. 62.0 days). The median system interval significantly increased from 62.0 to 66.0 days during the 6-years study period. Conclusion: The LC patient pathway significantly increased in Hungary over the 6-years study period. There were no significant differences in the length of the whole LC patient pathway according to age, however, female sex, surgery as first-line treatment, and adenocarcinoma were associated with longer system intervals.
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Affiliation(s)
- Zoltan Kiss
- MSD Pharma Hungary Ltd., Budapest, Hungary
- *Correspondence: Zoltan Kiss,
| | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Matrahaza Healthcare Center and University Teaching Hospital, Matrahaza, Hungary
| | - Nóra Bittner
- Department of Pulmonology, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | - Balázs Nagy
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Krisztián Horváth
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary
- Department of Biomathematics and Computer Science, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - Judit Moldvay
- 1st Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary
- 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Vokó
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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16
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Gálffy G, Vastag A, Bogos K, Kiss Z, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Polányi Z, Nagy-Erdei Z, Daniel A, Knollmajer K, Várnai M, Szegner P, Vokó Z, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Pozsgai É, Barcza Z, Moldvay J, Tamási L. Significant Regional Differences in Lung Cancer Incidence in Hungary: Epidemiological Study Between 2011 and 2016. Pathol Oncol Res 2021; 27:1609916. [PMID: 34594159 PMCID: PMC8478017 DOI: 10.3389/pore.2021.1609916] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/27/2021] [Indexed: 12/09/2022]
Abstract
Objective: Hungary has one of the highest incidences and mortality rates of lung cancer (LC), therefore the objective of this study was to analyse and compare LC incidence and mortality rates between the main Hungarian regions. Methods: This nationwide, retrospective study used data from the National Health Insurance Fund and included patients aged ≥20 years who were diagnosed with lung cancer (ICD-10 C34) between Jan 1, 2011 and Dec 31, 2016. Age-standardized incidence and mortality rates were calculated and compared for the main regions. Results: The highest incidence rate in males was recorded in Northern Hungary (146.8/100,000 person-years [PY]), while the lowest rate was found in Western Transdanubia (94.7/100,000 PY in 2011). All rates showed a declining trend between 2011 and 2016, with the largest decrease in the Northern Great Plain (−20.0%; p = 0.008). LC incidence and mortality rates in women both showed a rising tendency in all regions of Hungary, reaching the highest in Central Hungary (59.86/100,000 PY in 2016). Lung cancer incidence and mortality rates in males correlated with the level of education and smoking prevalence (p = 0.006 and p = 0.01, respectively) in the regions. A correlation with GDP per capita and Health Development Index (HDI) index could also be observed in the Hungarian regions, although these associations were not statistically significant. No correlations could be detected between these parameters among females. Conclusion: This analysis revealed considerable differences in the epidemiology of LC between the 7 main Hungarian regions. LC incidence and mortality rates significantly correlated with smoking and certain socioeconomic factors in men, but not in women. Further research is needed to explain the regional differences.
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Affiliation(s)
- Gabriella Gálffy
- Department of Pulmonology, Pulmonology Hospital Törökbálint, Törökbálint, Hungary
| | | | - Krisztina Bogos
- Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Gyula Ostoros
- Department of Pulmonology, Pulmonology Hospital Törökbálint, Törökbálint, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Department of Pulmonology, Mátraháza Healthcare Center and University Teaching Hospital, Mátraháza, Hungary
| | - Nóra Bittner
- Pulmonology Clinic, University of Debrecen, Debrecen, Hungary
| | - Veronika Sárosi
- Department of Pulmonology, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | | | | | | | | | - Máté Várnai
- MSD Pharma Hungary Ltd, Budapest, Hungary.,Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Péter Szegner
- MSD Pharma Hungary Ltd, Budapest, Hungary.,Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Balázs Nagy
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Krisztián Horváth
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary.,Department of Biostatistics, University of Veterinary Medicine Budapest, Budapest, Hungary
| | - Éva Pozsgai
- Department of Primary Health Care, University of Pécs Medical School, Pécs, Hungary
| | - Zsófia Barcza
- Syntesia Medical Communications Ltd., Budapest, Hungary
| | - Judit Moldvay
- Department of Tumor Biology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary.,MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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17
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Lavorini F, Chudek J, Gálffy G, Pallarés-Sanmartin A, Pelkonen AS, Rytilä P, Syk J, Szilasi M, Tamási L, Xanthopoulos A, Haahtela T. Switching to the Dry-Powder Inhaler Easyhaler ®: A Narrative Review of the Evidence. Pulm Ther 2021; 7:409-427. [PMID: 34581994 PMCID: PMC8477976 DOI: 10.1007/s41030-021-00174-5] [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: 07/19/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are major causes of morbidity and mortality worldwide. Optimal control of these conditions is a constant challenge for both physicians and patients. Poor inhaler practice is widespread and is a substantial contributing factor to the suboptimal clinical control of both conditions. The practicality, dependability, and acceptability of different inhalers influence the overall effectiveness and success of inhalation therapy. In this paper, experts from various European countries (Finland, Germany, Hungary, Italy, Poland, Spain, and Sweden) address inhaler selection with special focus on the Easyhaler® device, a high- or medium–high resistance dry-powder inhaler (DPI). The evidence examined indicates that use of the Easyhaler is associated with effective control of asthma or COPD, as shown by the generally accepted indicators of treatment success. Moreover, the Easyhaler is widely accepted by patients, is reported to be easy to learn and teach, and is associated with patient adherence. These advantages help patient education regarding correct inhaler use and the rational selection of drugs and devices. We conclude that switching inhaler device to the Easyhaler may improve asthma and COPD control without causing any additional risks. In an era of climate change, switching from pressurized metered-dose inhalers to DPIs is also a cost-effective way to reduce emissions of greenhouse gases. Enhanced feature (slides, video, animation) (MP4 43768 kb)
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland
| | | | | | - Anna S Pelkonen
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Paula Rytilä
- Global Medical Affairs, R&D, Orion Pharma, PO Box 65, 02101, Espoo, Finland.
| | - Jörgen Syk
- Academic Primary Health Care Centre, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Szilasi
- National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
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18
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Tamási L, Horváth K, Kiss Z, Bogos K, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Daniel A, Nagy B, Rokszin G, Abonyi-Tóth Z, Moldvay J, Vokó Z, Gálffy G. Age and Gender Specific Lung Cancer Incidence and Mortality in Hungary: Trends from 2011 Through 2016. Pathol Oncol Res 2021; 27:598862. [PMID: 34257553 PMCID: PMC8262188 DOI: 10.3389/pore.2021.598862] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/28/2021] [Indexed: 01/10/2023]
Abstract
Objective: No assessment was conducted describing the age and gender specific epidemiology of lung cancer (LC) prior to 2018 in Hungary, thus the objective of this study was to appraise the detailed epidemiology of lung cancer (ICD-10 C34) in Hungary based on a retrospective analysis of the National Health Insurance Fund database. Methods: This longitudinal study included patients aged ≥20 years with LC diagnosis (ICD-10 C34) between January 1, 2011 and December 31, 2016. Patients with different cancer-related codes 6 months before or 12 months after LC diagnosis or having any cancer treatment other than lung cancer protocols were excluded. Results: Lung cancer incidence and mortality increased with age, peaking in the 70–79 age group (375.0/100,000 person-years) among males, while at 60–69 age group for females (148.1/100,000 person-years). The male-to-female incidence rate ratio reached 2.46–3.01 (p < 0.0001) among the 70–79 age group. We found 2–11% decrease in male incidence rate at most age groups, while a significant 1–3% increase was observed in older females (>60) annually during the study period. Conclusion: This nationwide epidemiology study demonstrated that LC incidence and mortality in Hungary decreased in younger male and female population, however we found significant increase of incidence in older female population, similar to international trends. Incidence rates peaked in younger age-groups compared to Western countries, most likely due to higher smoking prevalence in these cohorts, while lower age LC incidence could be attributed to higher competing cardiovascular risk resulting in earlier mortality in smoking population.
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Affiliation(s)
- Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Krisztián Horváth
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | | | - Krisztina Bogos
- National Korányi Institute of Pulmonology, Department of Pulmonology, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Department of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Mátraháza Healthcare Center and University Teaching Hospital, Mátraháza, Hungary
| | - Nóra Bittner
- Pulmonology Clinic, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | - Balázs Nagy
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary.,University of Veterinary Medicine, Budapest, Hungary
| | - Judit Moldvay
- Department of Tumor Biology, National Korányi Institute of Pulmonology - Semmelweis University, Budapest, Hungary.,2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.,Pulmonology Hospital, Törökbálint, Hungary
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19
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Bogos K, Kiss Z, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Daniel A, Vokó Z, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Barcza Z, Gálffy G, Moldvay J. Improvement in Lung Cancer Survival: 6-Year Trends of Overall Survival at Hungarian Patients Diagnosed in 2011-2016. Pathol Oncol Res 2021; 27:603937. [PMID: 34257563 PMCID: PMC8262181 DOI: 10.3389/pore.2021.603937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/24/2021] [Indexed: 12/25/2022]
Abstract
Objective: Lung cancer is one of the most common cancers worldwide and its survival is still poor. The objective of our study was to estimate long-term survival of Hungarian lung cancer patients at first time based on a nationwide review of the National Health Insurance Fund database. Methods: Our retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with lung cancer (ICD-10 C34) between January 1, 2011 and December 31, 2016. Survival rates were evaluated by year of diagnosis, patient gender and age, and morphology of lung cancer. Results: 41,854 newly diagnosed lung cancer patients were recorded. Mean age at diagnosis varied between 64.7 and 65.9 years during study period. One- and 5-year overall survival rates for the total population were 42.2 and 17.9%, respectively. Survival was statistically associated with gender, age and type of lung cancer. Female patients (n = 16,362) had 23% better survival (HR: 0.77, 95% confidence interval (CI): 0.75–0.79; p < 0.001) than males (n = 25,492). The highest survival rates were found in the 20–49 age cohort (5Y = 31.3%) and if the cancer type was adenocarcinoma (5Y = 20.5%). We measured 5.3% improvement (9.2% adjusted) in lung cancer survival comparing the period 2015–2016 to 2011–2012 (HR: 0.95 95% CI: 0.92–0.97; p = 0.003), the highest at females <60 year (0.86 (adjusted HR was 0.79), interaction analysis was significant for age and histology types. Conclusion: Our study provided long-term Lung cancer survival data in Hungary for the first time. We found a 5.3% improvement in 5-year survival in 4 years. Women and young patients had better survival. Survival rates were comparable to–and at the higher end of–rates registered in other East-Central European countries (7.7%–15.7%).
