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921.
Harper G. Hubbeling Emily F. Schapira Nora K. Horick Kelly E.H. Goodwin Jessica J. Lin Kevin S. Oh Alice T. Shaw William A. Mehan Helen A. Shih Justin F. Gainor 《Journal of thoracic oncology》2018,13(4):550-558
Introduction
Intracranial metastases are a common cause of morbidity and mortality in patients with advanced NSCLC, and are frequently managed with radiation therapy (RT). The safety of cranial RT in the setting of treatment with immune checkpoint inhibitors (ICIs) has not been established.Methods
We identified patients with advanced NSCLC with brain metastases who received cranial RT and were treated with or without programmed cell death 1/programmed death ligand 1 inhibitors between August 2013 and September 2016. RT-related adverse events (AEs) were retrospectively evaluated and analyzed according to ICI treatment status, cranial RT type, and timing of RT with respect to ICI.Results
Of 163 patients, 50 (31%) received ICIs, whereas 113 (69%) were ICI naive. Overall, 94 (58%), 28 (17%), and 101 (62%) patients received stereotactic radiosurgery, partial brain irradiation, and/or whole brain RT, respectively. Fifty percent of patients received more than one radiation course. We observed no significant difference in rates of all-grade AEs and grade 3 or higher AEs between the ICI-naive and ICI-treated patients across different cranial RT types (grade ≥3 AEs in 8% of ICI-naive patients versus in 9% of ICI-treated patients for stereotactic radiosurgery [p = 1.00] and in 8% of ICI-naive patients versus in 10% of ICI-treated patients for whole brain RT [p = 0.71]). Additionally, there was no difference in AE rates on the basis of timing of ICI administration with respect to RT.Conclusions
Treatment with an ICI and cranial RT was not associated with a significant increase in RT-related AEs, suggesting that use of programmed cell death 1/programmed death ligand 1 inhibitors in patients receiving cranial RT may have an acceptable safety profile. Nonetheless, additional studies are needed to validate this approach. 相似文献922.
Ryota Nakamura Yoshihisa Inage Rika Tobita Satoshi Yoneyama Takeshi Numata Kyoko Ota Hidetoshi Yanai Takeo Endo Yukinori Inadome Shingo Sakashita Hiroaki Satoh Kenji Yuzawa Toru Terashima 《Journal of thoracic oncology》2018,13(7):895-903
Introduction
Skeletal muscle depletion, referred to as sarcopenia, has recently been identified as a risk factor for poor outcomes in various malignancies. However, the prognostic significance of sarcopenia in patients with NSCLC after surgery has not been adequately determined. This study investigated the impact of sarcopenia in patients undergoing pulmonary resection for lung cancer.Methods
This retrospective study consisted of 328 patients with pathologically confirmed NSCLC who underwent curative resection between January 2005 and April 2017. Preoperative computed tomography imaging at the third lumbar vertebrae level was assessed to measure the psoas muscle mass index (PMI, cm2/m2). Sarcopenia was defined as a cutoff value of PMI less than 6.36 cm2/m2 for males and 3.92 cm2/m2 for females, based on PMI values from “healthy” subjects.Results
The median patient age was 71 years and 59% were male. Sarcopenia was present in 183 (55.8%) and was significantly related with increasing age (p < 0.001), being male (p < 0.001), smoking habit (p < 0.001), lower body mass index (p < 0.001), and postoperative major complication (Clavien-Dindo grade ≥3, p = 0.036). The prevalence of sarcopenia was higher in men than in women, and the prevalence increased with age in men, whereas the prevalence did not increase in females older than 70 years. The 5-year survival rate was 61% in patients with sarcopenia and 91% in those without. Multivariate analysis revealed that sarcopenia was an independent unfavorable prognostic factor (p = 0.019).Conclusions
Sarcopenia as determined using preoperative computed tomography could be used to predict postoperative major complication and prognosis in patients with resected NSCLC. Our results may provide some important information for preoperative management. 相似文献923.
