5 research outputs found
Efficacy of second-line chemotherapy in patients with pulmonary large cell neuroendocrine carcinoma
Abstract The efficacy of second-line chemotherapy in patients with pulmonary large cell neuroendocrine carcinoma (LCNEC) is unclear. This study aimed to evaluate the efficacy of second-line chemotherapy in patients with pulmonary LCNEC. We retrospectively reviewed patients with pulmonary LCNEC or possible LCNEC (pLCNEC) who received platinum-based chemotherapy as the first-line treatment. Among these patients, we evaluated the efficacy of second-line treatment by comparing patients with small cell lung cancer (SCLC group). Of the 61 patients with LCNEC or pLCNEC (LCNEC group) who received first-line chemotherapy, 39 patients were treated with second-line chemotherapy. Among the 39 patients, 61.5% received amrubicin monotherapy. The median progression-free survival (PFS) and overall survival (OS) in the LCNEC groups were 3.3 and 8.3Â months, respectively. No significant differences in the PFS (hazard ratio [HR]: 0.924, 95% confidence interval [CI] 0.647â1.320; Pâ=â0.664) and OS (HR: 0.926; 95% CI 0.648â1.321; Pâ=â0.670) were observed between the LCNEC and SCLC groups. In patients treated with amrubicin, the PFS (Pâ=â0.964) and OS (Pâ=â0.544) were not different between both the groups. Second-line chemotherapy, including amrubicin, may be considered as a treatment option for patients with pulmonary LCNEC
Relationship between patterns of immunohistochemical conventional neuroendocrine markers and efficacy of immune check point inhibitors in patients with extensive disease small cell lung cancer
Abstract Background Which patients benefit from the addition of immune checkpoint inhibitors (ICIs) to chemotherapy for small cell lung cancer (SCLC) remains unclear. There have been few reports on the efficacy of ICIs based on conventional immunohistochemical neuroendocrine (NE) markers (synaptophysin, chromogranin A, and neural cell adhesion molecule [NCAM]). In the present study, we aimed to analyze the relationship between the expression of immunohistochemical NE markers and the efficacy of ICIs in patients with extensive disease (ED)âSCLC, to assess whether conventional NE markers are predictive of ICIs. Methods Patients with untreated EDâSCLC who received firstâline therapy at the Shizuoka Cancer Center between November 2002 and July 2021 were retrospectively reviewed. We evaluated the efficacy of firstâline chemotherapy according to the expression status of each immunohistochemical NE marker in patients treated with ICI plus chemotherapy (ICIâchemo group) and with chemotherapy alone (chemo group). Results A total of 227 patients were included in the ICIâchemo and chemo groups, respectively. The progressionâfree survival (PFS) tended to be better in patients in the ICIâchemo group than those treated with chemotherapy alone in patients with NE markerâpositive SCLC. In particular, it was statistically significant in patients with chromogranin Aâpositive SCLC (pâ=â0.036). In patients with NE markerânegative SCLC, no significant differences were observed in PFS between the two groups. There were no significant differences in overall survival (OS), regardless of the expression of any conventional NE marker. Conclusion Our study suggests that the efficacy of ICIs in addition to chemotherapy may be poor in patients with NE markerânegative SCLC
Clinical impact of tumour burden on the efficacy of PDâ1/PDâL1 inhibitors plus chemotherapy in nonâsmallâcell lung cancer
Abstract Background Programmed cell death 1 (PDâ1)/programmed cell death ligand (PDâL1) inhibitors plus chemotherapy (ICIâ+âChemo) is the standard treatment for advanced nonâsmallâcell lung cancer (NSCLC). However, the impact of tumour burden on the efficacy of ICIâ+âChemo remains unknown. Methods We retrospectively evaluated 92 patients with advanced NSCLC treated with ICIâ+âChemo. Tumour burden was assessed as the sum of the longest diameter of the target lesion (BSLD) and number of metastatic lesions (BNMLs). We categorised the patients into three groups based on the combined BSLD and BNML values. Results Sixtyâeight patients (74%) had progressive disease or died. Fortyâfour patients (48%) in the lowâBSLD group had a median progressionâfree survival (PFS) of 9.5 months, whereas patients in the highâBSLD group had a median PFS of 4.6 months (hazard ratio [HR] = 0.54, p = 0012). Twentyâfive patients (27%) in the lowâBNML group had a median PFS of 9.6 months, whereas patients in the highâBNML group had a median PFS of 6.5 months (HR = 0.51, p = 0.029). LowâBSLD and lowâBNML were associated independently with improved PFS in multivariate analysis. Analysis of the tumour burden combined with BSLD and BNML revealed a trend towards improved PFS as the tumour burden decreased, with median PFS of 22.3, 8.7, and 3.9 months in the lowâ (N = 13), mediumâ (N = 42) and highâburden (N = 37) groups respectively. Conclusions Our findings demonstrated that a high tumour burden negatively impacts the efficacy of ICIâ+âChemo in patients with advanced NSCLC
Incidence and Treatment Outcome of Radiation Pneumonitis in Patients With Limited-stage Small Cell Lung Cancer Treated With Concurrent Accelerated Hyperfractionated Radiation Therapy and Chemotherapy
Purpose: This study aimed to clarify the characteristics of and evaluate the risk factors for radiation pneumonitis (RP) induced by chemoradiation therapy (CRT) using accelerated hyperfractionated (AHF) radiation therapy (RT) in patients with limited-stage small cell lung cancer (LS-SCLC). Methods and Materials: Between September 2002 and February 2018, 125 patients with LS-SCLC were treated with early concurrent CRT using AHF-RT. Chemotherapy was comprised of carboplatin/cisplatin with etoposide. RT was administered twice daily (45 Gy/30 fractions). We collected data regarding onset and treatment outcomes for RP, and analyzed the relationship between RP and total lung doseâvolume histogram findings. Uni- and multivariate analyses were performed to assess patient- and treatment-related factors for grade â„2 RP. Results: The median age of patients was 65 years, and 73.6% of participants were men. In addition, 20% and 80.0% of participants presented with disease stage II and III, respectively. The median follow-up time was 73.1 months. Grades 1, 2, and 3 RP were observed in 69, 17, and 12 patients, respectively. Grades 4 to 5 RP were not observed. RP was treated with corticosteroids in patients with grade â„2 RP, without recurrence. The median time from initiation of RT to onset of RP was 147 days. Three patients developed RP within 59 days, 6 within 60 to 89 days, 16 within 90 to 119 days, 29 within 120 to 149 days, 24 within 150 to 179 days, and 20 within â„180 days. Among the doseâvolume histogram parameters, the percentage of lung volume receiving >30 Gy (V30) was most strongly related to the incidence of grade â„2 RP, and the optimal threshold to predict RP incidence was V30 â„20%. On multivariate analysis, V30 â„20% was an independent risk factor for grade â„2 RP. Conclusions: The incidence of grade â„2 RP correlated strongly with a V30 of â„20%. Contrarily, the onset of RP induced by concurrent CRT using AHF-RT may occur later. RP is manageable in patients with LS-SCLC