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Affiliation(s)
- Krisztina Bogos
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Matrahaza Healthcare Center and University Teaching Hospital, Matrahaza, Hungary
| | - Nóra Bittner
- Pulmonology Clinic University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd. Szolnok, Budapest, Hungary.,University of Veterinary Medicine Budapest, Budapest, Hungary
| | | | | | - Judit Moldvay
- Ist Department of Pulmonology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary.,2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
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20
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Gálffy G, Emmeluth M, Koltun A, Kopietz F, Nguyen DT, Kuhl HC. Allergic Rhinitis Therapy Decisions During a Routine Consultation: A Multicenter, Cross-Sectional Survey. J Asthma Allergy 2021; 14:335-345. [PMID: 33854340 PMCID: PMC8039052 DOI: 10.2147/jaa.s291747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Allergic rhinitis (AR) is characterized by nasal and ocular symptoms, and substantially impacts the quality of life. Therapy selection for patients with AR depends on several factors, including symptom severity, age, patient preference, patient adherence, and cost. Methods The purpose of this multicenter, noninterventional, cross-sectional survey was to evaluate current therapy decisions in routine clinical practice for patients with symptomatic AR, and to determine how these decisions are linked to experiences with previous treatments and current symptom severity as assessed by aVAS. The survey included patients aged 18 years or older in Spain and 12 years or older in Hungary who consulted a physician for treatment of AR symptoms. Physicians recorded AR symptom burden in the previous 7 days, previous AR treatments, and the current AR therapy decision made at the visit. Results Overall, 72.9% of 181 patients (Spain) and 67.1% of 228 patients (Hungary) had received treatment in the previous 7 days. Among patients who had received step 3 treatment, 82.9% (Spain) and 75.8% (Hungary) received a free combination of intranasal corticosteroid (INCS) and antihistamines. Despite the high number of pretreated patients in both countries, 72.9% and 78.9% in Spain and Hungary, respectively, reported uncontrolled symptoms (VAS ≥50 mm). Of pretreated patients, 58.3% (Spain) and 61.4% (Hungary) received a step-up in treatment during the visit. Physicians more often prescribed a fixed combination of INCS and intranasal antihistamine than a free combination. However, of patients with uncontrolled symptoms who received previous therapy, 28.0% (Hungary) and 40.6% (Spain) did not receive a step-up as suggested by the guidelines. Conclusion Many patients suffering from acute AR symptoms consulted with their physician because of insufficient medications. Not all patients with uncontrolled symptoms received a step-up in treatment, underscoring the need for improved physician education to enhance AR management and control in accordance with consensus treatment guidelines.
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Affiliation(s)
- Gabriella Gálffy
- Onco-Pulmonology Department, Pest County Pulmonology Hospital, Törökbálint, Hungary
| | - Melanie Emmeluth
- Global Medical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | - Arkady Koltun
- Global Medical Affairs, Mylan, Inc, Canonsburg, PA, USA
| | - Ferdinand Kopietz
- Global Medical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | - Duc Tung Nguyen
- Global Medical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | - Hans Christian Kuhl
- Global Medical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
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21
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Andric Z, Gálffy G, Dols MC, Szima B, Stojanovic G, Petrovic M, Font EF, Baz DV, Aix SP, Juan-Vidal O, Tehenes S, Szalai Z, Losonczy G, Blanco AC, Bernabe R, Duecker K, Zhou D, Schroeder A, Guezel G, Ciardiello F. 103P First-line avelumab in combination with cetuximab and chemotherapy in patients with advanced squamous non-small cell lung cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01945-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Bogos K, Kiss Z, Gálffy G, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Vokó Z, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Barcza Z, Moldvay J. Lung Cancer in Hungary. J Thorac Oncol 2021; 15:692-699. [PMID: 32340676 DOI: 10.1016/j.jtho.2019.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/02/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Krisztina Bogos
- IV. Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | | | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- IV. Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Mátraháza Healthcare Center and University Teaching Hospital, Mátraháza, Hungary
| | - Nóra Bittner
- University of Debrecen, Pulmonology Clinic, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary; University of Veterinary Medicine, Budapest, Hungary
| | | | - Judit Moldvay
- Department of Tumor Biology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary; MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
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23
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van Weissenbruch R, Klimek L, Gálffy G, Emmeluth M, Koltun A, Kopietz F, Nguyen DT, Kuhl HC, Pohl W, Scadding GK, Price D, Mullol J. MP-AzeFlu Improves the Quality-of-Life of Patients with Allergic Rhinitis. J Asthma Allergy 2020; 13:633-645. [PMID: 33293835 PMCID: PMC7719305 DOI: 10.2147/jaa.s277734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients with poorly controlled allergic rhinitis (AR) experience nasal symptoms, sleep disturbances, activity impairment, and decreased quality-of-life (QoL). MP-AzeFlu is safe and effective for moderate-to-severe seasonal and perennial AR, but its impact on QoL requires investigation in the real-world, especially among phenotypes of immunoglobulin (Ig)E-mediated AR. This subanalysis of an observational study evaluated response to MP-AzeFlu via assessment of sleep quality and trouble with daily activities. Patients and Methods This multicenter, prospective, non-interventional, real-life study included a convenience sample of patients with a history of moderate-to-severe AR presenting with acute AR symptoms (visual analog scale [VAS] ≥50 mm). Over approximately 14 days of treatment with MP-AzeFlu (137 µg azelastine HCL and 50 µg fluticasone propionate administered via single 0.137-mL spray in each nostril twice daily), changes in sleep quality and trouble with daily work, school, social, and outdoor activities were evaluated using a VAS for the entire study population and for four subgroups based on IgE response phenotype. VAS scores ranged from “not at all troubled” (0 mm) to “extremely troubled” (100 mm). Results Following MP-AzeFlu treatment, mean VAS scores for sleep quality impairment and work or school impairment decreased from 55.2 mm at baseline to 22.1 mm and 57.6 mm at baseline to 23.0 mm, respectively, after ~14 days. Similar results were observed for mean VAS scores for impairment of social activity (55.1 mm to 22.4 mm) and impairment of outdoor activity (64.4 mm to 25.0 mm). For all VAS scores, results were similar across populations, regardless of phenotype of IgE-mediated disease, comorbidity, age, and sex. Conclusion MP-AzeFlu relieves symptoms and improves patient-reported QoL, illustrated by better sleep quality and less impairment of work, school, social, and outdoor activities after 14 days. The QoL benefits of MP-AzeFlu were consistent regardless of the phenotype of IgE-mediated disease. Registration Clinical Trial Registration (CTR) Number: EUPAS23075. Trial Register Date: March 12, 2018. First patient visit; Last patient visit: February 2018; April 2019.