Qinghua Xu Fei Zhou Hui Liu Tao Jiang Xuefei Li Yaping Xu Caicun Zhou 《Journal of thoracic oncology》2018,13(9):1383-1392
Introduction
The aim of the current study was to investigate whether consolidative local ablative therapy (LAT) can improve the survival of patients with stage IV EGFR-mutant NSCLC who have oligometastatic disease treated with first-line EGFR–tyrosine kinase inhibitor (TKI) therapy.Methods
Patients with stage IV EGFR-mutant NSCLC and no more than five metastases within 2 months of diagnosis were identified. All patients were treated with first-line EGFR-TKIs. Consolidative LAT included radiotherapy, surgery, or both. Overall survival (OS) and progression-free survival (PFS) were estimated by Kaplan-Meier curves.Results
From October 2010 to May 2016, 145 patients were enrolled, including 51 (35.2%) who received consolidative LAT to all oligometastatic sites (all-LAT group), 55 (37.9%) who received consolidative LAT to either primary tumor or oligometastatic sites (part-LAT group), and 39 (26.9%) who did not receive any consolidative LAT (non-LAT group). The median PFS in all-LAT, part-LAT, and non-LAT groups were 20.6, 15.6, and 13.9 months, respectively (p < 0.001). The median OS in all-LAT, part-LAT, and non-LAT groups were 40.9, 34.1, and 30.8 months, respectively (p < 0.001). The difference was statistically significant between the all-LAT group and part-LAT or non-LAT group but was not between the part-LAT and non-LAT group. The median OS was significantly improved with consolidative LAT for primary tumor (40.5 versus 31.5 months, p < 0.001), brain metastases (38.2 versus 29.2 months, p = 0.002), and adrenal metastases (37.1 versus 29.2 months, p = 0.032). Adverse events (grade ≥ 3) due to radiotherapy included pneumonitis (7.7%) and esophagitis (16.9%).Conclusions
The current study showed that consolidative LAT to all metastatic sites was a feasible option for patients with EGFR-mutant oligometastatic NSCLC during first-line EGFR-TKI treatment, with significantly improved PFS and OS compared with consolidative LAT to partial sites or observation alone. 相似文献924.
David R. Gandara Joachim von Pawel Julien Mazieres Richard Sullivan Åslaug Helland Ji-Youn Han Santiago Ponce Aix Achim Rittmeyer Fabrice Barlesi Toshio Kubo Keunchil Park Jerome Goldschmidt Mayank Gandhi Cindy Yun Wei Yu Christina Matheny Pei He Alan Sandler Louis Fehrenbacher 《Journal of thoracic oncology》2018,13(12):1906-1918
Introduction
Cancer immunotherapy may alter tumor biology such that treatment effects can extend beyond radiographic progression. In the randomized, phase III OAK study of atezolizumab (anti–programmed death-ligand 1) versus docetaxel in advanced NSCLC, overall survival (OS) benefit with atezolizumab was observed in the overall patient population, without improvement in objective response rate (ORR) or progression-free survival (PFS). We examine the benefit-risk of atezolizumab treatment beyond progression (TBP).Methods
Eight hundred fifty patients included in the OAK primary efficacy analysis were evaluated. Atezolizumab was continued until loss of clinical benefit. Docetaxel was administered until Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) disease progression (PD)/unacceptable toxicity; no crossover to atezolizumab was allowed. ORR, PFS, post-PD OS, target lesion change, and safety were evaluated.Results
In atezolizumab-arm patients, ORR was 16% versus 14% and median PFS was 4.2 versus 2.8 months per immune-modified RECIST versus RECIST v1.1. The median post-PD OS was 12.7 months (95% confidence interval [CI]: 9.3–14.9) in 168 atezolizumab-arm patients continuing TBP, 8.8 months (95% CI: 6.0–12.1) in 94 patients switching to nonprotocol therapy, and 2.2 months (95% CI: 1.9–3.4) in 70 patients receiving no further therapy. Of the atezolizumab TBP patients, 7% achieved a post-progression response in target lesions and 49% had stable target lesions. Atezolizumab TBP was not associated with increased safety risks.Conclusions
Within the limitations of this retrospective analysis, the post-PD efficacy and safety data from OAK are consistent with a positive benefit-risk profile of atezolizumab TBP in patients performing well clinically at the time of PD. 相似文献925.
926.
MAP治疗非小细胞肺癌的疗效分析 总被引：8，自引：0，他引：8
选取本院１９９０年２月～１９９２年２月经细胞学、组织学证实的非小细胞肺癌６３例，用ＭＡＰ方案治疗取得满意效果。其中腺型占６５．１％，鳞型及低分化型分别占２５．４％和９．５％。化疗后总有效率为３９．７％（２５／６３）均为ＰＲ，１例ＰＤ。Ⅱ、Ⅲ、Ⅳ期有效率分别为６０．０％、４２．４％和３２．０％；鳞型和腺型有效率分别为３７．５％和３４．２％，低分化型非小细胞癌最佳达８３．３％，Ｐ值均＞０．０５。副反应 相似文献
927.
自1993年10月至1996年2月,我院用IAP方案和CAP方案共治疗非小细胞肺癌51例,其中IAP方案组22例（IFO＋ADM＋DDP）,获CR1例,PR8例,有效率40．9％（9/22）,CAP方案组29例（CTX＋ADM＋DDP）,获CR1例,PR10例,总有效率37．9％（11/29）,统计学分析两组疗效无显著性差异。本文分析了诸因素对疗效的影响,认为IAP方案同CAP方案一样疗效确切,病人可以耐受,可以作为一般状况好的非小细胞肺癌病人的新辅助治疗方案。 相似文献
928.
