scholarly journals Predicting Tyrosine Kinase Inhibitor Treatment Response in Stage IV Lung Adenocarcinoma Patients With EGFR Mutation Using Model-Based Deep Transfer Learning

2021 ◽  
Vol 11 ◽  
Author(s):  
Runping Hou ◽  
Xiaoyang Li ◽  
Junfeng Xiong ◽  
Tianle Shen ◽  
Wen Yu ◽  
...  
Keyword(s):  
Prediction Model ◽  
Transfer Learning ◽  
Clinical Features ◽  
Hybrid Model ◽  
Egfr Mutation ◽  
Stage Iv ◽  
Classification Model ◽  
First Line ◽  
Tki Treatment ◽  
3D Cnn

BackgroundFor stage IV patients harboring EGFR mutations, there is a differential response to the first-line TKI treatment. We constructed three-dimensional convolutional neural networks (CNN) with deep transfer learning to stratify patients into subgroups with different response and progression risks.Materials and MethodsFrom 2013 to 2017, 339 patients with EGFR mutation receiving first-line TKI treatment were included. Progression-free survival (PFS) time and progression patterns were confirmed by routine follow-up and restaging examinations. Patients were divided into two subgroups according to the median PFS (<=9 months, > 9 months). We developed a PFS prediction model and a progression pattern classification model using transfer learning from a pre-trained EGFR mutation classification 3D CNN. Clinical features were fused with the 3D CNN to build the final hybrid prediction model. The performance was quantified using area under receiver operating characteristic curve (AUC), and model performance was compared by AUCs with Delong test.ResultsThe PFS prediction CNN showed an AUC of 0.744 (95% CI, 0.645–0.843) in the independent validation set and the hybrid model of CNNs and clinical features showed an AUC of 0.771 (95% CI, 0.676–0.866), which are significantly better than clinical features-based model (AUC, 0.624, P<0.01). The progression pattern prediction model showed an AUC of 0.762(95% CI, 0.643–0.882) and the hybrid model with clinical features showed an AUC of 0.794 (95% CI, 0.681–0.908), which can provide compensate information for clinical features-based model (AUC, 0.710; 95% CI, 0.582–0.839).ConclusionThe CNN exhibits potential ability to stratify progression status in patients with EGFR mutation treated with first-line TKI, which might help make clinical decisions.

scholarly journals The Efficacy of Traditional Chinese Herbal Medicine in the Treatment of EGFR Mutated Stage IV Pulmonary Adenocarcinoma Patients Who Received First-Line EGFR-TKI Treatment

2016 ◽  
Vol 16 (1) ◽  
pp. 126-131 ◽  
Author(s):  
Hsiu-Ying Hung ◽  
Yen-Han Tseng ◽  
Chia-Miao Liao ◽  
Sung-Yi Chen ◽  
Ta-Peng Wu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Herbal Medicine ◽  
Chinese Herbal Medicine ◽  
Stage Iv ◽  
Pulmonary Adenocarcinoma ◽  
First Line ◽  
Chinese Herbal ◽  
Tki Treatment ◽  
Egfr Mutated ◽  
Egfr Tki

Background. Chinese herbal medicine (CHM) has been used for thousands of year in Eastern countries. First-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) treatment is the standard treatment in stage IV pulmonary adenocarcinoma patients who had tumor EGFR mutations. This study was to find the efficacy of CHM on lung cancer treatment. Materials and Methods. We retrospectively reviewed chart records of our stage IV EGFR-mutated pulmonary adenocarcinoma patients who received first-line EGFR-TKI treatment from January 2010 to September 2014. Results. Total, 527 patients were studied. Among them, 34 patients received CHM treatment, including 24 patients who received CHM treatment from the beginning of first-line EGFR-TKI treatment and 10 patients who started to receive CHM treatment after their disease had progressed to EGFR-TKI treatment. Median progression-free survival (PFS) of first-line EGFR-TKI treatment was numerically better in patients who also received CHM than those who did not (12.1 months vs 10.5 months, P = .7668). Overall survival of those 24 patient who received CHM treatment together with EGFR-TKI was 30.63 months (95% CI = 11.7 to not reached), compared to 23.67 months in the remaining patients (95% CI = 21.37-26; hazard ratio = 0.75; P = .399). No increase of CHM-related toxicities was found during CHM treatment, compared with EGFR-TKI treatment alone ( P > .05). Conclusion. Alternative CHM treatment during first-line EGFR-TKI treatment did no harm to the patients and PFS and overall survival was numerically better, although not significant, than those patients who did not receive CHM treatment.

scholarly journals Detailed Analysis and Radiomic Prediction of First Progression Sites of First-Line Targeted Therapy for EGFR-Mutant Lung Adenocarcinoma Patients With Systemic Metastasis

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaoyang Li ◽  
Runping Hou ◽  
Wen Yu ◽  
Xueru Zhu ◽  
Hongwei Li ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Kinase Inhibitor ◽  
Stage Iv ◽  
Clinical Information ◽  
Ct Images ◽  
First Line ◽  
Systemic Metastasis ◽  
Pre Treatment ◽  
Tki Treatment ◽  
Egfr Mutant