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Affiliation(s)
| | - Ludger Klimek
- Department of Otorhinolaryngology and Head and Neck Plastic Surgery, Zentrum für Rhinologie und Allergologie, Wiesbaden, Germany
| | | | - Melanie Emmeluth
- Global Medical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | | | - Ferdinand Kopietz
- Global Medical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | - Duc Tung Nguyen
- GBK Clinical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | - Hans Christian Kuhl
- Global Medical Affairs, MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | - Wolfgang Pohl
- Department of Respiratory and Pulmonary Diseases, Karl Landsteiner Gesellschaft, Institute of Clinical and Experimental Pneumology, Vienna, Austria
| | | | - David Price
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona IDIBAPS University of Barcelona, CIBERES, Barcelona, Catalonia, Spain
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24
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Sultész M, Horváth A, Molnár D, Katona G, Mezei G, Hirschberg A, Gálffy G. Prevalence of allergic rhinitis, related comorbidities and risk factors in schoolchildren. Allergy Asthma Clin Immunol 2020; 16:98. [PMID: 33292450 PMCID: PMC7661153 DOI: 10.1186/s13223-020-00495-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background The study aimed to determine the prevalence and risk factors of allergic rhinitis and related comorbidities in school-age children in Budapest, capital of Hungary. Data and epidemiological studies on this disease are still limited. Methods A cross sectional study was conducted in 21 representative and randomly selected primary schools in 2019. International Study of Asthma and Allergies in Childhood-based questionnaires (n = 6869) inquiring about prevalence and related risk factors of allergic rhinitis were distributed to all parents. The data were characterised with standard descriptive statistics: frequencies (percentages) and means for categorical and quantitative data, respectively. Results 3836 of the questionnaires (1857 M/1979F) were completed. The prevalence of current allergic rhinitis was 29.3% (1043), physician-diagnosed allergic rhinitis was 9.7% (373), cumulative allergic rhinitis was 36.2% (1289) and current allergic rhinoconjunctivitis was 16.2% (577). The presence of physician diagnosed atopic disease–asthma (p < 0.0001, OR = 4.398, 95% CI 3.356–5.807), food allergy (p < 0.0001, OR = 2.594, 95% CI 1.995–3.378), and eczema (p < 0.0001, OR = 1.899, 95% CI 1.568–2.300)-were significantly related to an increased risk of cumulative allergic rhinitis. Significant factors associated with allergic rhinitis include male gender (p < 0.0001), family history of atopy (p < 0.0001), frequent upper respiratory tract infections (p < 0.0001), tonsillectomy (p = 0.0054), antibiotics given in the first year of life (p < 0.0001), paracetamol given in the first year of life (p = 0.0038), long-lasting common infections caused by viruses and/or bacteria before the appearance of the allergy (p < 0.0001), consumption of drinks containing preservatives or colourants (p = 0.0023), duration of living in Budapest (p = 0.0386), smoking at home (p = 0.0218), smoking at home in the first year of life (p = 0.0048), birds at home (p = 0.0119), birds at home in the first year of life (p = 0.0052), visible mould in the bedroom (p = 0.0139), featherbedding (p = 0.0126), frequent or constant heavy-vehicle traffic (p = 0.0039), living in a weedy area (p < 0.0001) and living in the vicinity of an air-polluting factory or mine (p = 0.0128). Conclusions The prevalence of allergic rhinoconjunctivitis in 6–12-year-old children in Budapest is higher than reported for most of the surrounding European countries. While asthma (OR = 4.398) is the most significant comorbidity, environmental factors such as birds at home in the first year of life (OR = 2.394) and living in a weedy area (OR = 1.640) seem to be the most important factors associated with AR. Strategies for preventive measures should be implemented. Trial registration number: KUT-19/2019. The study was approved by the Ethics Committee at Heim Pál National Pediatric Institute,
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Affiliation(s)
- Monika Sultész
- Department of Oto-Rhino-Laryngology, Heim Pál National Pediatric Institute, 86. Üllői street, Budapest, 1089, Hungary
| | - Alpár Horváth
- Pest County Pulmonology Hospital, 70. Munkácsy Mihály Street, Törökbálint, 2045, Hungary.,Medical Department of Chiesi Hungary Ltd, 2. Dunavirág street, Budapest, 1138, Hungary
| | - Dávid Molnár
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Centre, Hungarian Defence Forces, 109-111. Podmaniczky street, Budapest, 1062, Hungary.,Department of Anatomy, Histology and Embryology, Semmelweis University, 58 Tűzoltó street, Budapest, 1085, Hungary
| | - Gábor Katona
- Department of Oto-Rhino-Laryngology, Heim Pál National Pediatric Institute, 86. Üllői street, Budapest, 1089, Hungary
| | - Györgyi Mezei
- Division of Allergo-Pulmonology, 1st Department of Paediatrics, Semmelweis University, 53-54 Bókay János street, Budapest, 1083, Hungary.
| | - Andor Hirschberg
- Department of Oto-Rhino-Laryngology and Maxillo-Facial Surgery, Saint John's Hospital, 1-3. Diós árok, Budapest, 1125, Hungary
| | - Gabriella Gálffy
- Pest County Pulmonology Hospital, 70. Munkácsy Mihály Street, Törökbálint, 2045, Hungary.,Department of Thoracic Surgery, Semmelweis University, 7-9 Ráth György street, Budapest, 1122, Hungary
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25
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Gál Z, Gézsi A, Semsei ÁF, Nagy A, Sultész M, Csoma Z, Tamási L, Gálffy G, Szalai C. Investigation of circulating lncRNAs as potential biomarkers in chronic respiratory diseases. J Transl Med 2020; 18:422. [PMID: 33168013 PMCID: PMC7653503 DOI: 10.1186/s12967-020-02581-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/24/2020] [Indexed: 12/17/2022] Open
Abstract
Background In the present study the blood expression level of inflammatory response and autoimmunity associated long non-coding RNAs (lncRNAs) were compared in patients with different chronic respiratory diseases and investigated whether they could be used as biomarkers in these diseases. Methods In the discovery cohort, the gene expression level of 84 lncRNAs were measured in the blood of 24 adult patients including healthy controls and patients with asthma and COPD. In the replication cohort the expression of 6 selected lncRNAs were measured in 163 subjects including healthy controls and adults with allergic rhinitis, asthma, COPD and children with asthma. It was evaluated whether these lncRNAs can be used as diagnostic biomarkers for any studied disease. With systems biology analysis the biological functions of the selected lncRNAs were predicted. Results In the discovery cohort, the mean expression of 27 lncRNAs showed nominally significant differences in at least one comparison. OIP5-AS1, HNRNPU, RP11-325K4.3, JPX, RP11-282O18.3, MZF1-AS1 were selected for measurement in the replication cohort. Three lncRNAs (HNRNPU, RP11-325K4.3, JPX) expressed significantly higher in healthy children than in adult controls. All the mean expression level of the 6 lncRNAs differed significantly between adult allergic rhinitis patients and controls. RP11-325K4.3, HNRNPU and OIP5-AS1 expressed higher in allergic asthma than in non-allergic asthma. COPD and asthma differed in the expression of RP11-325K4.3 from each other. In examining of the lncRNAs as biomarkers the weighted accuracy (WA) values were especially high in the comparison of healthy controls and patients with allergic rhinitis. OIP5-AS1 and JPX achieved 0.98 and 0.9 WA values, respectively, and the combination of the selected lncRNAs also resulted in a high performance (WA = 0.98). Altogether, OIP5-AS1 had the highest discriminative power in case of three out of six comparisons. Conclusion Differences were detected in the expression of circulating lncRNAs in chronic respiratory diseases. Some of these differences might be utilized as biomarkers and also suggest a possible role of these lncRNAs in the pathomechanism of these diseases. The lncRNAs and the associated pathways are potential therapeutic targets in these diseases, but naturally additional studies are needed for the confirmation of these results.
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Affiliation(s)
- Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - András Gézsi
- Department of Measurements and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary.,MTA-SE Immune-Proteogenomics Extracellular Vesicle Research Group, Semmelweis University, Budapest, Hungary
| | - Ágnes F Semsei
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | | | | | - Zsuzsanna Csoma
- National Korányi Institute of TB and Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary. .,Heim Pál Children's Hospital, Budapest, Hungary.
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26
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Horváth A, Farkas Á, Szipőcs A, Tomisa G, Szalai Z, Gálffy G. Numerical simulation of the effect of inhalation parameters, gender, age and disease severity on the lung deposition of dry powder aerosol drugs emitted by Turbuhaler®, Breezhaler® and Genuair® in COPD patients. Eur J Pharm Sci 2020; 154:105508. [DOI: 10.1016/j.ejps.2020.105508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
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Gálffy G. [From rare mutations to classical ones, inhibition of signaling pathways in non-small cell lung cancer]. Magy Onkol 2020; 64:196-204. [PMID: 32966350] [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] [Received: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Lung cancer is the leading cause of cancer deaths not only in Hungary but also in the world. Within this, women's lung cancer morbidity and mortality have increased significantly in recent years. For many years, we only had a chemotherapy option to treat lung cancer. The year 2005 was a major breakthrough in the treatment of non-small cell lung cancer with the advent of a new treatment strategy, targeted treatments, EGFR-TKI treatments. Since then, we have several years of experience with first-, second-, and even third-generation TKI treatments in lung adenocarcinoma. The second major step in targeted therapy for lung cancer was to learn about ALK mutant lung cancer and the emergence of ALK inhibitor therapies on the therapeutic palette with the advent of first, second and third generation formulations. In recent years, the range of options for targeted therapeutic targets has expanded to include personalized therapeutic options. By recognizing and targeting the ROS1, BRAF, MET, RET, NTRK, HER2 mutations, we can tailor the most optimal treatment to more and more patients.
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Megyesfalvi Z, Bárány N, Valkó Z, Bugyik E, Paku S, Berta J, Lantos A, Fillinger J, Moldvay J, Bogos K, Rezeli M, Gálffy G, Lang C, Lohinai Z, Hécz R, Lovas T, Rényi-Vámos F, László V, Döme B. [Heterogeneity of small cell lung cancer: biological and clinicopathological implications]. Magy Onkol 2020; 64:243-255. [PMID: 34608895] [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] [Received: 07/08/2020] [Accepted: 08/09/2020] [Indexed: 06/13/2023]
Abstract
Small cell lung cancer (SCLC; comprising approximately 14% of all lung cancer cases in Hungary) is an aggressive tumor type characterized by rapid growth and early metastasis. Although SCLC is a particularly malignant form of cancer, targeted therapies in its treatment have remained largely unsuccessful and thus there were no major therapeutic advances in the last three decades. SCLC was once considered a molecularly homogeneous malignancy. However, recent analyses led to the classification of neuroendocrine and molecular subtypes, based on the dominant expression of one of the following four transcriptional regulator genes: ASCL1, NEUROD1, YAP1 and POU2F3. Because these genetically and biologically distinct subtypes might contribute to therapeutic resistance, the better understanding of their biological and clinicopathological characteristics may help in the development of more effective SCLC therapies.
