Fatigue in lung cancer

Cancer-related fatigue is common among patients with lung cancer. Cancer-related fatigue affects physical functioning, emotional well-being and overall quality of life. The aetiology of fatigue is multifactorial and includes cancer itself, anti-cancer therapy, intercurrent disorders such as anaemia and infection, pain, depression and other factors. Fatigue can easily be assessed by QoL instruments such as the FACT Fatigue Scale. Diagnosis should focus on the presence and severity of fatigue and attempt to identify potential causes of fatigue. The treatment of fatigue should focus on correction of the underlying cause. Besides anti- -cancer therapy and enhanced supportive care measures, other important treatment options include anaemia correction, treatment of infections, correction of metabolic disorders, pain control, anti-depressive treatment and regular sleep. Whereas avoidance of unnecessary physical activities might be necessary in some patients, physical training might help in selected patients. Oncologists must be aware of the impact of fatigue and offer adequate treatment options to their patients. Finally, more research on the clinical relevance of fatigue and its treatment options are warranted.Osłabienie związane z chorobą nowotworową jest częste u chorych na raka płuca. Osłabienie nowotworowe wpływa niekorzystnie na stan fizyczny, stan emocjonalny oraz ogólną jakość życia pacjenta. Etiologia osłabienia jest wieloczynnikowa. Do jego przyczyn należą: sama obecność nowotworu, towarzyszące zaburzenia, takie jak niedokrwistość i zakażenia, ból, depresja i inne czynniki. Osłabienie można łatwo oceniać za pomocą narzędzi określających jakość życia, np. Skali Osłabienia FACT. Diagnostyka powinna koncentrować się na ocenie obecności i nasilenia osłabienia oraz na identyfikacji potencjalnych przyczyn tego stanu, a leczenie - na usuwaniu przyczyny. Oprócz terapii przeciwnowotworowej oraz intensywnego leczenia objawowego należy uwzględnić wyrównywanie niedokrwistości, leczenie zakażeń, korektę zaburzeń metabolicznych, kontrolę bólu, leczenie przeciwdepresyjne oraz regularny sen. U niektórych pacjentów konieczne jest ograniczanie aktywności fizycznej, u innych natomiast aktywność fizyczna może być korzystna. Onkolodzy powinni być świadomi wpływu osłabienia na komfort życia pacjentów i zapewnić chorym odpowiednie leczenie. Należy przeprowadzić również dalsze badania nad znaczeniem klinicznym osłabienia oraz możliwościami leczenia tego stanu

THE "WHERE?" IN PARTICIPATORY LOCAL LAND USE PLANNING - A WEB MAPPING APPROACH IN SOUTH-WEST CAMEROON

International audienc

Pemetrexed with or without Matuzumab as Second-Line Treatment for Patients with Stage IIIB/IV Non-small Cell Lung Cancer

INTRODUCTION: This randomized phase II study investigated pemetrexed in combination with the epidermal growth factor receptor (EGFR)-targeting monoclonal antibody matuzumab compared with pemetrexed alone as second-line therapy for patients with advanced non-small cell lung cancer. METHODS: Patients received pemetrexed 500 mg/m every 3 weeks either alone (n = 50) or in combination with matuzumab at either 800 mg weekly (n = 51) or 1600 mg every 3 weeks (n = 47). The primary end point was objective response, as assessed by an independent review committee. RESULTS: Tumor EGFR expression was detected in 87% of randomized patients. The objective response rate for the pooled matuzumab-treated arms was 11% compared with 5% for pemetrexed alone (p = 0.332). Apart from one patient in the pemetrexed alone group, all responses occurred in patients whose tumors expressed EGFR. The objective response rate for patients receiving weekly matuzumab was 16% compared with 2% for those receiving matuzumab every 3 weeks. There was also a trend for improved overall survival in patients receiving matuzumab weekly versus every 3 weeks (12.4 months versus 5.9 months, respectively, versus 7.9 months for pemetrexed alone). The combination of pemetrexed and matuzumab demonstrated an acceptable safety profile, with the most common grade 3/4 adverse event being neutropenia. CONCLUSION: Although the analysis on the pooled matuzumab-treated arms did not demonstrate a statistically significant improvement in objective response for the addition of matuzumab to pemetrexed compared with pemetrexed alone, the trends for improvement in objective response and overall survival for pemetrexed plus weekly matuzumab compared with pemetrexed alone warrant confirmation in additional clinical trials

