scholarly journals Analysis of systemic inflammatory biomarkers in neuroendocrine carcinomas of the lung: prognostic and predictive significance of NLR, LDH, ALI, and LIPI score

2020 ◽  
Vol 12 ◽  
pp. 175883592094237
Author(s):  
Antonio Galvano ◽  
Marta Peri ◽  
Aurelia Ada Guarini ◽  
Marta Castiglia ◽  
Antonino Grassadonia ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Neuroendocrine Carcinoma ◽  
Group Performance ◽  
Univariate Analysis ◽  
Eastern Cooperative Oncology Group ◽  
Prognostic Index ◽  
Inflammatory Biomarkers ◽  
Advanced Lung Cancer ◽  
First Line ◽  
Line Chemotherapy

Background: Lung neuroendocrine carcinoma (NEC) is characterized by aggressive clinical behavior and lack of treatment advances. We evaluate the prognostic and the predictive roles of systemic inflammatory biomarkers in patient circulating blood: neutrophil–lymphocyte ratio (NLR), lactate dehydrogenase (LDH), advanced lung cancer inflammation index (ALI), and the Lung Immune Prognostic Index (LIPI) score. Methods: A total of 120 patients with small-cell lung cancer (SCLC) ( n = 110) and large cell neuroendocrine carcinoma (LCNEC) ( n = 10) were enrolled. Overall survival (OS) was evaluated by Kaplan–Meier estimator and univariate and multivariate Cox proportional hazard analyses were performed to determine prognostic factors associated with OS while χ2 test was used for categorical data. Results: NLR cutoff value was 1.93. NLR was measured before and after first-line chemotherapy; 25 (21%) patients had higher NLR (delta NLR >1), whereas NLR was lower in 37 (31%). At the univariate analysis, median OS was 12 months: OS for SCLC and LCNEC were 11 months and 14 months, respectively. OS had a prognostic positive value in patients with pre-treatment NLR <1.93 ( p = 0.0002), LDH <600 U/L ( p = 0,03) and ALI ⩾34 ( p = 0,0065). At the multivariate analysis, Eastern Cooperative Oncology Group performance status, LDH levels and response after first-line chemotherapy were independently associated with OS. Median OS for good, intermediate, and poor LIPI was 15 months, 11 months, and 9 months, respectively( p = 0.091). Patients with higher NLR (>1.93) had an increased probability of tumor progression ( p = 0.045, χ2 test). Conclusion: This study demonstrated that systemic inflammatory biomarkers could facilitate the understanding of survival differences in the clinical management of lung NEC patients, underlying the need for prospective biomarker-driven studies in the immune checkpoint inhibitors setting.

scholarly journals Simplified Graded Baseline Symptom Assessment in Patients With Lung Cancer Undergoing First-Line Chemotherapy: Correlations and Prognostic Role in a Resource-Constrained Setting

2017 ◽  
Vol 3 (1) ◽  
pp. 54-63 ◽  
Author(s):  
Potsangbam Sarat Singh ◽  
Ashutosh Nath Aggarwal ◽  
Digambar Behera ◽  
Rakesh Kapoor ◽  
Navneet Singh
Keyword(s):  
Lung Cancer ◽  
Chest Pain ◽  
Group Performance ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Multivariable Analysis ◽  
Prognostic Role ◽  
First Line ◽  
Vas Score ◽  
Line Chemotherapy

Purpose There are limited data from developing countries on graded baseline symptom (BS) assessment in lung cancer. This prospective study aimed to assess the prognostic role of BS and correlation of BS with comorbidity, demographic, and investigation profiles in a cohort of 238 patients with lung cancer undergoing first-line chemotherapy over a 15-month period. Methods The Medical Research Council (MRC) scale was used to assess dyspnea, whereas the visual analog scale (VAS; score of 1 to 10) was used to assess anorexia, fatigue, chest pain, and cough. Weight loss (WL) was noted as percentage of pre-illness baseline. All patients received histology-guided platinum doublet chemotherapy. Outcomes assessed were overall survival (OS) and radiologic responses by RECIST. Results Significant correlations (Spearman ρ) were noted for fatigue and anorexia with all other BSs. Dyspnea differed significantly among groups on the basis of either the simplified comorbidity score or Charlson comorbidity index. Median OS was 287 days (95% CI, 232 to 342 days). OS was significantly higher for anorexia VAS score less than 4 (388 v 229 days for VAS score ≥ 4), fatigue VAS score less than 3 (388 v 213 days for VAS score ≥ 3), WL less than 5% (410 v 259 days for WL ≥ 5%), and MRC dyspnea grade less than 3 (377 v 187 days for MRC grade ≥ 3). On univariable Cox proportional hazards analysis, worse OS was noted for all BSs, stage, and performance status, but on multivariable analysis, only fatigue (hazard ratio [HR], 1.21), Eastern Cooperative Oncology Group performance status ≥ 2 (HR, 1.57), and stage IV disease (HR, 1.61) were significant. Nonresponders (stable disease and progressive disease [PD]) had a higher percentage of WL and higher mean VAS scores for cough, chest pain, anorexia, and fatigue. On multivariable logistic regression analysis, PD was associated with fatigue and percentage of WL. Conclusion BSs are prognostic for patients with lung cancer on first-line chemotherapy. Fatigue is prognostic for worse OS and PD. Comorbidity and investigation profiles do not correlate with either OS or response rates.