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Affiliation(s)
- Zsolt Megyesfalvi
- Mellkassebészeti Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Nándor Bárány
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary
| | | | - Edina Bugyik
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary
| | - Sándor Paku
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, Budapest, Hungary
| | - Judit Berta
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary
| | - András Lantos
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary
| | - János Fillinger
- Országos Onkológiai Intézet bázisán működő Mellkassebészeti Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Judit Moldvay
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary
| | | | - Melinda Rezeli
- Department of Biomedical Engineering, Clinical Protein Science and Imaging, Lund University, Lund, Sweden
| | - Gabriella Gálffy
- Országos Onkológiai Intézet bázisán működő Mellkassebészeti Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Christian Lang
- Mellkassebészeti Tanszék, Bécsi Orvostudományi Egyetem, Vienna, Austria
| | - Zoltán Lohinai
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary
| | - Réka Hécz
- Tüdőgyógyintézet, Törökbálint, Hungary
| | | | - Ferenc Rényi-Vámos
- Mellkassebészeti Osztály, Országos Onkológiai Intézet, Budapest, Hungary
| | - Viktória László
- Országos Onkológiai Intézet bázisán működő Mellkassebészeti Klinika, Semmelweis Egyetem, Budapest, Hungary.
| | - Balázs Döme
- Mellkassebészeti Osztály, Országos Onkológiai Intézet, Budapest, Hungary
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Bogos K, Kiss Z, Gálffy G, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Vokó Z, Nagy B, Rokszin G, Abonyi-Tóth Z, Moldvay J. [Novel approaches to the epidemiology of lung cancer in Hungary]. Magy Onkol 2020; 64:175-181. [PMID: 32966347] [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] [Received: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
In the international publications, in the last decades, incidence and mortality of lung cancer was the highest in Hungary in the ranking of European countries and even worldwide, despite the fact that no lung cancer incidence data were reported from Hungary until 2019. In the studies published by our working group at the end of 2019 and in the first half of 2020, we were the first to publish Hungarian lung cancer incidence and mortality data based on research on the NEAK database. The results of this study showed a significant, 25-30% lower incidence of lung cancer in Hungary than the previously reported data. Based on these findings, it was determined that the previously reported Hungarian lung cancer incidence and mortality data can be compiled due to different methodological applications of inadequately calculated results, and Hungarian lung cancer incidence and mortality are equally high, but not higher than the average in Central European countries. In addition, a decrease in the incidence and mortality of male lung cancer was measured between 2011 and 2016, while increasing values were found for women.
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Affiliation(s)
| | | | | | - Lilla Tamási
- Pulmonológiai Klinika, Semmelweis Egyetem, Budapest, Hungary
| | - Gyula Ostoros
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary.
| | - Veronika Müller
- Pulmonológiai Klinika, Semmelweis Egyetem, Budapest, Hungary
| | | | - Nóra Bittner
- Tüdőgyógyászati Klinika, Debreceni Egyetem Klinikai Központ, Debrecen, Hungary
| | - Veronika Sárosi
- I. Sz. Belgyógyászati Klinika, Pécsi Egyetem Klinikai Központ, Pulmonológiai Tanszék, Pécs, Hungary
| | | | | | | | | | | | | | | | - Judit Moldvay
- Országos Korányi Pulmonológiai Intézet, Budapest, Hungary.
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Klimek L, Price D, Gálffy G, Emmeluth M, Koltun A, Kopietz F, Nguyen DT, van Weissenbruch R, Pohl W, Kuhl HC, Scadding G, Mullol J. Effect of Specific Immunoglobulin E Response and Comorbidities on Effectiveness of MP-AzeFlu in a Real-Life Study. Int Arch Allergy Immunol 2020; 181:754-764. [PMID: 32829329 DOI: 10.1159/000508749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Phenotyping allergic rhinitis (AR) by immunoglobulin E (IgE) sensitivity and comorbidities may help characterize AR and provide a framework for treatment decisions. METHODS This prospective, noninterventional study evaluated the effectiveness of MP-AzeFlu (azelastine hydrochloride plus fluticasone propionate intranasal spray formulation) across AR phenotypes. Patients with moderate-to--severe seasonal or perennial AR for whom MP-AzeFlu was prescribed were enrolled. AR subpopulations (ARPs) were assigned based on the classification of IgE response and comorbidities. AR symptoms over the previous 24 h were documented using an AR visual analog scale (AR-VAS), with ratings from "not at all bothersome" (0 mm) to "extremely bothersome" (100 mm), at the inclusion visit and on days 1, 3, 7, and the last day of the study (approximately day 14). AR quality-of-life measures were recorded using a VAS. RESULTS A total of 1,103 patients with AR were included. Mean baseline AR-VAS scores ranged from 70.3 to 75.1 mm (severe) across ARPs. In the overall population, 86.6% of patients responded to treatment (AR-VAS score <50 mm on ≥1 days). In the ARPs, response rates ranged from 79.3 to 89.6%. Mean reduction in AR-VAS scores ranged from 47.9 to 40.9 mm, a decrease from severe to mild across all ARPs. Quality-of-life VAS scores were similarly reduced in the total population and ARPs. DISCUSSION/CONCLUSION MP-AzeFlu treatment reduced VAS severity and quality-of-life scores from baseline in the total population and ARPs, supporting MP-AzeFlu as an effective treatment for all patients with moderate-to-severe AR, regardless of AR phenotype or comorbidities.
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Affiliation(s)
- Ludger Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden, Germany,
| | - David Price
- Primary Care Respiratory Medicine, University of Aberdeen, Aberdeen, United Kingdom
| | | | | | | | | | - Duc Tung Nguyen
- MEDA Pharma GmbH & Co. KG (A Mylan Co.), Bad Homburg, Germany
| | | | - Wolfgang Pohl
- Karl Landsteiner Gesellschaft, Institut für Klinische und Experimentelle Pneumologie, Vienna, Austria
| | | | - Glenis Scadding
- Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
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Price D, Klimek L, Gálffy G, Emmeluth M, Koltun A, Kopietz F, Nguyen DT, van Weissenbruch R, Pohl W, Kuhl HC, Scadding G, Mullol J. Allergic rhinitis and asthma symptoms in a real-life study of MP-AzeFlu to treat multimorbid allergic rhinitis and asthma. Clin Mol Allergy 2020; 18:15. [PMID: 32782442 PMCID: PMC7412849 DOI: 10.1186/s12948-020-00130-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/28/2020] [Indexed: 12/30/2022] Open
Abstract
Background Asthma affects up to nearly 40% of patients with allergic rhinitis (AR). Poor control of AR symptoms is associated with poor asthma control. The goal of this study was to evaluate the effect of AR treatment with MP-AzeFlu on symptoms of AR as well as symptoms of asthma. Methods This prospective study used a visual analog scale (VAS) to assess symptoms of AR and asthma before and after treatment with MP-AzeFlu (Dymista®; azelastine hydrochloride plus fluticasone propionate; 1 spray in each nostril twice daily for 2 weeks). Participants suffered from moderate-to-severe AR according to Allergic Rhinitis and its Impact on Asthma criteria, with acute AR symptoms (AR-VAS scores ≥ 50 mm) on inclusion day. In addition to symptom assessment, patients recorded the impact of AR symptoms on quality-of-life measures before, during, and at the conclusion of the treatment period (approximately 14 days). Patients self-reported change in frequency of their usage of asthma reliever medication on the last day of treatment. Results Of 1103 study participants, 267 (24.2%) had comorbid asthma. These participants reported using a mean of 5.1 puffs of asthma reliever medication in the week before treatment with MP-AzeFlu. A total of 81.8% of patients with comorbid asthma responded to AR therapy (AR-VAS < 50 mm on at least 1 study day). Among patients with AR and comorbid asthma, MP-AzeFlu was associated with improved VAS scores across all study parameters, including AR symptom severity, asthma symptom severity, sleep quality, daily work or school activities, daily social activities, and daily outdoor activities. Asthma symptom severity decreased from a mean of 48.9 mm to 24.1 mm on the VAS. Self-reported frequency of asthma reliever medication use was reduced for 57.6% of participants (n = 139/241). Conclusion MP-AzeFlu used to relieve AR symptoms was associated with reduced asthma symptom VAS scores and frequency of asthma reliever medication usage. Changes in overall symptoms of AR and asthma were correlated.
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Affiliation(s)
- David Price
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD UK.,Optimum Patient Care, Cambridge, UK.,Observational and Pragmatic Research Institute (OPRI), Pte
- #02-05 883 North Bridge Road, Singapore, 198785 Singapore
| | - Ludger Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden, Germany
| | | | - Melanie Emmeluth
- MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | | | | | - Duc Tung Nguyen
- MEDA Pharma GmbH & Co. KG (A Mylan Company), Bad Homburg, Germany
| | | | - Wolfgang Pohl
- Karl Landsteiner Gesellschaft, Institut für Klinische und experimentelle Pneumologie, Vienna, Austria
| | | | | | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Catalonia Spain
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Gál Z, Gézsi A, Pállinger É, Visnovitz T, Nagy A, Kiss A, Sultész M, Csoma Z, Tamási L, Gálffy G, Szalai C. Author Correction: Plasma neutrophil extracellular trap level is modified by disease severity and inhaled corticosteroids in chronic inflammatory lung diseases. Sci Rep 2020; 10:13182. [PMID: 32737369 PMCID: PMC7395788 DOI: 10.1038/s41598-020-69873-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - András Gézsi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary.,MTA-SE Immune-Proteogenomics Extracellular Vesicle Research Group, Semmelweis University, Budapest, Hungary.,Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - Tamás Visnovitz
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - Adrienne Nagy
- Heim Pál Children's Hospital, Budapest, 1089, Hungary
| | - András Kiss
- Heim Pál Children's Hospital, Budapest, 1089, Hungary
| | | | - Zsuzsanna Csoma
- National Korányi Institute of TB and Pulmonology, Budapest, 1121, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, 1083, Hungary
| | | | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary. .,Heim Pál Children's Hospital, Budapest, 1089, Hungary.
