Challenge of Proving the Value of Proton Therapy in an Unselected Patient Population in the Era of Precision Oncology: The Fallacy of a One-Size-Fits-All Strategy in Radiotherapy for Lung Cancer

2018 ◽  
Vol 36 (19) ◽  
pp. 2003-2004 ◽  
Author(s):  
Ramesh Rengan ◽  
Mary Redman ◽  
Jing Zeng
2014 ◽  
Vol 32 (18) ◽  
pp. 1902-1908 ◽  
Author(s):  
Tomoya Kawaguchi ◽  
Masahiko Ando ◽  
Kazuhiro Asami ◽  
Yoshio Okano ◽  
Masaaki Fukuda ◽  
...  

Purpose To investigate the efficacy of erlotinib versus docetaxel in previously treated patients with advanced non–small-cell lung cancer (NSCLC) in an epidermal growth factor receptor (EGFR) –unselected patient population. Patients and Methods The primary end point was progression-free survival (PFS). Secondary end points included overall survival (OS), response rate, safety, and analyses on EGFR wild-type tumors. Patients with stage IIIB or IV NSCLC, previous treatment with one or two chemotherapy regimens, evaluable or measurable disease, and performance status of 0 to 2 were eligible. Results From August 2009 to July 2012, 150 and 151 patients were randomly assigned to erlotinib (150 mg daily) and docetaxel (60 mg/m2 every 3 weeks), respectively. EGFR wild-type NSCLC was present in 109 and 90 patients in the erlotinib and docetaxel groups, respectively. Median PFS for erlotinib versus docetaxel was 2.0 v 3.2 months (hazard ratio [HR], 1.22; 95% CI, 0.97 to 1.55; P = .09), and median OS was 14.8 v 12.2 months (HR, 0.91; 95% CI, 0.68 to 1.22; P = .53), respectively. In a subset analysis of EGFR wild-type tumors, PFS for erlotinib versus docetaxel was 1.3 v 2.9 months (HR, 1.45; 95% CI, 1.09 to 1.94; P = .01), and OS was 9.0 v 10.1 months (HR, 0.98; 95% CI, 0.69 to 1.39; P = .91), respectively. Conclusion Erlotinib failed to show an improvement in PFS or OS compared with docetaxel in an EGFR-unselected patient population.


2021 ◽  
Author(s):  
Ariel Bar-Mashiah ◽  
Emily R. Soper ◽  
Sinead Cullina ◽  
Gillian M. Belbin ◽  
Eimear E. Kenny ◽  
...  

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Christof Burgstahler ◽  
Harald Brodoefel ◽  
Anja Reimann ◽  
Ilias Tsiflikas ◽  
Martin Heuschmid ◽  
...  

Objective: The aim of this study was to assess DSCT for evaluation of coronary artery disease in an unselected patient population. Impact of heart rate, heart rate variability and calcification on image quality and diagnostic accuracy were, thereby, considered. Subjects and Methods: 100 consecutive patients with known or suspected CAD underwent DSCT and invasive coronary angiography. Image quality (IQ) was assessed using a 4-point scale (1: excellent; 4: non-diagnostic). Accuracy of DSCT in detection or exclusion of significant stenosis (>50%) was evaluated on a per-segment and per-patient level. Effects of heart rate, heart rate variability and calcification on IQ and accuracy were analyzed by multivariate regression and between subgroups of predictor variables. Simple regression was performed to calculate thresholds for adequate IQ. Results: Average heart rate was 64.9± 13.2 bpm, mean variability 23.6± 36.2 beats per CT-examination and mean Agatston score 786.5± 965.9. Diagnostic image quality was obtained in 90.2% of segments. Sensitivity, specificity, positive and negative predictive values for the presence of significant stenosis was: by segment 91.1%, 92.0%, 75.4% and 97.5%; by patient 100%, 81.5%, 93.6% and 100%. According to multivariate regression, IQ was significantly related to heart rate variability and calcification (P=0.025; P<0.0001); number of non-diagnostic segments was significantly affected by calcification only. Also, in a multivariate regression, calcification was the single factor with significant impact on diagnostic accuracy (P=0.0003). Conclusion: Whilst DSCT achieves heart rate independent image quality, the latter remains prone to heart rate variability and calcification. In an unselected patient collective, calcium burden proves to be the single determinant of diagnostic accuracy.


1992 ◽  
Vol 44 (1) ◽  
pp. 9-20 ◽  
Author(s):  
Gabor I. Keitner ◽  
Christine E. Ryan ◽  
Robert Kohn ◽  
Ivan W. Miller ◽  
William H. Norman ◽  
...  

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0146190 ◽  
Author(s):  
Maria Rasenack ◽  
Jonathan Rychen ◽  
Michaela Andelova ◽  
Yvonne Naegelin ◽  
Christoph Stippich ◽  
...  

2009 ◽  
Vol 24 (4) ◽  
pp. 854-858 ◽  
Author(s):  
Sebastian V. Demyttenaere ◽  
Simon Bergman ◽  
Thomas Pham ◽  
Joel Anderson ◽  
Rebecca Dettorre ◽  
...  

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