Healing efficacy in lung adenocarcinoma after targeted therapy, Covid 19 disease and radiosurgery of brain metastasеs

2021 ◽  
Vol 6 ◽  
Keyword(s):  
Targeted Therapy ◽  
Brain Metastases ◽  
Lung Adenocarcinoma ◽  
Pulmonary Adenocarcinoma ◽  
Egfr Mutations ◽  
Common Disease ◽  
Shortness Of Breath ◽  
Men And Women ◽  
Local Progression ◽  
Metastatic Lung

Lung adenocarcinoma is a common disease, in which high mortality is due to both men and women. In the article we present a 58-year-old man who has been diagnosed with metastatic pulmonary adenocarcinoma/T2B N2 M1a in 2018, on the occasion of dry irritating cough and shortness of breath. Also a positive EGFR mutations has been proven. Targeted therapy (TT) with gefitinib has been carried out for two years till 2020. The patient has been switched on osimertinib in 2020 due to local progression. Brain metastasis has been found in 2021. Radiosurgery (RS) with a singal fraction 15Gy was conducted for treatment of 4 brain metastases . The patient was infected after RS with Covid 19 in April 2021. Patients with specific EGFR mutations can be effectively treated with TT. After treatment with TT, brain metastases of pulmonary adenocarcinoma with specific EGFR mutations are more radiоsensibility and responded very well by high single radiation dose realized by radiosurgery (RS). Despite the worsened prognosis, including Covid 19 disease, by combining TT and RS, we achieved three-year survival in metastatic lung adenocarcinoma.

scholarly journals Clinical efficacy analysis of preoperative neoadjuvant chemotherapy in patients with pulmonary adenocarcinoma during stage IIIA.

2019 ◽  
Vol 5 (suppl) ◽  
pp. 128-128
Author(s):  
Ting ting Zhang ◽  
Ying Cheng
Keyword(s):  
Targeted Therapy ◽  
Neoadjuvant Chemotherapy ◽  
Lung Adenocarcinoma ◽  
Pulmonary Adenocarcinoma ◽  
Targeted Treatment ◽  
Good Effect ◽  
Stage Iiia ◽  
Efficacy Evaluation ◽  
Local Progression ◽  
Tki Treatment

128 Background: The purpose of this study is to compare the effectiveness and safety of neoadjuvant chemotherapy with targeted therapy. In order to explore the best treatment mode of lung cancer in local progression period. Methods: 42 patients with stage IIIA lung adenocarcinoma who were admitted to the Cancer Hospital of Jilin Province from 2015 to 2017 were retrospectively analyzed. They received at least 2 cycles of neoadjuvant chemotherapy or at least 6 weeks of new adjuvant targeted therapy before surgery. Results: 42 patients who met the criteria were included in this study, all of them were stage IIIA lung adenocarcinoma. Of the total number of cases, a total of 13 patients received preoperative assisted single drug EGFR-TKI treatment (including Eluotini) and 27 patients received preoperative assisted chemotherapy. Two patients received neoadjuvant chemotherapy before receiving new adjuvant targeted therapy. In patients with EGFR sensitive mutations in stage IIIA, the objective remission rate of newly assisted TKI therapy was 63.2 %, while neoadjuvant chemotherapy was 36.8 % (P = 0.021). Of the 13 patients who received new assisted targeted treatment before surgery, 11 patients continued to receive targeted treatment after the first efficacy evaluation (3 weeks): After the first efficacy evaluation PR case continued to be treated with TKI The tumor can continue to shrink until 3 months, However, there was no significant change in tumor size after the first evaluation of SD continued with TKI treatment. There was no difference between the two groups in postoperative complications, postoperative pleural drainage and postoperative hospitalization time. Conclusions: Compared with preoperative neoadjuvant chemotherapy, neoadjuvant targeted therapy has a good effect in patients with pulmonary adenocarcinoma with EGFR mutation in stage IIIA. Patients with partial remission for the first treatment evaluation can try to continue TKI treatment for 1 month after surgical resection.

scholarly journals Survival of patients with melanoma metastatic brain metastases in the era of novel systemic therapies in Cardiff, Wales

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv13-iv13
Author(s):  
Joseph Pasquale ◽  
Joanita Ocen ◽  
James Powell ◽  
Satish Kumar
Keyword(s):  
Targeted Therapy ◽  
Brain Metastases ◽  
Small Sample Size ◽  
Brain Lesion ◽  
Small Sample ◽  
Simultaneous Treatment ◽  
Local Progression ◽  
Significant Difference ◽  
Retrospective Nature ◽  
The Uk