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33
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Gál Z, Gézsi A, Molnár V, Nagy A, Kiss A, Sultész M, Csoma Z, Tamási L, Gálffy G, Bálint BL, Póliska S, Szalai C. Corrigendum: Investigation of the Possible Role of Tie2 Pathway and TEK Gene in Asthma and Allergic Conjunctivitis. Front Genet 2020; 11:702. [PMID: 32754197 PMCID: PMC7381303 DOI: 10.3389/fgene.2020.00702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - András Gézsi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary.,MTA-SE Immune-Proteogenomics Extracellular Vesicle Research Group, Semmelweis University, Budapest, Hungary.,Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Viktor Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Adrienne Nagy
- Department of Allergology, Heim Pál Children's Hospital, Budapest, Hungary
| | - András Kiss
- Department of Urology, Heim Pál Children's Hospital, Budapest, Hungary
| | - Monika Sultész
- Department of Ear, Nose and Throat, Heim Pál Children's Hospital, Budapest, Hungary
| | - Zsuzsanna Csoma
- Outpatient Care for Allergy and Asthma, National Korányi Institute of TB and Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gabriella Gálffy
- Adult Inpatient Care, Pulmonology Hospital Törökbálint, Törökbálint, Hungary
| | - Bálint L Bálint
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, Debrecen, Hungary
| | - Szilárd Póliska
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, Debrecen, Hungary
| | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary.,Department of Research and Development, Heim Pál Children's Hospital, Budapest, Hungary
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Gál Z, Gézsi A, Pállinger É, Visnovitz T, Nagy A, Kiss A, Sultész M, Csoma Z, Tamási L, Gálffy G, Szalai C. Plasma neutrophil extracellular trap level is modified by disease severity and inhaled corticosteroids in chronic inflammatory lung diseases. Sci Rep 2020; 10:4320. [PMID: 32152402 PMCID: PMC7062787 DOI: 10.1038/s41598-020-61253-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/10/2019] [Accepted: 02/17/2020] [Indexed: 12/13/2022] Open
Abstract
A flow cytometry-based method was developed to quantify in vivo circulating neutrophil extracellular trap (NET) levels in plasma and compare them in patients with different chronic inflammatory lung diseases. Seventeen asthmatic and 11 control children, 12 adult controls, 46 asthmatic, 6 COPD and 6 adult patients with asthma-COPD overlap syndrome (ACOS) were recruited in the study. The presence of NETs in unstimulated cell-free plasma was confirmed and visualized by confocal laser-scanning microscopy. No significant differences were found in plasma NET levels between children and adults, children with or without asthma and adults with or without asthma, COPD or ACOS. When asthmatic patients were stratified according to their disease severity the average plasma NET level was significantly higher in asthmatic patients with more serious symptoms (adjusted p = 0.027). Patients with poorer pulmonary functions had higher plasma NET levels which negatively correlated with the FEV1 values (r = -0.39, p = 0.002). Patients who were medicated daily with inhaled corticosteroids (ICS) had significantly lower average plasma NET level than patients who did not or just occasionally used ICS (p = 0.027). If further studies confirm the NET-lowering effect of ICS in the circulation, it can be utilized in diseases where NETosis contributes to the pathogenesis.
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Affiliation(s)
- Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - András Gézsi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
- MTA-SE Immune-Proteogenomics Extracellular Vesicle Research Group, Semmelweis University, Budapest, Hungary
- Department of Measurement and Information Systems, Budapest University of Technology and Economics, Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - Tamás Visnovitz
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary
| | - Adrienne Nagy
- Heim Pál Children's Hospital, Budapest, 1089, Hungary
| | - András Kiss
- Heim Pál Children's Hospital, Budapest, 1089, Hungary
| | | | - Zsuzsanna Csoma
- National Korányi Institute of TB and Pulmonology, Budapest, 1121, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, 1083, Hungary
| | | | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, 1089, Hungary.
- Heim Pál Children's Hospital, Budapest, 1089, Hungary.
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Gál Z, Gézsi A, Molnár V, Nagy A, Kiss A, Sultész M, Csoma Z, Tamási L, Gálffy G, Bálint BL, Póliska S, Szalai C. Investigation of the Possible Role of Tie2 Pathway and TEK Gene in Asthma and Allergic Conjunctivitis. Front Genet 2020; 11:128. [PMID: 32180797 PMCID: PMC7057532 DOI: 10.3389/fgene.2020.00128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022] Open
Abstract
Tie2, coded by the TEK gene, is a tyrosine kinase receptor and plays a central role in vascular stability. It was suggested that variations in the TEK gene might influence the susceptibility to asthma and allergic conjunctivitis. The aim of this study was to further investigate these suggestions, involving different populations and to study the Tie2 related pathway on a mouse model of asthma. The discovery, stage I cohort involved 306 patients with moderate and severe allergic rhinitis, the stage II study consisted of four cohorts, namely, adult and pediatric asthmatics and corresponding controls. Altogether, there were 1,258 unrelated individuals in these cohorts, out of which 63.9% were children and 36.1% were adults. In stage I, 112 SNPs were screened in the TEK gene of the patients in order to search for associations with asthma and allergic conjunctivitis. The top associated SNPs were selected for association studies on the replication cohorts. The rs3824410 SNP was nominally associated with a reduced risk of asthma in the stage I cohort and with severe asthma within the asthmatic population (p=0.009; OR=0.48) in the replication cohort. In the stage I study, 5 SNPs were selected in conjunctivitis. Due to the low number of adult patients with conjunctivitis, only children were involved in stage II. Within the asthmatic children, the rs622232 SNP was associated with conjunctivitis in boys in the dominant model (p=0.004; OR=4.76), while the rs7034505 showed association to conjunctivitis in girls (p=0.012; OR=2.42). In the lung of a mouse model of asthma, expression changes of 10 Tie2 pathway-related genes were evaluated at three points in time. Eighty percent of the selected genes showed significant changes in their expressions at least at one time point during the process, leading from sensitization to allergic airway inflammation. The expressions of both the Tek gene and its ligands showed a reduced level at all time points. In conclusion, our results provide additional proof that the Tie2 pathway, the TEK gene and its variations might have a role in asthma and allergic conjunctivitis. The gene and its associated pathways can be potential therapeutic targets in both diseases.
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Affiliation(s)
- Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - András Gézsi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Viktor Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary
| | - Adrienne Nagy
- Department of Allergology, Heim Pál Children's Hospital, Budapest, Hungary
| | - András Kiss
- Department of Urology, Heim Pál Children's Hospital, Budapest, Hungary
| | - Monika Sultész
- Department of Ear, Nose and Throat, Heim Pál Children's Hospital, Budapest, Hungary
| | - Zsuzsanna Csoma
- Outpatient Care for Allergy and Asthma, National Korányi Institute of TB and Pulmonology, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gabriella Gálffy
- Adult Inpatient Care, Pulmonology Hospital Törökbálint, Törökbálint, Hungary
| | - Bálint L Bálint
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, Debrecen, Hungary
| | - Szilárd Póliska
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, Debrecen, Hungary
| | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary.,Department of Research and Development, Heim Pál Children's Hospital, Budapest, Hungary
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36
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Horváth P, Lázár Z, Gálffy G, Puskás R, Kunos L, Losonczy G, Mészáros M, Tárnoki ÁD, Tárnoki DL, Bikov A. Circulating P-Selectin Glycoprotein Ligand 1 and P-Selectin Levels in Obstructive Sleep Apnea Patients. Lung 2020; 198:173-179. [PMID: 31897593 PMCID: PMC7012996 DOI: 10.1007/s00408-019-00299-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/24/2019] [Accepted: 12/02/2019] [Indexed: 02/08/2023]
Abstract
Purpose Obstructive sleep apnea (OSA) is characterized by chronic intermittent hypoxia which induces inflammation in blood vessels leading to the development of cardiovascular comorbidities. Several studies implicated the role of P-selectin in vascular inflammation of OSA. P-selectin glycoprotein ligand 1 (PSGL-1) is the main activator for P-selectin and is involved in immune cell trafficking. However, PSGL-1 has not been analyzed in OSA. The aim of the study was to investigate plasma PSGL-1 and P-selectin levels to have a deeper understanding on their interaction in obstructive sleep apnea. Methods Fifty-one untreated patients with OSA and 42 non-OSA controls were recruited. Plasma PSGL-1 levels were determined in evening and morning samples, P-selectin levels were analyzed in morning samples using commercially available ELISA kits. Polysomnography was performed in all participants. OSA was defined by an apnea–hypopnea index ≥ 5/h. Results PSGL-1 levels did not differ between controls and OSA patients either in the evening or in the morning. Although, there was no difference between controls (16.9/6.8–40.8 ng/ml) and patients with OSA (19.6/8.4–56.8, p = 0.24), patients with severe OSA had increased plasma P-selectin levels (25.6/8.4–56.8 ng/ml) compared to mild OSA patients (14.1/8.5–35.3 ng/ml, p = 0.006) and controls (p = 0.03). Conclusions P-selectin expression relates to disease severity suggesting a pathophysiological role in endothelial cell activation. PSGL-1 levels are unaltered in OSA, suggesting an alternative activation pathway for P-selectin in OSA.
