Purpose
Squamous cell carcinomas (SqCC) of the lung often express high levels of thymidylate synthase (TS), which is associated with primary resistance to pemetrexed. We explored the efficacy of pemetrexed in a selected population of patients with lung SqCC with low TS expression.
Materials and Methods
In this single-arm phase II trial, we enrolled 32 previously-treated patients with advanced lung SqCC exhibiting low immunohistochemical staining for TS (i.e., in 10% or less of tumor cells). The primary endpoint was 12-week progression-free survival (PFS) rate.
Results
Of 32 patients, eight patients (25%) had an Eastern Cooperative Oncology Group performance status of 2, and seven patients (22%) had previously received three or more lines of chemotherapy. The disease control rate from pemetrexed treatment was 30%, and no objective response was observed. The 12-week PFS rate was 24.5% (95% confidence interval [CI], 13.0 to 46.1). Median PFS was 1.3 months (95% CI, 1.3 to 2.7), and median overall survival was 11.8 months (95% CI, 8.1 to not applicable). Most of adverse events were grade 1 or 2.
Conclusion
Pemetrexed demonstrated modest activity as a salvage chemotherapy in patients with advanced lung SqCC with low TS expression, although its toxicity was generally manageable.
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Bioengineered miR-7-5p modulates non–small cell lung cancer cell metabolism to improve therapy Gavin M. Traber, Mei-Juan Tu, Su Guan, Neelu Batra, Ai-Ming Yu Molecular Pharmacology.2025; 107(1): 100006. CrossRef
Purpose
Immune checkpoint inhibitors (ICI) and targeted small-molecule drugs are mainstay elements of lung cancer chemotherapy. However, they are associated with development of pneumonitis, a rare, but potentially life-threatening event. We analyzed lung cancer patients treated with ICI to evaluate the effect of sequential therapeutic administration on the incidence of pneumonitis.
Materials and Methods
In this retrospective study, 242 patients were included. Serial radiologic findings taken during and immediately after ICI treatment were reviewed. Factors that increased pneumonitis and the relationship between peri-ICI chemotherapy and the development of pneumonitis were evaluated.
Results
Pneumonitis developed in 23 patients (9.5%); severe pneumonitis (grade ≥ 3) occurred in 13 of 23 patients (56%); pneumonitis-related death occurred in six. High-dose thoracic radiation (≥ 6,000 cGy) revealed a tendency toward high risk of pneumonitis (odds ratio, 2.642; 95% confidence interval, 0.932 to 7.490; p=0.068). Among 149 patients followed for ≥ 8 weeks after the final ICI dose, more patients who received targeted agents within 8-weeks post-ICI experienced pneumonitis (3/16, 18.8%) compared with patients who received cytotoxic agents (4/54, 7.4%) or no chemotherapy (4/79, 5.1%) (p=0.162). Targeted therapy was associated with earlier-onset pneumonitis than treatment with cytotoxic agents (35 vs. 62 days post-ICI, p=0.007); the resulting pneumonitis was more severe (grade ≥ 3, 100% vs. 0%, p=0.031).
Conclusion
Sequential administration of small-molecule targeted agents immediately after ICI may increase the risk of severe pneumonitis. The sequence of chemotherapy regimens that include ICI and targeted agents should be carefully planned to reduce the risk of pneumonitis in lung cancer patients.
