Biomarkers for efficacy of adjuvant chemotherapy following complete resection in NSCLC stages I–IIIA

Biomarkers may be useful when deciding which nonsmall cell lung cancer (NSCLC) patients may benefit from adjuvant chemotherapy following complete resection and which chemotherapeutic agents may be used preferably in individual patients in order to maximise survival. A literature search covering the period from 2003 to May, 2014 was conducted using PubMed and the following search terms: “non-small cell lung cancer”, “NSCLC”, “adjuvant chemotherapy”, “randomized”, “randomised”, “biomarkers”, “prognostic”, “predictive”. This review focuses on current knowledge of biomarkers for prognosis or efficacy of adjuvant treatment following complete resection in stage I–IIIA NSCLC patients. This review includes results on 18 different biomarkers and five gene profiles. A statistically significant prognostic impact was reported for: iNTR, TUBB3, RRM1, ERCC1, BRCA1, p53, MRP2, MSH2, TS, mucin, BAG-1, pERK1/2, pAkt-1, microRNA, TopIIA, 15-gene profile, 92-gene profile, 31-gene profile and 14-gene profile. A statistically significant predictive impact was reported for: ERCC1, p53, MSH2, p27, TUBB3, PARP1, ATM, 37-gene profile, 31-gene profile, 15-gene profile and 92-gene profile. Uncertainties regarding the optimal analysis method and cut-off levels for the individual markers may blur the prognostic or predictive signals. None of the possible predictive markers have been validated in prospective trials. Thus, there are no biomarkers ready to use in an adjuvant setting in NSCLC

Chemotherapy induced pathologic complete response in malignant pleural mesothelioma: a review and case report

IntroductionMalignant pleural mesothelioma is a rare aggressive disease with a poor prognosis and usually modest responses to chemotherapy.Complete responses (CRs) to chemotherapy are rare. Evaluation is usually based on radiology, and CR is therefore clinical CR (cCR) and whether this indicates absence of viable tumor cells is unknown. We have observed two cases of CR which at subsequent surgery were histologically verified, thus being pathologic CRs (pCRs). pCR after chemotherapy is thus possible but rare, and we here present the cases from our institution together with a review on the literature available on the subject.MethodsA literature search using relevant keywords was performed in PubMed and MedLine.ResultsA larger number of reports on cCR but only five reports on pCR were identified. All published cases of pCR, 16 patients in five trials, are presented and discussed, and larger trials reporting cCR are mentioned. pCR did not in all cases correspond to cCR. The cases having pCR identified all had the epithelial or unknown subtype, and all had early-stage disease before treatment.ConclusionpCR is possible but rare, and a pCR does not always require a cCR. So far reported cases of pCR have all had the epithelial or unknown subtype and pretreatment stages have been low. The cases in our institution also had epithelial subtype but had stage III disease, and it thus seems possible to obtain a pCR despite a larger tumor burden

Polyneuropathy in a patient with malignant pleural mesothelioma: a paraneoplastic syndrome

AbstractParaneoplastic syndromes have only been reported in malignant pleural mesothelioma (MPM) in a few cases. In this case, we describe a 57-year-old man with MPM who developed sensory-motor polyneuropathy 18 days after diagnosis. Thorough endocrinological, neurological, and paraclinical examinations gave no explanation of the symptoms, and paraneoplasia was therefore suspected. The patient was treated with immunoglobulin and prednisolone, and this resulted in subjective, objective, and paraclinical improvement of the symptoms. We therefore suggest that polyneuropathy is a possible paraneoplastic syndrome in MPM