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Affiliation(s)
- P Horváth
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary.
| | - Z Lázár
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary
| | - G Gálffy
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary
| | - R Puskás
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary
| | - L Kunos
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary
| | - Gy Losonczy
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary
| | - M Mészáros
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary
| | - Á D Tárnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - D L Tárnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary
| | - A Bikov
- Department of Pulmonology, Semmelweis University, Tömő utca 25-29, Budapest, Hungary
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Bogos K, Kiss Z, Gálffy G, Tamási L, Ostoros G, Müller V, Urbán L, Bittner N, Sárosi V, Vastag A, Polányi Z, Nagy-Erdei Z, Vokó Z, Nagy B, Horváth K, Rokszin G, Abonyi-Tóth Z, Moldvay J. Revising Incidence and Mortality of Lung Cancer in Central Europe: An Epidemiology Review From Hungary. Front Oncol 2019; 9:1051. [PMID: 31709174 PMCID: PMC6819432 DOI: 10.3389/fonc.2019.01051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 08/15/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022] Open
Abstract
Objective: While Hungary is often reported to have the highest incidence and mortality rates of lung cancer, until 2018 no nationwide epidemiology study was conducted to confirm these trends. The objective of this study was to estimate the occurrence of lung cancer in Hungary based on a retrospective review of the National Health Insurance Fund (NHIF) database. Methods: Our retrospective, longitudinal study included patients aged ≥20 years who were diagnosed with lung cancer (ICD-10 C34) between 1 Jan 2011 and 31 Dec 2016. Age-standardized incidence and mortality rates were calculated using both the 1976 and 2013 European Standard Populations (ESP). Results: Between 2011 and 2016, 6,996 – 7,158 new lung cancer cases were recorded in the NHIF database annually, and 6,045 – 6,465 all-cause deaths occurred per year. Age-adjusted incidence rates were 115.7–101.6/100,000 person-years among men (ESP 1976: 84.7–72.6), showing a mean annual change of − 2.26% (p = 0.008). Incidence rates among women increased from 48.3 to 50.3/100,000 person-years (ESP 1976: 36.9–38.0), corresponding to a mean annual change of 1.23% (p = 0.028). Age-standardized mortality rates varied between 103.8 and 97.2/100,000 person-years (ESP 1976: 72.8–69.7) in men and between 38.3 and 42.7/100,000 person-years (ESP 1976: 27.8–29.3) in women. Conclusion: Age-standardized incidence and mortality rates of lung cancer in Hungary were found to be high compared to Western-European countries, but lower than those reported by previous publications. The incidence of lung cancer decreased in men, while there was an increase in incidence and mortality among female lung cancer patients.
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Affiliation(s)
- Krisztina Bogos
- Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | | | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- Department of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - László Urbán
- Mátraháza Healthcare Center, University Teaching Hospital, Mátraháza, Hungary
| | - Nóra Bittner
- Pulmonology Clinic, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | - Zoltán Vokó
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Balázs Nagy
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Krisztián Horváth
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary.,University of Veterinary Medicine, Budapest, Hungary
| | - Judit Moldvay
- Department of Tumor Biology, National Korányi Institute of Pulmonology, Semmelweis University, Budapest, Hungary.,2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary
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38
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Szentkereszty M, Komlósi ZI, Szűcs G, Barna G, Tamási L, Losonczy G, Gálffy G. Effect of COPD on Inflammation, Lymphoid Functions and Progression-Free Survival during First-Line Chemotherapy in Advanced Non-small Cell Lung Cancer. Pathol Oncol Res 2019; 26:1117-1128. [PMID: 31090020 PMCID: PMC7242273 DOI: 10.1007/s12253-019-00661-w] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common comorbidity of non-small cell lung cancer (NSCLC). COPD is characterized by systemic inflammation and lymphocyte dysfunction, mechanisms that are also known to accelerate progression of advanced (IIIB-IV) stage NSCLC. We aimed to find out whether COPD exerts an influence on tumor induced inflammatory and lymphoid responses and progression-free survival (PFS) after first-line treatment in advanced NSCLC. Patients suffering from NSCLC (n = 95), COPD (n = 54), NSCLC+COPD (n = 80) and healthy controls (n = 60) were included. PFS, neutrophil granulocyte and lymphocyte cell counts were recorded. Serum IFNγ, TNFα, VEGF concentrations were measured by using multiplex cytometric bead-based immunoassay. Prevalence of myeloid-derived suppressor cell populations (MDSC-s), and signs of T cell exhaustion were tested by using flow cytometry. Median PFS increased in the NSCLC+COPD group compared to NSCLC patients without COPD (7.4 vs 4.9 months, p < 0.01). NSCLC+COPD patients had 1.7 times (1.2-2.4) more likely to have longer PFS compared to NSCLC patients without COPD (Cox analysis, p < 0.01). Neutrophil cell counts, CRP, IFNγ and TNFα concentrations were all reduced in NSCLC+COPD (all p < 0.05 vs NSCLC). NSCLC+COPD was also associated with reduced serum IL-10 concentration and increased granzyme-B positive CD8 cell counts compared to NSCLC without COPD. The effects of VEGF and MDSC-s on systemic inflammation appeared to be blunted by COPD in patients suffering from advanced NSCLC. Concomitant COPD moderates tumor-induced inflammation and supports some effector lymphoid functions and thereby may be an independent positive predictive factor of longer PFS after first-line therapy in advanced NSCLC.
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Affiliation(s)
- Márton Szentkereszty
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary.,1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Zsolt István Komlósi
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - Gergő Szűcs
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - Gábor Barna
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
| | - György Losonczy
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary.
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Diós árok 1/C, Budapest, H-1121, Hungary
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Lázár Z, Horváth P, Puskás R, Gálffy G, Losonczy G, Horváth I, Bikov A. A suitable protocol for measuring alveolar nitric oxide in asthma with differing severity to assess peripheral airways inflammation. J Asthma 2018; 56:584-593. [PMID: 29923757 DOI: 10.1080/02770903.2018.1477957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Extended nitric oxide (NO) analysis offers the partitioned monitoring of inflammation in central and peripheral airways. Different mathematical models are used to estimate pulmonary NO dynamics in asthma with variable results and limitations. We aimed to establish a protocol for extended NO analysis in patients with differing asthma severity. METHODS Forty patients with stable asthma and 25 matched control subjects were recruited. Exhaled NO was measured at constant flow rates between 10 and 300 mL/s. Twelve controls performed NO measurements weekly for 4 weeks. RESULTS The proportions of patients with technically acceptable measurements at 10-30-50-100-150-200-250-300 mL/s exhalation flow rates were 8-58-100-98-98-95-90-80%, respectively. Alveolar NO (CANO) and total flux of NO in the conducting airways (JawNO) were calculated with the linear method from NO values measured at 100-150-200-250 mL/s exhalation flows. The mean intrasubject bias for JawNO and CANO in controls was 0.16 nL/s and 0.85 ppb, respectively. Both JawNO (1.31/0.83-2.97/vs. 0.70/0.54-0.87/nL/s, p < 0.001) and CANO (4.08/2.63-7.16/vs. 2.42/1.83-2.89/ppb, p < 0.001) were increased in patients with asthma compared to controls. In patients, CANO correlated with RV/TLC (r = 0.58, p < 0.001), FEF25-75% (p = 0.02, r = -0.36) and DL,CO (r = -0.46, p = 0.004). JawNO was not related to lung function parameters. CONCLUSIONS Calculation of alveolar NO concentration with the linear method from values obtained at medium flow rates (100-250 mL/s) is feasible even in asthmatic patients with severe airflow limitation and may provide information on small airways dysfunction in asthma.
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Affiliation(s)
- Zsófia Lázár
- a Department of Pulmonology , Semmelweis University , 1/c Diós árok
| | - Péter Horváth
- a Department of Pulmonology , Semmelweis University , 1/c Diós árok
| | - Rita Puskás
- a Department of Pulmonology , Semmelweis University , 1/c Diós árok
| | - Gabriella Gálffy
- a Department of Pulmonology , Semmelweis University , 1/c Diós árok
| | - György Losonczy
- a Department of Pulmonology , Semmelweis University , 1/c Diós árok
| | - Ildikó Horváth
- b National Korányi Institute of Pulmonology , 1 Pihenő Street , Budapest , Hungary
| | - András Bikov
- a Department of Pulmonology , Semmelweis University , 1/c Diós árok
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40
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Gálffy G. [Lipegfilgrastim - long acting G-CSF in prevention of chemotherapy-induced neutropenia]. Magy Onkol 2018; 62:195-200. [PMID: 30256886] [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] [Received: 07/21/2018] [Accepted: 08/20/2018] [Indexed: 06/08/2023]
Abstract
One of the most dangerous complications of bone marrow suppression due to chemotherapy is febrile neutropenia. The treatment of the affected patients is a multidisciplinary task. In addition to chemotherapy, adequate G-CSF therapy as a primary or secondary prophylaxis can be used to prevent a large part of febrile neutropenic events. Before each chemotherapy cycle, the risk of febrile neutropenia should be evaluated, taking into account the chemotherapeutic combination and patient-specific parameters. Appropriate antibiotic and G-CSF therapy initiated in the course of febrile neutropenia is essential for the success of the therapy. Long-acting G-CSF therapy for secondary prevention, lipegfilgrastim is effective, safe and simple dosing for the patient. The oncologists can reach treatment success in the patient's therapy if he or she provides the patient the adequate supportive medications at the appropriate time. Lipegfilgrastim is not a biosimilar, but a new molecule created by a two-step empiric glycopegylation process.
