Comorbidity: Usage of, and survival after chemotherapy for advanced lung cancer.

e19157 Background: Comorbidity may influence prognosis in lung cancer, affect performance status (PS) of patients as well as complicate treatment. The present study examines usage and outcome of chemotherapy (CT) for advanced-stage lung cancer, and focuses on the role of comorbidity. Methods: Patients with advanced-stage lung cancer were identified in the Danish Lung Cancer Registry. A total of 22,999 patients with non-resectable, advanced-stage lung cancer were identified. Data on stage, PS, Charlson comorbidity score (ChS), age, histology and type of first treatment (if any) were avaliable. First treatment was categorized as chemotherapy (n=7,346), chemo-radiotherapy (2,636), radiotherapy (n=4,155) or no therapy (n=8,862). Survival was examined separately for 0-1 year and 1-5 years, and further distinction was made between metastatic and non-metastatic lung cancer. Data are presented for the subgroup of patients receiving chemotherapy as first treatment only. All estimates are derived from logistic regression model adjusting for the effect of performance status, pulmonary function and histological type, except for usage where models included same variables plus stage. Results: Use of chemotherapy was less frequent for more comorbid patients (OR 0.86, 0.64, 0.56 for Charlson score 1, 2, 3+ respectively compared to no comorbidity). Older patients and men were less likely to receive CT. For patients receiving CT as first treatment for non-metastatic lung cancer, survival in the first year was slightly worse for those with co-morbidity (HR 0-1year, non metastatic =0.91, 0.92, 0.87 for ChS 1,2,3+ respectively). For 1-5years and for metastatic lung cancer no correlation between comorbidity and survival was noted. In contrast, PS and sex was strongly associated with survival. Conclusions: With increasing co morbidity, chemotherapy was used less often. Comorbidity is not an important prognostic factor in advanced lung cancer treated with chemotherapy. However, sex and especially performance status remain as strong prognostic factors in this patient group.

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Overview of Ca2+ signaling in lung cancer progression and metastatic lung cancer with bone metastasis

Exploration of Targeted Anti-tumor Therapy ◽

10.37349/etat.2021.00045 ◽

2021 ◽

Author(s):

Manh Tien Tran

Keyword(s):

Lung Cancer ◽

Bone Metastasis ◽

Cancer Progression ◽

Negative Impact ◽

Second Messengers ◽

Advanced Stage ◽

Metastatic Lung Cancer ◽

Metastatic Lung ◽

Advanced Stage Lung Cancer ◽

Stage Lung Cancer

Intracellular Ca2+ ions that are thought to be one of the most important second messengers for cellular signaling, have a substantial diversity of roles in regulating a plethora of fundamental cellular physiology such as gene expression, cell division, cell motility and apoptosis. It has been suggestive of the Ca2+ signaling-dependent cellular processes to be tightly regulated by the numerous types of Ca2+ channels, pumps, exchangers and sensing receptors. Consequently, dysregulated Ca2+ homeostasis leads to a series of events connected to elevated malignant phenotypes including uncontrolled proliferation, migration, invasion and metastasis, all of which are frequently observed in advanced stage lung cancer cells. The incidence of bone metastasis in patients with advanced stage lung cancer is estimated in a range of 30% to 40%, bringing about a significant negative impact on both morbidity and survival. This review dissects and summarizes the important roles of Ca2+ signaling transduction in contributing to lung cancer progression, and address the question: if and how Ca2+ signaling might have been engaged in metastatic lung cancer with bone metastasis, thereby potentially providing the multifaceted and promising solutions for therapeutic intervention.

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“Randomized trial of physical activity on quality of life and lung cancer biomarkers in patients with advanced stage lung cancer: a pilot study”

BMC Cancer ◽

10.1186/s12885-021-08084-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Brett C. Bade ◽

Geliang Gan ◽

Fangyong Li ◽

Lingeng Lu ◽

Lynn Tanoue ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Lung Cancer ◽

Randomized Trial ◽

Cancer Biomarkers ◽

Advanced Stage ◽

Home Based ◽

Advanced Stage Lung Cancer ◽

Stage Lung Cancer

Abstract Background Lung cancer survivors need more options to improve quality of life (QoL). It is unclear to what extent patients with advanced stage disease are willing to participate in home-based physical activity (PA) and if these interventions improve QoL. The goal of our study was to determine interest in participating in our 3-month home-based walking regimen in patients with advanced stage lung cancer. We used a randomized design to evaluate for potential benefit in PA and patient-reported outcomes. Methods We performed an open-label, 1:1 randomized trial in 40 patients with stage III/IV non-small cell lung cancer (NSCLC) evaluating enrollment rate, PA, QoL, dyspnea, depression, and biomarkers. Compared to usual care (UC), the intervention group (IG) received an accelerometer, in-person teaching session, and gain-framed text messages for 12 weeks. Results We enrolled 56% (40/71) of eligible patients. Participants were on average 65 years and enrolled 1.9 years from diagnosis. Most patients were women (75%), and receiving treatment (85%) for stage IV (73%) adenocarcinoma (83%). A minority of patients were employed part-time or full time (38%). Both groups reported low baseline PA (IG mean 37 (Standard deviation (SD) 46) vs UC 59 (SD 56) minutes/week; p = 0.25). The IG increased PA more than UC (mean change IG + 123 (SD 212) vs UC + 35 (SD 103) minutes/week; p = 0.051)). Step count in the IG was not statistically different between baseline (4707 step/day), week 6 (5605; p = 0.16), and week 12 (4606 steps/day; p = 0.87). The intervention improved EORTC role functioning domain (17 points; p = 0.022) with borderline improvement in dyspnea (− 13 points; p = 0.051) compared to UC. In patients with two blood samples (25%), we observed a significant increase in soluble PD-1 (219.8 (SD 54.5) pg/mL; p < 0.001). Conclusions Our pilot trial using a 3-month, home-based, mobile health intervention enrolled over half of eligible patients with stage III and IV NSCLC. The intervention increased PA, and may improve several aspects of QoL. We also identified potential biomarker changes relevant to lung cancer biology. Future research should use a larger sample to examine the effect of exercise on cancer biomarkers, which may mediate the association between PA and QoL. Clinical trial registration Clinicaltrials.gov (NCT03352245).

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Patients with Metastatic Lung Cancer and Oncologists’ Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study

Medical Decision Making ◽

10.1177/0272989x21998951 ◽

2021 ◽

pp. 0272989X2199895

Author(s):

Adinda Mieras ◽

Annemarie Becker-Commissaris ◽

Hanna T. Klop ◽

H. Roeline W. Pasman ◽

Denise de Jong ◽

...

Keyword(s):

Lung Cancer ◽

Multicenter Study ◽

Systemic Treatment ◽

Treatment Decision ◽

Treatment Goals ◽

Metastatic Lung Cancer ◽

Prospective Multicenter Study ◽

Cancer Data ◽

Metastatic Lung ◽

The Right

Background Previous studies have investigated patients’ treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. Aim To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. Design and Participants A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. Results According to patients and oncologists, treatment goals were achieved in 30% and 37% for ‘quality of life,’ 49% and 41% for ‘life prolongation,’ 26% and 44% for ‘decrease in tumor size,’ and 44% for ‘cure’, respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment and also if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do ‘something.’ Conclusions Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing ‘something.’

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