Does the extent of brain metastasis affect outcome of non-small cell lung cancer patients treated with chemotherapy?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20616-e20616
Author(s):  
Yong Won Choi ◽  
Mi Sun Ahn ◽  
Hyun Woo Lee ◽  
Seok Yun Kang ◽  
Jin-Hyuk Choi
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Kinase Inhibitor ◽  
Univariate Analysis ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Line Chemotherapy

e20616 Background: More than one third of advanced non-small cell lung cancer (NSCLC) patients (pts) experience brain metastases in the course of their disease. Although the outcome of NSCLC pts with brain metastasis is generally poor, identifying subgroups of pts that could benefit from appropriate therapeutic approach is clinically important, particularly in EGFR tyrosine kinase inhibitor (TKI) era. Methods: A retrospective review was conducted on 85 NSCLC pts with synchronous brain metastasis who underwent at least first-line chemotherapy, after treatment (Tx) for brain metastasis (gamma knife surgery or fractionated stereotactic radiotherapy : 42, whole brain radiation therapy : 38, surgical resection : 1, and no Tx : 4) from Jan 2002 to Dec 2013. Overall survival (OS) of all pts was analyzed according to the clinicopathological characteristics, Tx modality for brain metastasis, and chemotherapy. Results: The median OS for all pts after the initiation of first-line chemotherapy was 9 months. In univariate analysis, pts who received TKI (13 months versus 6 months, p= 0.001) and third- or further-line chemotherapy (15 months versus 6 months, p< 0.001) had significantly longer median OS. The presence of extracranial extrathoracic metastasis, number of brain metastasis, and Tx modality for brain metastasis showed no significant association with OS. In multivariate analysis, third- or further-line chemotherapy (24 pts) was the only independent prognostic factor for favorable OS ( p< 0.001). Pts who underwent third- or further-line chemotherapy were characterized by high proportion of non-squamous histology ( p= 0.016), extracranial extrathoracic metastasis ( p= 0.015), and TKI Tx ( p< 0.001). Conclusions: The present study suggests that judicious but active use of chemotherapy after appropriate Tx for brain metastasis may result in favorable outcome in NSCLC pts with synchronous brain metastasis, regardless of the number of brain metastatic lesions or local Tx modalities.

scholarly journals Real-world study of PD-L1 testing patterns and treatment distribution in patients with metastatic non-small-cell lung cancer in Israel

Immunotherapy ◽  
2021 ◽  
Author(s):  
Sarah Sharman Moser ◽  
Lior Apter ◽  
Ashwini Arunachalam ◽  
Thomas Burke ◽  
Varda Shalev ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Group Performance ◽  
Eastern Cooperative Oncology Group ◽  
Small Cell ◽  
Egfr Mutations ◽  
Small Cell Lung ◽  
First Line ◽  
Testing Patterns

Aim: We describe PD-L1 testing patterns and first-line treatment for patients with metastatic non-small-cell lung cancer in a 2.3 million-member state-mandated health service in Israel. Materials & methods: Newly diagnosed stage IV non-small-cell lung cancer patients initiating systemic anticancer treatment from 1 January 2017 until 31 December 2018 were identified from the national cancer registry and Maccabi Healthcare Service database and followed until 30 June 2019. Results: The cohort consisted of 410 patients; 58% males, median age 68 years, 70% current/former smokers, 81% adenocarcinoma, 14% had brain metastases, and Eastern Cooperative Oncology Group performance status was 46/17/37% for 0–1/2–4/unknown, respectively. A total of 80% tested for PD-L1 expression, of which 47% had tumor proportion score (TPS) ≥ 50%. A total of 95% with TPS ≥ 50% and no known tumor aberrations (including EGFR mutations, and translocations in ALK and ROS1) received first-line PD-1/PD-L1-inhibitor monotherapy, and 80% of untested/TPS < 50% received platinum doublets. Conclusion: Fast uptake of testing was observed, and treatment patterns showed high adherence to guidelines.