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Affiliation(s)
- Gabriella Gálffy
- Onkológiai és Járóbeteg Centrum, Tüdõgyógyintézet Törökbálint, Törökbálint, Hungary.
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Tamási L, Szilasi M, Gálffy G. Clinical Effectiveness of Budesonide/Formoterol Fumarate Easyhaler ® for Patients with Poorly Controlled Obstructive Airway Disease: a Real-World Study of Patient-Reported Outcomes. Adv Ther 2018; 35:1140-1152. [PMID: 30066185 PMCID: PMC6096955 DOI: 10.1007/s12325-018-0753-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The effectiveness of inhaled therapies can be influenced by many factors, including the type of inhaler, which may have clinical implications. We report a real-world, multicenter, open-label, non-randomized, non-interventional study conducted by 200 pulmonologists across 200 centers in Hungary. The effectiveness of budesonide/formoterol inhalation therapy in daily clinical practice, delivered via the Bufomix Easyhaler®, was evaluated in patients with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap (ACO). METHODS Effectiveness was assessed after 12 weeks of treatment by spirometry, the Asthma Control Test, mini-Asthma Quality of Life Questionnaire, COPD Assessment Test and modified Medical Research Council dyspnea scale. Patient satisfaction with the Bufomix Easyhaler® and physicians' assessments (ease of use and time taken to learn the technique) were also assessed. RESULTS A total of 1498 patients with obstructive airway disease were evaluated (asthma: n = 621; COPD: n = 778; ACO: n = 99), of whom 455 (30.4%) were newly diagnosed inhaler-naïve patients and 1043 (69.6%) were switching from other inhalers. Significant improvements in lung function, disease control and health-related quality of life measures (all p ≤ 0.002) were reported after 12 weeks of Bufomix Easyhaler® use. Improvements were observed in both inhaler-naïve patients and those who switched to a Bufomix Easyhaler® from other devices. After switching, 72.4% of patients regarded the Bufomix Easyhaler® as 'very good' and > 90.0% of physicians described the Bufomix Easyhaler® as easy to teach; 73.8% and 98.9% of patients learned the technique within 5 and 10 min of teaching, respectively. CONCLUSION Twelve weeks' treatment with the Bufomix Easyhaler® resulted in significant improvements in disease control and quality of life. The Bufomix Easyhaler® was considered easy to use, and most patients were satisfied with the inhaler. Results confirm the real-world effectiveness of the Bufomix Easyhaler® in the treatment of adult outpatients with obstructive airway disease. FUNDING Orion Corp., Orion Pharma.
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42
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Gálffy G. [Diagnosis and treatment of the neuroendocrine tumors of the lung]. Magy Onkol 2018; 62:113-118. [PMID: 30027939] [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] [Received: 03/25/2018] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
Lung neuroendocrine tumors comprise 20% of all pulmonary tumors. Their appearance and behavior are very heterogeneous. Histologically they are divided into four groups, well-differentiated and low-malignant typical carcinoid, poorly differentiated and worse prognosis atypical carcinoid, and highly malignant small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma. Of these, the most common is small cell lung cancer with an incidence of 15%, while those of large cell neuroendocrine tumors and lung carcinoids are 3% and 2%, respectively. The treatment and prognosis of carcinoids are very different from those of highly malignant small cell and large cell neuroendocrine carcinomas. The paper summarizes the characteristics of lung neuroendocrine tumors.
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Molnár V, Nagy A, Tamási L, Gálffy G, Böcskei R, Bikov A, Czaller I, Csoma Z, Krasznai M, Csáki C, Zsigmond G, Csontos Z, Kurucz A, Kurucz E, Fábos B, Bálint BL, Sasvári-Székely M, Székely A, Kótyuk E, Kozma GT, Cserta G, Farkas A, Gál Z, Gézsi A, Millinghoffer A, Antal P, Szalai C. From genomes to diaries: a 3-year prospective, real-life study of ragweed-specific sublingual immunotherapy. Immunotherapy 2018; 9:1279-1294. [PMID: 29130793 DOI: 10.2217/imt-2017-0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
During the last decades, the prevalence of allergy has dramatically increased. Allergen-specific immunotherapy is the only currently available medical intervention that has the potential to affect the natural course of the disease, but there are still many questions and unmet needs hindering its widespread use to fulfill its treatment potential and maximize its benefits for the society. To provide a comprehensive phenome-wide overview in sublingual immunotherapy, using ragweed allergy as a target, we planned and carried out a longitudinal, prospective, observational, open-label study (DesensIT). In this paper we present challenges of using deep and comprehensive phenotypes embracing biological, clinical and patient-reported outcomes in allergen-specific immunotherapy and show how we designed the DesensIT project to optimize data collection, processing and evaluation.
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Affiliation(s)
- Viktor Molnár
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Adrienne Nagy
- Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Renáta Böcskei
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - András Bikov
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Ibolya Czaller
- Department of Pulmonology, Semmelweis University, 1125 Budapest, Diós Árok 1C, Hungary
| | - Zsuzsanna Csoma
- National Korányi Institute of TB & Pulmonology, 1121 Budapest, Pihenő út 1, Hungary
| | - Magdolna Krasznai
- Department of Otorhinolaryngology, Semmelweis University, Head & Neck Surgery, 1083 Budapest, Szigony u. 36, Hungary
| | - Csilla Csáki
- Svábhegyi Healing Facility, 1037 Budapest, Bokor u. 17, Hungary
| | | | - Zoltán Csontos
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Anikó Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Edina Kurucz
- Debrecen Town Pulmonary Care, 4032 Debrecen Jerikó u. 21, Hungary
| | - Beáta Fábos
- Somogy County Kaposi Mór Teaching Hospital, 7400 Kaposvár Tallián Gyula u. 20-32, Hungary
| | - Bálint L Bálint
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary
| | - Mária Sasvári-Székely
- Institute of Medical Chemistry, Molecular Biology & Pathobiochemistry, Semmelweis University, 1094 Budapest, Tűzoltó utca 37-47, Hungary
| | - Anna Székely
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Eszter Kótyuk
- Institute of Psychology, Eötvös Loránd University, 1064 Budapest, Izabella utca 46, Hungary
| | - Gergely T Kozma
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Gábor Cserta
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Anita Farkas
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary
| | - Zsófia Gál
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Gézsi
- Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| | - András Millinghoffer
- Department of Biochemistry & Molecular Biology, Genomic Medicine & Bioinformatic Core Facility, University of Debrecen, 4032 Debrecen, Nagyerdei krt 98, Hungary.,Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Péter Antal
- Department of Measurement & Information Systems, University of Technology & Economics, 1177 Budapest, Magyar Tudósok krt. 2/I, Hungary
| | - Csaba Szalai
- Csertex Research Laboratory, 1037 Budapest, Bécsi út 224, Hungary.,Heim Pal Children Hospital, 1089 Budapest, Üllői út 86, Hungary.,Department of Genetics, Cell- & Immunobiology, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
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Lázár Z, Kelemen Á, Gálffy G, Losonczy G, Horváth I, Bikov A. Central and peripheral airway nitric oxide in patients with stable and exacerbated chronic obstructive pulmonary disease. J Breath Res 2018; 12:036017. [DOI: 10.1088/1752-7163/aac10a] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Markóczy Z, Sárosi V, Kudaba I, Gálffy G, Turay ÜY, Demirkazik A, Purkalne G, Somfay A, Pápai-Székely Z, Rásó E, Ostoros G. Erlotinib as single agent first line treatment in locally advanced or metastatic activating EGFR mutation-positive lung adenocarcinoma (CEETAC): an open-label, non-randomized, multicenter, phase IV clinical trial. BMC Cancer 2018; 18:598. [PMID: 29801465 PMCID: PMC5970529 DOI: 10.1186/s12885-018-4283-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Erlotinib is approved for the first line treatment of epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer. Since the number of prospective studies in Caucasian patients treated in routine clinical setting is limited we conducted a multicenter, phase IV clinical trial to determine the efficacy and safety of erlotinib and to demonstrate the feasibility of the validated standardized companion diagnostic method of EGFR mutation detection. Methods 651 chemonaive, cytologically or histologically verified advanced stage lung adenocarcinoma patients from Hungary, Turkey and Latvia were screened for exon19 microdeletions and exon21 L858R EGFR mutations using the companion diagnostic EGFR test. EGFR mutation-positive, locally advanced or metastatic lung adenocarcinoma patients received as first line treatment erlotinib at 150 mg/day. The primary endpoint was progression-free survival (PFS). Results 62 EGFR mutation-positive patients (9.5% of screened) were included in the safety/intent-to-treat cohort. Median PFS was 12.8 months (95%CI, 9.9–15.8), objective response rate and one-year survival was 66.1% and 82.5%, respectively. Most frequent treatment related adverse events were diarrhoea and rash. Eastern Oncology Cooperative Group Performance Status (ECOG PS), smoking status and M1a/M1b disease stage were significant prognosticators of PFS (p = 0.017, p = 0.045 and p = 0.002, respectively). There was no significant difference in PFS between the subgroups stratified by gender, age or exon19 vs exon21 mutation. Conclusions Our study confirmed the efficacy and safety of first line erlotinib monotherapy in Caucasian patients with locally advanced or metastatic lung adenocarcinoma carrying activating EGFR mutations based on the screening with the approved companion diagnostic procedure. Trial registration ClinicalTrials.gov Identifier: NCT01609543.