BackgroundWe aimed to analyze the first progression sites of first-line tyrosine kinase inhibitor (TKI) treatment for EGFR-mutant lung adenocarcinoma patients with systemic metastasis to recognize the potential candidates who might benefit from radiotherapy and establish a radiomic-based model to predict the first progression sites.Materials and MethodsWe retrospectively collected the clinical information and pre-treatment chest CT images of patients in Shanghai Chest Hospital from 2013 to 2017. All patients were diagnosed with stage IV EGFR-mutant lung adenocarcinoma and received TKI as first-line treatment. The first progression sites and survival were analyzed. The pre-treatment chest non-contrast CT images were utilized to establish a radiomic-based model to predict the first progression sites.ResultsWe totally collected 233 patients with systemic metastasis, among whom, there were 84 (36.1%) and 149 (63.9%) patients developing first progression in original lesions (OP) and new lesions (NP), respectively. The PFS and OS of patients with OP were longer than those with NP (PFS 11 months vs. 8 months, p = 0.03, OS 50 months vs. 35 months, p = 0.046). For 67.9% of the patients with OF, disease progressed within five sites (oligoprogression). The radiomic-based model could predict the progression sites with an AUC value of 0.736, a specificity of 0.60, and a sensitivity of 0.750 in the independent validation set.ConclusionAmong patients with systemic metastasis, there were 36.1% of patients developing OP at first progression who had a better prognosis than those developing NP. Patients with OP may be potential candidates who might benefit from radiotherapy. Radiomics is a useful method to distinguish patients developing OP and could provide some indications for radiotherapy.

Best Response According to RECIST During First-line EGFR-TKI Treatment Predicts Survival in EGFR Mutation-positive Non–Small-cell Lung Cancer Patients

2018 ◽  
Vol 19 (3) ◽  
pp. e361-e372 ◽  
Author(s):  
Ting-Hui Wu ◽  
Emily Han-Chung Hsiue ◽  
Jih-Hsiang Lee ◽  
Chia-Chi Lin ◽  
Wei-Yu Liao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Egfr Mutation ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Lung Cancer Patients ◽  
Best Response ◽  
Tki Treatment ◽  
Egfr Tki

scholarly journals Cost Effectiveness of Personalized Therapy for First-Line Treatment of Stage IV and Recurrent Incurable Adenocarcinoma of the Lung

2012 ◽  
Vol 8 (5) ◽  
pp. 267-274 ◽  
Author(s):  
Elizabeth A. Handorf ◽  
Sean McElligott ◽  
Anil Vachani ◽  
Corey J. Langer ◽  
Mirar Bristol Demeter ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Egfr Mutation ◽  
Stage Iv ◽  
Egfr Mutations ◽  
Line Treatment ◽  
First Line ◽  
Adenocarcinoma Of The Lung ◽  
Effectiveness Analysis ◽  
First Line Treatment ◽  
Egfr Mutation Testing

Cost-effectiveness analysis supports EGFR mutation testing in patients with stage IV or recurrent lung adenocarcinoma, rebiopsying if insufficient tissue is available, and first-line erlotinib treatment for those with EGFR mutations.

scholarly journals American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non–Small-Cell Lung Cancer

2009 ◽  
Vol 27 (36) ◽  
pp. 6251-6266 ◽  
Author(s):  
Christopher G. Azzoli ◽  
Sherman Baker ◽  
Sarah Temin ◽  
William Pao ◽  
Timothy Aliff ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Egfr Mutation ◽  
Performance Status ◽  
Stage Iv ◽  
Cytotoxic Chemotherapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Line Therapy ◽  
Third Line

The purpose of this article is to provide updated recommendations for the treatment of patients with stage IV non–small-cell lung cancer. A literature search identified relevant randomized trials published since 2002. The scope of the guideline was narrowed to chemotherapy and biologic therapy. An Update Committee reviewed the literature and made updated recommendations. One hundred sixty-two publications met the inclusion criteria. Recommendations were based on treatment strategies that improve overall survival. Treatments that improve only progression-free survival prompted scrutiny of toxicity and quality of life. For first-line therapy in patients with performance status of 0 or 1, a platinum-based two-drug combination of cytotoxic drugs is recommended. Nonplatinum cytotoxic doublets are acceptable for patients with contraindications to platinum therapy. For patients with performance status of 2, a single cytotoxic drug is sufficient. Stop first-line cytotoxic chemotherapy at disease progression or after four cycles in patients who are not responding to treatment. Stop two-drug cytotoxic chemotherapy at six cycles even in patients who are responding to therapy. The first-line use of gefitinib may be recommended for patients with known epidermal growth factor receptor (EGFR) mutation; for negative or unknown EGFR mutation status, cytotoxic chemotherapy is preferred. Bevacizumab is recommended with carboplatin-paclitaxel, except for patients with certain clinical characteristics. Cetuximab is recommended with cisplatin-vinorelbine for patients with EGFR-positive tumors by immunohistochemistry. Docetaxel, erlotinib, gefitinib, or pemetrexed is recommended as second-line therapy. Erlotinib is recommended as third-line therapy for patients who have not received prior erlotinib or gefitinib. Data are insufficient to recommend the routine third-line use of cytotoxic drugs. Data are insufficient to recommend routine use of molecular markers to select chemotherapy.

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