First-cycle rash and survival in patients with advanced non-small-cell lung cancer receiving cetuximab in combination with first-line chemotherapy: A subgroup analysis of data from the FLEX phase 3 study

Background: The randomised phase 3 First-Line Erbitux in Lung Cancer (FLEX) study showed that the addition of cetuximab to cisplatin and vinorelbine significantly improved overall survival compared with chemotherapy alone in the first-line treatment of advanced non-small-cell lung cancer (NSCLC). The main cetuximab-related side-effect was acne-like rash. Here, we assessed the association of this acne-like rash with clinical benefit.Methods: We did a subgroup analysis of patients in the FLEX study, which enrolled patients with advanced NSCLC whose tumours expressed epidermal growth factor receptor. Our landmark analysis assessed if the development of acne-like rash in the first 21 days of treatment (first-cycle rash) was associated with clinical outcome, on the basis of patients in the intention-to-treat population alive on day 21. The FLEX study is registered with ClinicalTrials.gov, number NCT00148798.Findings: 518 patients in the chemotherapy plus cetuximab group-290 of whom had first-cycle rash-and 540 patients in the chemotherapy alone group were alive on day 21. Patients in the chemotherapy plus cetuximab group with first-cycle rash had significantly prolonged overall survival compared with patients in the same treatment group without first-cycle rash (median 15·0 months [95% CI 12·8-16·4] vs 8·8 months [7·6-11·1]; hazard ratio [HR] 0·631 [0·515-0·774]; p<0·0001). Corresponding significant associations were also noted for progression-free survival (median 5·4 months [5·2-5·7] vs 4·3 months [4·1-5·3]; HR 0·741 [0·607-0·905]; p=0·0031) and response (rate 44·8% [39·0-50·8] vs 32·0% [26·0-38·5]; odds ratio 1·703 [1·186-2·448]; p=0·0039). Overall survival for patients without first-cycle rash was similar to that of patients that received chemotherapy alone (median 8·8 months [7·6-11·1] vs 10·3 months [9·6-11·3]; HR 1·085 [0·910-1·293]; p=0·36). The significant overall survival benefit for patients with first-cycle rash versus without was seen in all histology subgroups: adenocarcinoma (median 16·9 months, [14·1-20·6] vs 9·3 months [7·7-13·2]; HR 0·614 [0·453-0·832]; p=0·0015), squamous-cell carcinoma (median 13·2 months [10·6-16·0] vs 8·1 months [6·7-12·6]; HR 0·659 [0·472-0·921]; p=0·014), and carcinomas of other histology (median 12·6 months [9·2-16·4] vs 6·9 months [5·2-11·0]; HR 0·616 [0·392-0·966]; p=0·033).Interpretation: First-cycle rash was associated with a better outcome in patients with advanced NSCLC who received cisplatin and vinorelbine plus cetuximab as a first-line treatment. First-cycle rash might be a surrogate clinical marker that could be used to tailor cetuximab treatment for advanced NSCLC to those patients who would be most likely to derive a significant benefit. Funding: Merck KGaA. © 2011 Elsevier Ltd.The sponsor of the FLEX study was Merck KGaA. Jim Heighway of Cancer Communications and Consultancy (Knutsford, UK) provided medical writing services on behalf of the study sponsor.Peer Reviewe

Association of cetuximab with adverse pulmonary events in cancer patients: a comprehensive review