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Affiliation(s)
- Zsolt Markóczy
- National Koranyi Institute of TB and Pulmonology, Piheno ut 1, Budapest, H-1122, Hungary
| | | | - Iveta Kudaba
- Riga East University Hospital Oncology Center, Riga, Latvia
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Ülkü Yilmaz Turay
- Clinic of Chest Diseases, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Ahmet Demirkazik
- Department of Medical Oncology, Ibn-i Sina Hospital, Ankara University Medical Faculty, Ankara, Turkey
| | - Gunta Purkalne
- Oncology Institute, Riga Stradins University, Riga, Latvia
| | - Attila Somfay
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | | | - Erzsébet Rásó
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Gyula Ostoros
- National Koranyi Institute of TB and Pulmonology, Piheno ut 1, Budapest, H-1122, Hungary.
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46
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Gálffy G. [Treatment of chemotherapy-induced febrile neutropenia in solid tumors]. Magy Onkol 2017; 61:261-266. [PMID: 28931099] [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] [Received: 08/02/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
One of the most dangerous complications of bone marrow suppression due to chemotherapy is febrile neutropenia. The treatment of the affected patients is a multidisciplinary task. In addition to chemotherapy, adequate G-CSF therapy as a primary and secondary prophylaxis can be used to prevent a large part of febrile neutropenic events. Before each chemotherapy cycle, the risk of febrile neutropenia should be evaluated, taking into account the chemotherapeutic combination and patient-specific parameters. Appropriate antibiotic and G-CSF therapy initiated in the course of febrile neutropenia is essential for the success of the therapy. The oncologists can reach treatment success in the patient's therapy if he or she provides the patient the adequate supportive medications at the appropriate time.
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Abstract
INTRODUCTION Although the prevalence of ragweed allergy in Europe is still low, it is increasing according to recent statistics. In contrast, in Hungary ragweed is the most common allergen with very high sensitisation in the general Hungarian population. AIM We investigated the number and clinical characteristics of ragweed allergy in the Hungarian population, as the first comprehensive study to evaluate ragweed allergy in Hungary. METHOD One thousand Hungarian adult subjects were screened with a questionnaire for ragweed allergy. People with ragweed allergy answered further specific questions about their disease history, symptoms and medication use. RESULTS 305 subjects reported allergy from which 218 patients had symptoms during ragweed pollination suggesting ragweed allergy. 40% of these had symptoms for more than 5 years. Asthma was reported in 18.3%. Around 24% of these patients were undiagnosed; they did not take any medications or visited professionals because of their symptoms. Compared to the non-ragweed allergic patients, subjects with ragweed allergy were older and better educated, but the dominance of female gender was less prominent than in the non-ragweed group (all p<0.05). CONCLUSIONS Around 22% of the Hungarian population suffers from ragweed allergy. Studies should focus on eradication strategy and improvement of patient care. Orv. Hetil., 2016, 157(50), 1989-1993.
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Affiliation(s)
- Zsuzsa Márk
- Tüdőgyógyintézet Törökbálint, Munkácsy M. u. 70., 2045
| | - András Bikov
- Pulmonológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Gabriella Gálffy
- Pulmonológiai Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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48
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Gálffy G, Puskás R. [Role of pembrolizumab in the treatment of non-small cell lung cancer (NSCLC)]. Magy Onkol 2017; 61:107-110. [PMID: 28273195] [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] [Received: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
Lung cancer is the leading cause of cancer-related death, not only in our country but also worldwide. It is particularly the incidence and mortality regarding females that have increased significantly in recent years. For many years chemotherapeutic treatments of lung cancer were the only way forward in the treatment of patients. In 2015 immunotherapy proved to be a great breakthrough in the treatment of non-small cell lung cancer (NSCLC), resulting from a new treatment strategy, described as immune checkpoint inhibition. Recent studies have shown the best efficacy of immunotherapy, especially in squamous cell lung cancer and the smoking-related non-squamous cell lung cancer which is explained by research regarding the high occurrence of increased mutation rate caused by smoking. The introduction of immunotherapy carries a great challenge for clinicians regarding the best therapeutic efficacy, longer survival, better quality of life as well as the management of the different profile of side effects. Pembrolizumab was the first PD-1 inhibitor, which was registered for first-line, second-line or greater treatment of non-small cell lung cancer.
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Affiliation(s)
| | - Rita Puskás
- Pulmonológiai Klinika, Semmelweis Egyetem, Budapest, Hungary.
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Fodor LE, Gézsi A, Ungvári L, Semsei AF, Gál Z, Nagy A, Gálffy G, Tamási L, Kiss A, Antal P, Szalai C. Investigation of the Possible Role of the Hippo/YAP1 Pathway in Asthma and Allergy. Allergy Asthma Immunol Res 2017; 9:247-256. [PMID: 28293931 PMCID: PMC5352576 DOI: 10.4168/aair.2017.9.3.247] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/09/2016] [Accepted: 11/16/2016] [Indexed: 01/29/2023]
Abstract
Purpose Several lines of evidence indicate that the Hippo/Yes-associated protein 1 (YAP1) pathways might play a role in the pathogenesis of asthma. To investigate the possible role of the Hippo/YAP1 pathway in the pathogenesis of asthma or its phenotypes. Methods The levels of gene expressions of the members of the Hippo/YAP1 were compared. The presence of the proteins of the YAP1 and FRMD6 were analyzed with Western blot in induced sputum of 18 asthmatic subjects and 10 control subjects. Fourteen single nucleotide polymorphisms (SNPs) in the YAP1 gene were genotyped in 522 asthmatic subjects and 711 healthy controls. The results were evaluated with traditional frequentist methods and with Bayesian network-based Bayesian multilevel analysis of relevance (BN-BMLA). Results The mRNA of all the members of the Hippo/YAP1 pathway could be detected in the induced sputum of both controls and cases. A correlation was found between YAP1 mRNA levels and sputum bronchial epithelial cells (r=0.575, P=0.003). The signal for the FRMD6 protein could be detected in all sputum samples while the YAP1 protein could not be detected in the sputum samples, of the healthy controls and severe asthmatics, but it was detectable in mild asthmatics. The rs2846836 SNP of the YAP1 gene was significantly associated with exercise-induced asthma (odds ratio [OR]=2.1 [1.3-3.4]; P=0.004). The distribution of genotypes of rs11225138 and certain haplotypes of the YAP1 gene showed significant differences between different asthma severity statuses. With BN-BMLA, 2 SNPs, genetic variations in the FRMD6 gene proved to be the most relevant to exercise-induced asthma and allergic rhinitis. These 2 SNPs through allergic rhinitis and exercise-induced asthma were in epistatic interaction with each other. Conclusions Our results provided additional evidence that the FRMD6/Hippo/YAP1 pathway plays a role in the pathogenesis of asthma. If additional studies can confirm these findings, this pathway can be a potential novel therapeutic target in asthma and other inflammatory airway diseases.
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Affiliation(s)
- Lili E Fodor
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - András Gézsi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Ldikó Ungvári
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Agnes F Semsei
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Zsófia Gál
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary
| | | | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - András Kiss
- Heim, Pal Children Hospital, Budapest, Hungary
| | - Péter Antal
- Department of Measurement and Information Systems, University of Technology and Economics, Budapest, Hungary
| | - Csaba Szalai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Budapest, Hungary.,Heim, Pal Children Hospital, Budapest, Hungary.
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Müller V, Gálffy G, Orosz M, Kováts Z, Odler B, Selroos O, Tamási L. Characteristics of reversible and nonreversible COPD and asthma and COPD overlap syndrome patients: an analysis of salbutamol Easyhaler data. Int J Chron Obstruct Pulmon Dis 2016; 11:93-101. [PMID: 26834466 PMCID: PMC4716721 DOI: 10.2147/copd.s92331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The choice of inhaler device for bronchodilator reversibility is crucial since suboptimal inhalation technique may influence the result. On the other hand, bronchodilator response also varies from time to time and may depend on patient characteristics. In this study, patients with airway obstruction (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ratio <70% in chronic obstructive pulmonary disease [COPD]; <80% in asthma) were included (n=121, age: 57.8±17.3 years). Bronchodilator reversibility (American Thoracic Society/European Respiratory Society criteria) was tested in patients with COPD (n=63) and asthma and COPD overlap syndrome (ACOS; n=12). Forty-six asthmatics served as controls. Reversibility was tested with 400 µg salbutamol dry powder inhaler (Buventol Easyhaler, Orion Pharma Ltd, Espoo, Finland). Demographic data and patients' perceptions of Easyhaler compared with β2-agonist pressurized metered dose inhalers (pMDIs) were analyzed. American Thoracic Society/European Respiratory Society guideline defined reversibility was found in 21 out of 63 COPD patients and in two out of 12 ACOS patients. Airway obstruction was more severe in COPD patients as compared with controls (mean FEV1 and FEV1% predicted both P<0.0001). Average response to salbutamol was significantly lower in COPD patients compared with asthma controls (P<0.0001). Reversibility was equally often found in smokers as in never-smokers (33% vs 34%). Nonreversible COPD patients had higher mean weight, body mass index, and FEV1/FVC compared with reversible COPD patients. Most patients preferred Easyhaler and defined its use as simpler and more effective than use of a pMDI. Never-smokers and patients with asthma experienced Easy-haler somewhat easier to use than smokers and patients with COPD. In conclusion, a substantial part of patients with COPD or ACOS showed reversibility to salbutamol dry powder inhaler. Nonreversible patients with COPD were characterized by higher weight and body mass index, and a higher FEV1/FVC ratio. Most patients preferred Easyhaler compared with a pMDI.
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Affiliation(s)
- Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Gabriella Gálffy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Márta Orosz
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kováts
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Balázs Odler
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Lilla Tamási
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
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