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Toxicities associated with sequential or combined use of immune checkpoint inhibitors and small targeted therapies in non-small cell lung cancer: A critical review of the literature Anne-Laure Désage, Michael Duruisseaux, Claire Lafitte, Sophie Bayle-Bleuez, Christos Chouaid, Pierre Fournel, Thomas Pierret Cancer Treatment Reviews.2024; 129: 102805. CrossRef
Deep learning for predicting the risk of immune checkpoint inhibitor-related pneumonitis in lung cancer M. Cheng, R. Lin, N. Bai, Y. Zhang, H. Wang, M. Guo, X. Duan, J. Zheng, Z. Qiu, Y. Zhao Clinical Radiology.2023; 78(5): e377. CrossRef
Evaluating Pneumonitis Incidence in Patients with Non–small Cell Lung Cancer Treated with Immunotherapy and/or Chemotherapy Using Real-world and Clinical Trial Data Qi Liu, Chenan Zhang, Yue Huang, Ruihao Huang, Shiew-Mei Huang, Erin Larkins, Liza Stapleford, Donna R. Rivera, Paul G. Kluetz, Shenggang Wang, Hao Zhu, James Weese, Elizabeth Cromartie, Mahder Teka, Sheetal Walters, Frank Wolf, Thomas D. Brown Cancer Research Communications.2023; 3(2): 258. CrossRef
Pulmonary toxicity in driver gene positive non-small cell lung cancer therapy Yi-Pu Zhao, Yong Long Current Medical Research and Opinion.2022; 38(8): 1369. CrossRef
Immune checkpoint inhibitor-related pneumonitis in non-small cell lung cancer: A review Yuxuan Hao, Xiaoye Zhang, Li Yu Frontiers in Oncology.2022;[Epub] CrossRef
Improving Time-to-Treatment for Advanced Non-Small Cell Lung Cancer Patients through Faster Single Gene EGFR Testing Using the Idylla™ EGFR Testing Platform Norbert Banyi, Deepu Alex, Curtis Hughesman, Kelly McNeil, Diana N. Ionescu, Carmen Ma, Stephen Yip, Barbara Melosky Current Oncology.2022; 29(10): 7900. CrossRef
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Deep learning model enables the discovery of a novel immunotherapeutic agent regulating the kynurenine pathway Jeong Hun Kim, Won Suk Lee, Hye Jin Lee, Hannah Yang, Seung Joon Lee, So Jung Kong, Soyeon Je, Hyun-Jin Yang, Jongsun Jung, Jaekyung Cheon, Beodeul Kang, Hong Jae Chon, Chan Kim OncoImmunology.2021;[Epub] CrossRef
Purpose
Concurrent chemoradiotherapy (CCRT) is the standard care for stage III non-small cell lung cancer (NSCLC) patients; however, a more effective regimen is needed to improve the outcome by better controlling occult metastases. We conducted two parallel randomized phase II studies to incorporate erlotinib or irinotecan-cisplatin (IP) into CCRT for stage III NSCLC depending on epidermal growth factor receptor (EGFR) mutation status.
Materials and Methods
Patients with EGFR-mutant tumors were randomized to receive three cycles of erlotinib first and then either CCRT with erlotinib followed by erlotinib (arm A) or CCRT with IP only (arm B). Patients with EGFR unknown or wild-type tumors were randomized to receive either three cycles of IP before (arm C) or after CCRT with IP (arm D).
Results
Seventy-three patients were screened and the study was closed early because of slow accrual after 59 patients were randomized. Overall, there were seven patients in arm A, five in arm B, 22 in arm C, and 25 in arm D. The response rate was 71.4% and 80.0% for arm A and B, and 70.0% and 73.9% for arm C and D. The median overall survival (OS) was 39.3 months versus 31.2 months for arm A and B (p=0.442), and 16.3 months versus 25.3 months for arm C and D (p=0.050). Patients with sensitive EGFR mutations had significantly longer OS than EGFR-wild patients (74.8 months vs. 25.3 months, p=0.034). There were no unexpected toxicities.
Conclusion
Combined-modality treatment by molecular diagnostics is feasible in stage III NSCLC. EGFR-mutant patients appear to be a distinct subset with longer survival.
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Purpose
Paclitaxel (P) and gemcitabine (G) are clinically synergistic in small cell lung cancer (SCLC). We evaluated the efficacy of PG as a salvage treatment for SCLC patients whose disease progressed after a platinum-containing regimen.
Materials and Methods
Eligibility included histologically confirmed SCLC, one dimensionally measurable disease, Eastern Cooperative Oncology Group performance status 0-2, and progressive disease after platinum-based chemotherapy. Treatment consisted of P (80 mg/m2) and G (1,000 mg/m2) on days 1 and 8 of each cycle of 21 days until disease progression.
Results
Thirty-three patients seen between December 2005 and February 2009 were selected into this study. Thirty patients (91%) had received irinotecan-platinum, and three had received etoposide-platinum. Sixteen patients (49%) had a treatment-free interval of less than 3 months. The overall response rate was 30.3% (29.4% in sensitive relapse and 31.3% in refractory relapse). The median time to progression was 12.0 weeks and median overall survival (OS) 31.0 weeks, with a 1-year OS rate of 30.3%. Toxicities were moderate and manageable with 18.2% grade (G) 4 neutropenia, 24.2% G3 thrombocytopenia, 6.1% G3 sensory neuropathy, and 3% G3 asthenia. One patient developed febrile neutropenia.
Conclusion
Second-line paclitaxel and gemcitabine were well-tolerated and moderately active in SCLC patients previously treated with platinum-based chemotherapy.
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The incidence of acute leukemia in pregnancy is rare. The treatment of acute leukemia during pregnancy is complicated and therapeutic options must be made with each individual patient. Complete remission can now be achieved in 60 to 70% of previously untreated adults with acute myelogenous leukemia (AML). Antileukemic chemotherapy can be administered safely during the second and third trimesters.