目的 观察健脾扶肺汤治疗非小细胞肺癌化疗后临床疗效.方法 选择2013年10月-2015年11月在陕西省中医医院肺病科曹利平专家门诊及陕西省肿瘤医院中西医结合科非小细胞肺癌化疗后患者,共纳入合格病例63例,中医组32例给予陕西省名中医曹利平自拟方健脾扶肺汤治疗,1剂/d,水煎服.西医组31例给予规范化方案化疗,同时结合西药对症支持治疗,持续观察24个月.结果 2组改善乏力及饮食状态比较,中医组疗效显著优于西医组(P<0.01);2组卡氏评分比较,中医组体力状况改善情况优于西医组,差异亦有统计学意义(P<0.01);中医组较西医组在6个月、1、2年内维持较高的生存率,生存期亦较长,差异亦有统计学意义(P<0.01);检验指标比较中医组改善率优于西医组(P<0.01);中医组总有效率、总稳定率均高于西医组(P<0.05).结论 健脾扶肺汤治疗非小细胞肺癌化疗后患者可以有效减轻临床症状,改善患者体力状况,改善血常规、肝肾功能等相关检验指标,延长生存期. 相似文献
929.
目的:评价分阶段中药辅助靶向药物治疗非小细胞肺癌的疗效和安全性。方法:纳入92例非小细胞肺癌患者,随机分为治疗组(46例)和对照组(46例)。两组均予表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor tyrosine kinase inhibitors,EGFR-TKIs)治疗,治疗组在服用EGFR-TKIs药物初始3个月内给予益气健脾、清热祛湿方药治疗,3个月后给予益气养阴方药治疗。治疗前后评估两组患者的Karnofsky功能状态(Karnofsky Performance Status,KPS)评分,治疗开始后1个月评估临床疗效,治疗过程中记录皮疹发生情况,比较两组患者的疾病无进展生存期(progression-free survival,PFS)。结果:治疗组的平均PFS为(13.58±5.07)个月,对照组为(10.02±2.85)个月,治疗组患者的PFS较对照组明显延长(P0.01)。治疗过程中,治疗组的皮疹发生率为66.7%,对照组为82.9%,治疗组的皮疹发生率明显低于对照组(P0.05),且治疗组的皮疹发生情况较对照组明显减轻(P0.05)。治疗1个月后,两组患者的临床疗效比较,差异无统计学意义(P0.05)。治疗后,两组患者的KPS评分较治疗前均明显升高(P0.05),且治疗组患者的KPS评分明显高于对照组(P0.05)。结论:分阶段中药辅助靶向药物治疗非小细胞肺癌可减轻患者的皮肤毒性,改善其生存质量,且可延迟患者对EGFR-TKIs耐药的发生时间。 相似文献
930.
目的研究核苷酸切除修复交叉互补基因1(ERCC1),抑癌基因p53(p53)和B细胞淋巴瘤因子2(bcl-2)基因的表达水平与晚期非小细胞肺癌(NSCLC)患者铂类化疗疗效的关系。方法收集晚期NSCLC患者的肿瘤组织并制备组织芯片,进行ERCC1,p53和bcl-2基因的免疫组织化学染色,检测其在NSCLC组织中的表达情况;同时采集患者外周血检测其血清中ERCC1,p53和bcl-2蛋白的表达情况。根据RECIST肿瘤化疗疗效的评价标准评价患者的疗效,分析影响NSCLC患者铂类化疗疗效的因素及3种基因的表达情况和疗效的关系。结果 ERCC1阴性表达和阳性表达时的化疗有效率分别为55.81%和25.58%(P<0.01);bcl-2阴性表达和阳性表达时的化疗有效率分别为45.28%和25%(P<0.05);p53阴性表达和阳性表达时的化疗有效率分别为53.85%和29.79%(P<0.05)。以ERCC1阴性,同时bcl-2阴性和p53阳性表达的患者人数为最多,与其他各组相比差异有统计学意义(P<0.05),而其他各组人数差异无统计学意义(P>0.05);以ERCC1阴性表达同时bcl-2阳性表达和p53阴性表达的患者采用铂类化疗的有效率为最高,与其他情况相比差异有统计学意义(P<0.05);而ERCC1,bcl-2和p53基因均为阳性表达时的化疗有效率最差,与其他情况相比差异有统计学意义(P<0.01)。结论 ERCC1,p53和bcl-2基因的表达水平可以作为预测NSCLC患者铂类化疗疗效和预后的指标。 相似文献