PILLAR-2: A randomized, double-blind, placebo-controlled, phase III study of adjuvant everolimus in poor-risk diffuse large B-cell lymphoma (DLBCL).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. TPS8118-TPS8118 ◽  
Author(s):  
Tongyu Lin ◽  
Jun Zhu ◽  
Kamal Bouabdallah ◽  
Michinori Ogura ◽  
Masayuki Hino ◽  
...  
Keyword(s):  
Group Performance ◽  
International Prognostic Index ◽  
Eastern Cooperative Oncology Group ◽  
Prognostic Index ◽  
Data Monitoring Committee ◽  
B Cell Lymphoma ◽  
Phase Iii ◽  
First Line ◽  
Double Blind ◽  
Poor Risk

TPS8118 Background: Effective DLBCL adjuvant therapy after first-line chemotherapy is needed as high-risk DLBCL is associated with a poor 4-year overall survival (OS) rate (Sehn et al, Blood 2007;109:1857-61). In a phase II study of the oral mammalian target of rapamycin inhibitor everolimus in relapsed, aggressive non-Hodgkin lymphoma, DLBCL patients (n=47) had a 30% overall response rate (Witzig et al, Leukemia 2011;25:341-7). Methods: PILLAR-2 is an ongoing international, randomized, double-blind, phase 3 study designed to compare everolimus efficacy and safety with that of placebo in poor-risk DLBCL patients who achieved complete response (CR) with first-line rituximab-based chemotherapy (R-chemo) (ClinicalTrials.gov: NCT00790036; sponsor: Novartis Pharmaceuticals). Eligibility criteria include age ≥18 years; confirmed stage II bulky, III, or IV DLBCL and International Prognostic Index 3-5 at diagnosis; confirmed CR per revised International Workshop Response Criteria for malignant lymphoma (Cheson et al, J Clin Oncol 2007;25:579-86) after first-line R-chemo regimen completed 6-14 weeks before study drug start; Eastern Cooperative Oncology Group performance status ≤2; no ongoing or post–R-chemo radiation; and no myelosuppressive chemotherapy or biologic therapy within 3 weeks. Patients are randomized 1:1 to everolimus 10 mg once daily or matching placebo and treated for 12 months or until disease relapse, unacceptable toxicity, or death. Radiologic tumor assessment is performed at baseline, every 12 weeks during years 1 and 2, every 24 weeks during years 3 and 4, and annually thereafter until start of new anticancer therapy or 5 years after last patient randomization. The primary endpoint is disease-free survival (DFS). Secondary endpoints are OS, lymphoma-specific survival, and safety. Expected enrollment is 687 patients. Final analysis will be performed when 279 DFS events occur; survival follow-up will continue until 338 deaths occur and the last randomized patient has been followed for ≥5 years. Currently, 422 patients are enrolled. The data monitoring committee last reviewed the trial in July 2011 and recommended that it continue as planned.

scholarly journals A randomized trial of the electronic Lung Cancer Symptom Scale for quality-of-life assessment in patients with advanced non-small-cell lung cancer

2019 ◽  
Vol 27 (2) ◽  
Author(s):  
J. C. Kuo ◽  
D. M. Graham ◽  
A. Salvarrey ◽  
F. Kassam ◽  
L. W. Le ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Advanced Nsclc ◽  
Small Cell ◽  
Advanced Lung Cancer ◽  
Small Cell Lung ◽  
First Line ◽  
Supportive Interventions ◽  
Line Chemotherapy

Introduction: Improving health-related quality of life (HRQL) is a key goal of systemic therapy in advanced lung cancer although routine assessment remains challenging. We aimed to analyze the impact of a real-time electronic HRQL tool, the eLCSS-QL, on palliative care referral (PCR) rates, patterns of chemotherapy treatment and use of other supportive interventions in patients with advanced non-small cell lung cancer (NSCLC) receiving first-line chemotherapy. Methods: Patients with advanced NSCLC starting first-line chemotherapy were randomized to their oncologist receiving or not receiving their eLCSS-QL data before each clinic visit.  Patients completed the eLCSS-QL scoring at baseline, prior to each chemotherapy cycle, and at subsequent follow-up visits until disease progression. Prospective data on PCR rate, HRQL and use of other supportive interventions were collected. Results: A total of 95 advanced NSCLC patients participated. Oncologists received real-time eLCSS-QL data for 44 patients (eLCSS-QL arm) and used standard clinical assessment only (standard arm) for 51 patients.  The primary end-point, the PCR rate, was numerically higher but statistically similar between patients in the eLCSS-QL and standard arms. HRQL scores over time were not significantly different between the two arms. Conclusions: The eLCSS-QL is feasible as a tool for use in routine clinical practice, although no statistically significant impact was demonstrated in this study. Improving access to supportive care through the collection of patient reported outcomes and HRQL should be an important component of care for advanced lung cancer patients. 

scholarly journals Pemetrexed/cisplatin as first-line chemotherapy for advanced lung cancer with brain metastases

Medicine ◽  
2016 ◽  
Vol 95 (32) ◽  
pp. e4401 ◽  
Author(s):  
Guangzhao He ◽  
Xiaoguang Xiao ◽  
Man Zou ◽  
Chengliang Zhang ◽  
Shu Xia
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Advanced Lung Cancer ◽  
First Line ◽  
Line Chemotherapy
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