Cytarabine (ara-C) and anthracycline has not been associated with birth defect. When a pregnant woman presents with acute leukemia, chemotherapy should be recommended as vigorously as in the non- pregnant woman. We reported a case of AML during pregnancy. The patient recieved induction chemotherapy with ara-C and idarubicin. The baby was delivered at 33 weeks of gestation and had transient neutropenia. The mother received consolidation chemotherapy after achievement of complete remission.
Cervical cancer is the most common gynecologic cancer, accounting for 22.2% of all cancers in Korean women and is almost of squamous cell type. The reported incidence of adenocarcinoma of the uterine cervix varies from 4 to 20% of all cervical malignancies, and have shown an increase in the percentage of adenocarcinoma. Adenocarcinoma may have a slightly poorer prognosis than squamous cell carcinoma for each stage of disease. Pulmonary metastases are observed in 2~9% of patients and correlates with stage of disease. We report a case of cervical adenocarcinoma with pulmonary metastases simulating miliary tuberculosis. These metastases was confirmed by open lung biopsy.
Keong Hae Jung, Young Iee Park, Kee Heung Lee, Young Suk Park, Chang In Suh, Won Ki Kang, Heung Tae Kim, Cheol Won Suh, Dae Seog Heo, Yung Jue Bang, Seonyang Park, Noe Kyeong Kim
Chang In Suh, Won Ki Kang, Heung Tae Kim, Jae Hoon Lee, Dae Seog Heo, Yung Jue Bang, Seonyang Park, Byoung Kook Kim, Noe Kyeong Kim, Young Suk Park, Keun Chil Park, Sung Rok Kim
Yoon Koo Kang, Dae Seog Heo, Heung Tae Kim, Won Ki Kang, Keun Chil Park, Si Young Kim, Kyung Sam Cho, Sung Rok Kim, Sang Jae Lee, Byoung Kook Kim, Jin Oh Lee, Tae Woong Kang
Ki Hyeong Lee, Won Ki Kang, Chang In Suh, Young Suk Park, Heung Tae Kim, Yoon Koo Kang, Hyo Jin Kim, Dae Seog Heo, Yung Jue Bang, Yong Bum Yoon, Noe Kyeong Kim, Yong Hyun Park
The postoperative adjuvant chemotherapy with 12 cycles of 5-FU and mitomycin-C has been administered in 162 patients with stage II or lll gastric adenocarcinoma after curative gastric resection. 1) After a median follow-up time of 81 months, 94/163 treated patients recurred (58%). The sites of recurrent cancer were as follows: loco-regional, 419, peritoneal, 24%, distant metastases, 26%, multiple sites, 9%. 2) The 5-year disease free survival rates were 36.8% 3) The 5-year overall survival rates were 45.0% and the median survival was 50.2 months. 4) The number of lymph nodes involvement and the T stage affected disease free and overall survival. 5) The FM regimen was well tolerated, and produced moderate bone marrow suppression, anorexia, nausea, vomiting and diarrhea.
Noe Kyeong Kim, Yung Jue Bang, Dae Seog Heo, Heung Tae Kim, Hyo Jin Kim, Keun Chil Park, Keun Chil Park, Dong Bok Shin, Myung Chul Lee, Byoung Kook Kim, Sang Goo Shin, Seong Hoe Park, Han Ik Cho
A phase I study of recombinant gamma-interferon (LBD-001) was conducted in 23 patients with advanced malignancy. The schedule was the intramuscular administration of recombinant interferon-gamma 6 consecutive days a week for 2 weeks followed by 2 weeks of rest and was repeated every 28 days. Patients were assigned to six dose levels. The maximum tolerated dose was 10.0x10(6) units/m/day and the major toxicities were flulike symptoms. After intramuscular injection, the pharmacological data fit the single compartmental modeL More than 2/3 of the dose administered was absorbed. The absorbance T 1/2 was longer with values of 247.6 minutes but interferon-gamma was cleared with a short half life of 49.9 minutes from the circulation. Antitumor effects occurred in patients with chronic myelogenous leukemia and malignant melanoma.
Thirty one patients with Non-Hodgkin's lymphoma of the central nervous system (CNS) were treated at the Seoul National University Hospital between Jan. 1978 and Mar. 1989. Clinical records of these patients were analyzed in order to define disease characteristics. clinical course, and risk factors for CNS involvement Six patients had primary CNS lymphoma and twenty five patients had secondary involvement of CNS. 5.3% of non-Hodgkin's lymphoma patients had secondary CNS involvement. Patients less than 30 years of age had increased risk for CNS involvement. Patients who had stage IV lymphoma had CNS invalvement more frequently than expected but without statistical significance. Median survival time was 14 months for primary CNS lymphoma and 4 months for secondary CNS lynsphoma. Cranial irradiation and intrathecal chemotherapy prolonged the survival but standard treatment should be established.
