Plasma Thrombopoietin Levels are Unlikely to Account for the Platelet-sparing Effect of Paclitaxel in Lung Cancer Patients

Purpose: The present study was designed to determine whether the combination of carboplatin (CBDCA) with paclitaxel (PTX) spared CBDCA-induced thrombocytopenia by increased plasma thrombopoietin (TPO) levels. Methods: Patients with non-small-cell and small-cell lung cancer were consecutively assigned to CBDCA with PTX regimen (CBDCA/PTX) and CBDCA with irinotecan (CPT-11) regimen (CBDCA/CPT-11), respectively. Results: Ten patients were entered into either CBDCA/PTX (n=5) or CBDCA/CPT-11 (n=5). CBDCA/PTX showed a lesser reduction of platelet counts than CBDCA/CPT-11 (p<0.05), although more severe neutropenia was observed in CBDCA/PTX (p<0.01). The plasma TPO levels were inversely correlated with circulating platelet counts in CBDCA/PTX and CBDCA/CPT-11. However, the increased rate of plasma TPO levels in CBDCA/PTX was not significantly different from that in CBDCA/CPT-11. Conclusions: These findings suggest that the increased plasma TPO levels in CBDCA/PTX result secondarily from thrombocytopenia, and that circulating TPO is probably not involved in the platelet-sparing effect of PTX

Evaluation of Bronchoalveolar Lavage as a Diagnostic Procedure for Primary Pulmonary B-cell Lymphoma

We evaluated retrospectively the role of bronchoalveolar lavage (BAL) in the diagnosis of primary pulmonary B-cell lymphoma in four patients. Histological examination of transbronchial lung biopsy specimens showed nonspecific infiltration of small lymphocytes. Examination of BAL fluid (BALF) samples showed lymphocytosis in all samples with dominant B-cell in two patients and T-cell in the remaining patients. In two patients only, there was a increase in B-cell bearing IgM light-chain or M-protein in BALF samples. our results suggest that the diagnostic value of BAL in primary pulmonary B-cell lymphoma is limited and that new molecular biological techniques should be adapted for analysis of BALF samples

Real-World Incidence of Febrile Neutropenia among Patients Treated with Single-Agent Amrubicin: Necessity of the Primary Prophylactic Administration of Granulocyte Colony-Stimulating Factor

Background: Single-agent amrubicin chemotherapy is a key regimen, especially for small cell lung cancer (SCLC); however, it can cause severe myelosuppression. Purpose: The purpose of this study was to determine the real-world incidence of febrile neutropenia (FN) among patients treated with single-agent amrubicin chemotherapy for thoracic malignancies. Patients and methods: The medical records of consecutive patients with thoracic malignancies, including SCLC and non-small cell lung cancer (NSCLC), who were treated with single-agent amrubicin chemotherapy in cycle 1 between January 2010 and March 2020, were retrospectively analyzed. Results: One hundred and fifty-six patients from four institutions were enrolled. Their characteristics were as follows: median age (range): 68 (32–86); male/female: 126/30; performance status (0/1/2): 9/108/39; SCLC/NSCLC/others: 111/30/15; and prior treatment (0/1/2/3-): 1/96/31/28. One hundred and thirty-four (86%) and 97 (62%) patients experienced grade 3/4 and grade 4 neutropenia, respectively. One hundred and twelve patients (72%) required therapeutic G-CSF treatment, and 47 (30%) developed FN. Prophylactic PEG-G-CSF was not used in cycle 1 in any case. The median overall survival of the patients with FN was significantly shorter than that of the patients without FN (7.2 vs. 10.0 months, p = 0.025). Conclusions: The real-world incidence rate of FN among patients with thoracic malignancies that were treated with single-agent amrubicin chemotherapy was 30%. It is suggested that prophylactic G-CSF should be administered during the practical use of single-agent amrubicin chemotherapy for patients who have already received chemotherapy

Pharmacokinetics of gefitinib predicts antitumor activity for advanced non-small cell lung cancer.

INTRODUCTION: We assessed the relationship between the plasma concentration of gefitinib and its efficacy in Japanese patients with advanced non-small cell lung cancer (NSCLC). METHODS: Plasma trough levels of gefitinib were measured on days 3 (D3) and 8 (D8) by high-performance liquid chromatography in 44 patients with advanced NSCLC treated with 250 mg gefitinib daily. Eligibility criteria included performance status < or =3, age < or = 80 years, and stages IIIB-IV cancer. Epidermal growth factor receptor mutations in 23 patients were analyzed retrospectively. RESULTS: The median plasma gefitinib values were 662 ng/ml on D3 and 1064 ng/ml on D8, and the D8/D3 ratio was 1.587. The median progression-free survival (PFS) was 71 days, and the median overall survival was 224 days. Adenocarcinoma, never smoking, and high D8/D3 ratio were associated with better PFS. Multivariate analysis showed that PFS was associated with never smoking and high D8/D3 ratio. Never-smokers with a high D8/D3 ratio showed the best PFS. Overall survival was not associated with the D8/D3 ratio. Epidermal growth factor receptor mutation analysis of 23 patients showed that 15 patients had exon 19 deletion and/or exon 21 point mutation. Median PFS was similar between mutation-positive and mutation-negative individuals in the high D8/D3 group, whereas mutation-negative individuals in the low D8/D3 group showed the worst median PFS. CONCLUSIONS: A high D8/D3 ratio was independently associated with better PFS in patients with NSCLC treated with gefitinib. Our findings suggest that the pharmacokinetics of gefitinib may be involved in its antitumor activity