Compounds derived from biologic sources, or biologicals, are increasingly utilized as therapeutic agents in malignancy. Development of anti-cancer targeted therapies from biologics is increasingly being utilized. Cetuximab, a chimeric monoclonal antibody, is one such anti-cancer targeted therapeutic that has shown efficacy in quelling the rate of patient decline in colorectal, head/neck, and non-small cell lung cancer. However, due to the relatively recent addition of biologic compounds to the therapeutic arsenal, information related to adverse reactions is less well known than those seen in traditional chemotherapeutics. Dermatologic reactions have been demonstrated as the most frequent side effect cited during cetuximab therapy for malignancy; however, other effects may lead to greater morbidity. In general, pulmonary complications of therapeutics can lead to significant morbidity and mortality. The purpose of this review is to compile the various pulmonary side effects seen in patients treated with cetuximab for various malignancies, and to compare the incidence of these adverse reactions to standard therapies

Novel active agents in patients with advanced NSCLC without driver mutations who have progressed after first-line chemotherapy

Despite the efficacy of a number of first-line treatments, most patients with advanced-stage non-small cell lung cancer (NSCLC) experience disease progression that warrants further treatment. In this review, we examine the role of novel active agents for patients who progress after first-line therapy and who are not candidates for targeted therapies. More therapeutic options are needed for the management of patients with NSCLC after failure of first-line chemotherapy. A PubMed search was performed for articles from January 2012 to May 2015 using the keywords NSCLC, antiangiogenic, immunotherapy, second-line, novel therapies and English language articles only. Relevant papers were reviewed; papers outside that period were considered on a case-by-case basis. A search of oncology congresses was performed to identify relevant abstracts over this period. In recent years, antiangiogenic agents and immune checkpoint inhibitors have been added to our armamentarium to treat patients with advanced NSCLC who have progressed on first-line chemotherapy. These include nintedanib, a triple angiokinase inhibitor; ramucirumab, a vascular endothelial growth factor receptor-2 antibody; and nivolumab, pembrolizumab and atezolizumab, just three of a growing list of antibodies targeting the programmed death receptor-1 (PD-1)/PD ligand-1 pathway. Predictive and prognostic factors in NSCLC treatment will help to optimise treatment with these novel agents. The approval of new treatments for patients with NSCLC after the failure of first-line chemotherapy has increased options after a decade of few advances, and holds promise for future evolution of the management of NSCLC

Multi-Level Targeting of the Phosphatidylinositol-3-Kinase Pathway in Non-Small Cell Lung Cancer Cells

Introduction: We assessed expression of p85 and p110a PI3K subunits in non-small cell lung cancer (NSCLC) specimens and the association with mTOR expression, and studied effects of targeting the PI3K/AKT/mTOR pathway in NSCLC cell lines. Methods: Using Automated Quantitative Analysis we quantified expression of PI3K subunits in two cohorts of 190 and 168 NSCLC specimens and correlated it with mTOR expression. We studied effects of two PI3K inhibitors, LY294002 and NVP-BKM120, alone and in combination with rapamycin in 6 NSCLC cell lines. We assessed activity of a dual PI3K/mTOR inhibitor

CYBEREMOTIONS – Collective Emotions in Cyberspace

AbstractEmotions are an important part of most societal dynamics. As with face to face meetings, Internet exchanges may not only include factual information but may also elicit emotional responses; how participants feel about the subject discussed or other group members. The development of automatic sentiment analysis has made large scale emotion detection and analysis possible using text messages collected from the web. We present results of two years of studies performed in the EU Large Scale Integrating Project CYBEREMOTIONS (Collective emotions in cyberspace) Our goal is to understand the role of collective emotions in creating, forming and breaking-up ICT mediated communities and to prepare the background for the next generation of emotionally-intelligent ICT services. Project results have already attracted a lot of attention from various mass media and research journals including the Science and New Scientist magazines. Nine Project teams are organised in three layers (data, theory and ICT output)