Stomach cancer is a leading malignant disease in many countries. Conventional combination chernotherapy approaches to advanced gastric cancer only produce paitial response and there has been no impact on patient survival from these approaches as well. Of several promising new approaches the combination of interferon (IFN) and chemotherapeutic agents are now being made to improve the effectiveness for the treatment of cancer. Preclinical studies suggested that IFN may biochemically modulate the cellular uptake or metabolism of 5-fluorouracil (5-FU) resulting in s synergistic antitumor effect. Based on these data, Wadler reparted a promising result with combina- tion of 5-FU and IFN-alpha in patients with advanced colorectal carcinoma. This study was conducted to investigate the combined effects af 5-FU and recombinant IFN- gamma at cellular level against four gastric carcinoma cell lines (SNU-1, SNU-5, SNU-16, and NCI-NB7). We used a semiautomated tetrazolium-based colorimetric (MTT) assay for cytotoxicity and an isobologram analysis to evaluate the effect of the combination. The experiment was perfor- med three times on each of the three cell lines. Only two experirnents for SNU-16 and NCI-N87 showed supraadditivity (p< 0.02). On isobologram plotted by the mean value of three experiments for each cell line, supraadditivity was suggested for only SNU-16 (p = 0.055). In conclusion, our result did not document in vitro synergy between 5-FU and IFN-gamma for gastric carcinoma cell lines but additivity within clinically achievable dose range. Because in vivo immunomodulatory effect of IFN-gamma on host is more important rather than antiproliferative effect, the combination of 5-FU and IFN gamma is expected to improve the treatment of advanced gastric cancer.
Young Hyuk Im, Kee Hyung Lee, Young Suk Park, Chang In Suh, Won Ki Kang, Hyo Jin Kim, Heung Tae Kim, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim, Soon Beom Kang, Hyo Pyo Lee, Jin Yong Lee, Seung Wook
Twenty-nine patient with advanced cervix cancer were treated with a combination chemotherapy of cisplatin, vincristine, bleomycin, and methotrexate between January, 1987 and December, 1988. 1) Among 19 evaluable patients, 4 patients (20.1%) achieved complete response and 6 patients (31. 6%) achieved partial response, giving an overall response rate of 51.7%. The median duration of remission was 23 weeks in the responders. 2) The median survival of overall patients was 50 7 weeks. The median survival of the responders did not reach the median value during the follow-up period of 15-81 weeks. In contrast, the median survival of the non-responders was 30.7 weeks, which was significantly shorter than that of the responders (p<0.05). 3) The only factor influencing remission rate was the pattem of failure, and the patients with distant metastasis showed higher remission rates (p<0.01). There were no prognostic factors influencing the remission duration. The factors improving survival rates were the early stage at diagnosis (p< 0. 005), the previous history of curative operation (p<0.005), and the presence of distant metastasis (p<0.01). 4) Considerable number of patients experienced toxicities. Among these, leukopenia (50%) and thrombocytopenia (4.7%) were the main hematologic toxicities. Most patients experienced nausea, vomiting, diarrhea (89.49o), stomatitis (26 3%), and alopecia (73.7%). Neurotoxicity due to vincristine or cispatin was found in 36.896 of patients, and 2 patients showed pulmonary fibrosis due to bleomycin toxicity. In conclusion, this regimen (PVBM) seems to be effective in terms of remission rates, but did not show any additional benifits in terms of remission duration or overall survival. In addition, the large number of patients experienced considerable side effects. Based on these findings, further studies are needed to find out the new regimen which is more effective and less toxic for the patients with advanced uterine cervix cancer.
Between October 1985 and January 1990, the combination chemotherapy with cyclophosphamide, adriamycin and cisplatin (CAP) has been administered in 16 patients with invasive, recurrent or metastatic thymoma. Among 14 evaluable patients, 1 patient(7%) achieved a complete response and 4 patients (29%) had a partial response. The 4 year overall survival rates were 56.7% with a median follow-up of 11.5 months. The mast frequent hematologic toxicity was leukopenia (15.9%) and nonhematologic toxicity (WHO criteria; grade II) were alopecia (80%) and nausea/vomiting (66.7%). The CAP regimen is effective and well tolerated for the treatment of invasive thymoma, and further study is needed to confirm the relative effectiveness of CAP regimen in comparison with other regimens and to find out the prognostic factors related to response rate and survival