Abstract The incidence of malignant melanoma (MM) is increasing in the UK; it’s projected to rise by 7% by 2035. MM has high predisposition to developing brain metastases (BM) with 50–60% of patients being affected. Stereotactic radiosurgery (SRS) and surgery, key interventions in managing patients with BM, have been shown to improve survival outcomes of patients. Patients’ prognosis and survival has also significantly improved with the advent of novel therapies in the last few years. It was noted that the Cardiff Neuro-Oncology multidisciplinary team were receiving increasing amount of referrals for consideration of surgery or SRS in patients with MM. 106 MDT referrals were retrospectively reviewed. 31 patients had surgery, 20 patients had SRS and the remaining 54 patients had WBRT. There was no significant difference in the patient distribution. The majority of patients had 1 brain lesion in both groups (in similar proportions). The 12 month survival for the surgical cohort was 65% for immunotherapy group, 55%- targeted therapy and 30%- no therapy. For the SRS group the 12 month survival for immunotherapy was 45%, targeted therapy- 40% and 20%- no therapy. The median OS for surgery versus SRS was 8 and 7 months respectively. The results suggest that simultaneous treatment with surgery or SRS in conjunction with SACT does improve survival. Interpretation of results will have to be taken with caution due to the retrospective nature and the small sample size. Going forward, we will delve deeper and review local progression rates and SACT timing/sequencing in our practice.

scholarly journals Brain metastases in lung adenocarcinoma: impact of EGFR mutation status on incidence and survival

2014 ◽  
Vol 48 (2) ◽  
pp. 173-183 ◽  
Author(s):  
Karmen Stanic ◽  
Matjaz Zwitter ◽  
Nina Turnsek Hitij ◽  
Izidor Kern ◽  
Aleksander Sadikov ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Lung Adenocarcinoma ◽  
Cumulative Incidence ◽  
Egfr Mutation ◽  
Growth Factor Receptor ◽  
Egfr Mutations ◽  
Mutation Status ◽  
Course Of Disease ◽  
Epidermal Growth ◽  
Egfr Mutant

AbstractBackground. The brain represents a frequent progression site in lung adenocarcinoma. This study was designed to analyse the association between the epidermal growth factor receptor (EGFR) mutation status and the frequency of brain metastases (BM) and survival in routine clinical practice.Patients and methods. We retrospectively analysed the medical records of 629 patients with adenocarcinoma in Slovenia who were tested for EGFR mutations in order to analyse the cumulative incidence of BM, the time from the diagnosis to the development of BM (TDBM), the time from BM to death (TTD) and the median survival.Results. Out of 629 patients, 168 (27%) had BM, 90 patients already at the time of diagnosis. Additional 78 patients developed BM after a median interval of 14.3 months; 25.8 months in EGFR positive and 11.8 months in EGFR negative patients, respectively (p = 0.002). EGFR mutations were present in 47 (28%) patients with BM. The curves for cumulative incidence of BM in EGFR positive and negative patients demonstrate a trend for a higher incidence of BM in EGFR mutant patients at diagnosis (19% vs. 13%, p = 0.078), but no difference later during the course of the disease. The patients with BM at diagnosis had a statistically longer TTD (7.3 months) than patients who developed BM later (3.1 months). The TTD in EGFR positive patients with BM at diagnosis was longer than in EGFR negative patients (12.6 vs. 6.8, p = 0.005), while there was no impact of EGFR status on the TTD of patients who developed BM later.Conclusions. Except for a non-significant increase of frequency of BM at diagnosis in EGFR positive patients, EGFR status had no influence upon the cumulative incidence of BM. EGFR positive patients had a longer time to CNS progression. While EGFR positive patients with BM at diagnosis had a longer survival, EGFR status had no influence on TTD in patients who developed BM later during the course of disease.

Cost-effectiveness of genomic profiling in veterans with metastatic lung adenocarcinoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7075-7075
Author(s):  
Pradeep Poonnen ◽  
Olivia Dong ◽  
David Winski ◽  
Shelby D. Reed ◽  
Vishal Vashistha ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Cost Effectiveness ◽  
Lung Adenocarcinoma ◽  
Anticancer Therapy ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Precision Oncology ◽  
Metastatic Lung ◽  
The Cost ◽  
Tumor Profiling

7075 Background: Tumor profiling identifies patients who are eligible for targeted anticancer therapies. Common tumor profiling approaches include targeted gene panel testing (TGPT), which tests for common mutations in select genes, and multigene panel sequencing (MGPS), which tests for a broad range of mutations in a comprehensive set of genes. Our objective was to determine the lifetime cost-effectiveness of MGPS and TGPT compared to no tumor profiling for Veterans with metastatic lung adenocarcinoma from the Veterans Health Administration’s (VHA) perspective. Methods: A decision analytic model was developed to simulate outcomes for a closed cohort of hypothetical Veterans with metastatic lung adenocarcinoma considering anticancer therapy. OncoKB genes with levels of evidence 1 and 2 for guiding therapy were included. Three profiling strategies were studied: TGPT ( ALK, EGFR, ROS1), MGPS ( ALK, BRAF, EGFR, HER2, MET, NTRK1, NTRK2, NTRK3, RET, ROS1), and no tumor profiling. We assumed 95% of patients with actionable mutations received targeted therapies. Non-targeted therapy options included chemotherapy and/or immunotherapy, and no anticancer therapy. Model inputs were derived from randomized trials (progression-free survival), VHA and Medicare (drug costs), published studies (non-drug cancer-related management costs, health care utilities), and VHA National Precision Oncology Program and cBioPortal for Cancer Genomics databases (mutation prevalence). Costs (2019 US$) and quality-adjusted life years (QALYs) were discounted at 3%/year. Base-case scenario, one-way sensitivity analyses, and probabilistic sensitivity analyses (PSA) using 1,000 Monte Carlo simulations were completed. Results: Base-case results and corresponding 95% credible intervals from the PSA indicated the cost/QALY gained was $309,399 ($280,371-$343,161) for TGPT and $324,707 ($296,086-$359,778) for MGPS compared to no tumor profiling. Of the 3 strategies, MGPS resulted in the highest number of QALYs. One-way sensitivity analyses revealed the cost/QALY estimates were most impacted by changes in health state utility on a targeted therapy (quality of life), costs of alectinib, and non-drug cancer-related costs in patients receiving targeted therapy. Compared to no tumor profiling, cost-effectiveness ratios for both profiling approaches surpassed the $150,000/QALY threshold in 100% of PSA simulations. Conclusions: Tumor profiling (TGPT or MGPS) can optimize anticancer therapy selection in patients with metastatic lung adenocarcinoma and improve quality-adjusted survival, but compared to no tumor profiling, is not cost-effective.

scholarly journals The Importance of Brain Metastasis in EGFR Mutation Positive NSCLC Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Vanita Noronha ◽  
Amit Joshi ◽  
Anant Gokarn ◽  
Vibhor Sharma ◽  
Vijay Patil ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Egfr Mutation ◽  
Egfr Mutations ◽  
Rank Test ◽  
Metastatic Lung Cancer ◽  
Lung Cancer Patients ◽  
Metastatic Lung ◽  
Extracranial Metastases

Introduction. Brain metastasis is a poor prognostic marker in lung cancer. However it is not known whether amongst patients with EGFR mutation those with brain metastases have a worse outcome. Methods. We compared the survival outcomes between EGFR mutation positive patients with and without brain metastases. In this retrospective analysis of prospective database of all metastatic lung cancer patients at our centre between July 2009 and December 2012, patients were treated with either combination chemotherapy or oral TKI. All patients with brain metastases received whole brain radiation. Kaplan Meier method was used for survival analysis and compared using log rank test. Results. 101 patients with EGFR mutated, metastatic lung cancer were studied. Fourteen had brain metastases and 87 did not. The common EGFR mutations were exon 19 deletion (61.3%) and exon 21 L858R mutation (28.7%). Overall response was 64% in extracranial metastasis group as compared to 50% in brain metastasis group. There was a significant worsening of median OS in the patients with brain metastases (11.6 months) compared with only extracranial metastases (18.7 months), P=0.029. Conclusion. Amongst patients with EGFR mutant NSCLC, the presence of brain metastases leads to a worse outcome as compared to patients with extracranial metastases alone.

scholarly journals B7-H3-Induced Signaling in Lung Adenocarcinoma Cell Lines with Divergent Epidermal Growth Factor Receptor Mutation Patterns

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Meng Ding ◽  
Haixiu Liao ◽  
Nannan Zhou ◽  
Ying Yang ◽  
Shihe Guan ◽  
...  
Keyword(s):  
Epidermal Growth Factor Receptor ◽  
Targeted Therapy ◽  
Growth Factor ◽  
Epidermal Growth Factor ◽  
Lung Adenocarcinoma ◽  
Cell Lines ◽  
Growth Factor Receptor ◽  
Egfr Mutations ◽  
Adenocarcinoma Cell ◽  
Epidermal Growth

The cosignal molecule B7-H3 is gaining attention due to its abnormal expression and abundant signal transduction in many types of malignancies. B7-H3-induced signaling includes at least three cascades: PI3K/AKT, JAK2/STAT3, and Raf/MEK/ERK1/2, which are also involved in epidermal growth factor receptor- (EGFR-) triggered signaling in lung adenocarcinoma cells. However, the correlation between B7-H3-induced signaling and EGFR signaling, and between B7-H3-targeted immunotherapy and EGFR-targeted therapy in lung adenocarcinoma, remains to be elucidated. Herein we find that knockout of B7-H3 gene decreased cell survival and increased EGFR-tyrosine kinase inhibitor gefitinib susceptibility of both H3255 and HCC827 cells, two lung adenocarcinoma cell lines harboring EGFR L858R (exon 21) and Del E746-A750 (exon 19) mutations, respectively. B7-H3 deletion resulted in dramatic reduction of phosphorylation level of AKT and STAT3 in H3255 cells while having mild-to-moderate suppression on AKT, STAT3, and ERK1/2 in HCC827 cells. Gefitinib had similar effects with B7-H3 deletion both in H3255 and HCC827 cells. Furthermore, B7-H3 ablation had significant synergistic effects with gefitinib in HCC827 cells. Collectively, our study reveals B7-H3-induced signaling in lung adenocarcinoma cell lines with divergent EGFR mutations, and a translational potential of combined targeted therapy of B7-H3 and EGFR in lung adenocarcinoma with EGFR Del E746-A750 mutation.

Sign in / Sign up

Export Citation Format

Share Document