Tracheoesophageal fistula in a treatment naive patient with lung cancer

2014 ◽  
Vol 62 (2) ◽  
pp. 174-176 ◽  
Author(s):  
Özge ÖZTÜRK ◽  
Deniz KÖKSAL ◽  
Salih EMRİ
Keyword(s):  
Lung Cancer ◽  
Tracheoesophageal Fistula ◽  
Naive Patient ◽  
Treatment Naïve

scholarly journals Systematic Review and Network Meta-Analysis of Anaplastic Lymphoma Kinase (ALK) Inhibitors for Treatment-Naïve ALK-Positive Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1966
Author(s):  
Cheng-Hao Chuang ◽  
Hsiao-Ling Chen ◽  
Hsiu-Mei Chang ◽  
Yu-Chen Tsai ◽  
Kuan-Li Wu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastasis ◽  
Anaplastic Lymphoma Kinase ◽  
Low Dose ◽  
Meta Analysis ◽  
Phase Iii ◽  
Pairwise Comparisons ◽  
Anaplastic Lymphoma ◽  
Treatment Naïve ◽  
Alk Positive

Several anaplastic lymphoma kinase inhibitors (ALKIs) have demonstrated excellent efficacy on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and also better adverse effect (AE) profiles compared to cytotoxic chemotherapy in advanced stage anaplastic lymphoma kinase (ALK) rearrangement-positive non-small cell lung cancer (NSCLC) in phase III randomized clinical trials (RCTs). We conducted this systematic review and network meta-analysis to provide a ranking of ALKIs for treatment-naïve ALK-positive patients in terms of PFS, ORR, and AEs. In addition, a sub-group analysis of treatment benefits in patients with baseline brain metastasis was also conducted. Contrast-based analysis was performed for multiple treatment comparisons with the restricted maximum likelihood approach. Treatment rank was estimated using the surface under the cumulative ranking curve (SUCRA), as well as the probability of being the best (Prbest) reference. All next-generation ALKIs were superior to crizotinib in PFS but lorlatinib and brigatinib had increased AEs. The probability of lorlatinib being ranked first among all treatment arms was highest (SUCRA = 93.3%, Prbest = 71.8%), although there were no significant differences in pairwise comparisons with high- (600 mg twice daily) and low- (300 mg twice daily) dose alectinib. In subgroup analysis of patients with baseline brain metastasis, low-dose alectinib had the best PFS (SUCRA = 87.3%, Prbest = 74.9%). Lorlatinib was associated with the best ranking for ORR (SUCRA = 90.3%, Prbest = 71.3%), although there were no significant differences in pairwise comparisons with the other ALKIs. In addition, low-dose alectinib had the best safety performance (SUCRA = 99.4%, Prbest = 97.9%). Lorlatinib and low-dose alectinib had the best PFS and ORR in the overall population and baseline brain metastasis subgroup, respectively. Low-dose alectinib had the lowest AE risk among the available ALKIs. Further head-to-head large-scale phase III RCTs are needed to verify our conclusions.

scholarly journals 269 Utilizing serum proteome to understand response and resistance to immune checkpoint inhibitors in advanced non-small cell lung cancer

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A292-A292
Author(s):  
Leeseul Kim ◽  
Young Kwang Chae ◽  
Dong-Uk Lee
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Immune Tolerance ◽  
Cell Lung Cancer ◽  
Immune Checkpoint ◽  
Small Cell ◽  
Primary Immune Response ◽  
Small Cell Lung ◽  
Blood Draw ◽  
Treatment Naïve

BackgroundPredictive biomarkers are more in need considering that responses and resistance to immune checkpoint inhibition (ICI) are poorly understood. We used a validated serum-based proteomic test, Primary Immune Response (PIR), to predict response and Protein Set Enrichment Analysis (PSEA) scores to elucidate mechanisms of early resistance to ICI in patients with advanced non-small cell lung cancer (NSCLC). (Muller et al., 2020)MethodsSerum of 43 consented NSCLC patients was collected prospectively at 2 timepoints: baseline (prior to ICI initiation) and 3 weeks after ICI initiation (median 22 days). Blinded samples were classified by the PIR test. Clinical response was evaluated using RECIST. Outcomes, including progression-free survival (PFS) and overall survival (OS), were analyzed by PIR classifications as intermediate/sensitive (not resistant) vs. resistant at baseline and 3 weeks. Multivariable regression was performed. PSEA scores indicating activity of 10 processes of interest (e.g., Type 1 immunity (Th1), complement, interferon-gamma (IFNγ)) were compared between PIR groups.ResultsOf the 43 patients, 28 received chemotherapy with ICI (chemo+ICI) and 15 received ICI alone. 31 of 43 patients (72%) were treatment naïve at baseline blood draw. PIR-resistant patients had worse survival compared to patients classified as not resistant (HR, 10.4; 95%CI, 1.3–81 ; P = 0.025). OS was also significantly lower for patients with PIR resistant result at 3 weeks (HR, 9.1; 95%CI, 1.2–72 ; P = 0.036). The difference in survival between PIR classification groups was consistently observed in the treatment naïve patients treated with chemo+ICI (log rank P = 0.02). No significant differences were observed in PFS. Clinical and pathologic characteristics, including PD-L1 expression, were not significantly associated with PIR result. In multivariable analysis including performance status, line of therapy, and PD-L1 status, PIR resistant remained a significant negative prognostic factor (HR, 8.2; 95%CI, 1.01–67; P = 0.049). PSEA scores at baseline and 3 weeks after ICI initiation showed significantly higher levels of complement, IFNγ, Th1, immune tolerance, and a lower level of wound healing (all P<0.0001) in PIR-resistant vs. PIR-intermediate/sensitive.ConclusionsThese data further validate the utility of the PIR test in predicting patient survival on ICI. Processes associated with PIR resistant result included activation of complement, IFNγ, Th1, and immune tolerance, elucidating early mechanisms of resistance to ICI in a clinical cohort.

scholarly journals Retrospective, observational study on usage of evogliptin in T2DM patients: A real-World experience in Indian patients

2021 ◽  
Vol 8 (3) ◽  
pp. 205-207
Author(s):  
Abhijit Trailokya ◽  
Amol Aiwale ◽  
Roshan Pawar ◽  
Suhas Erande
Keyword(s):  
Real World ◽  
Small Sample Size ◽  
Small Sample ◽  
Hypoglycemic Agents ◽  
P Value ◽  
Base Line ◽  
Oral Hypoglycemic Agents ◽  
Naive Patient ◽  
Indian Patients ◽  
Treatment Naïve

This study aimed to assess effectiveness and safety of Evogliptin 5 mg in patients with T2DM who were prescribed Evogliptin alone or with other oral hypoglycemic agents in real world scenario. Overall 20 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. Primary endpoint was mean changes in HbA1c from baseline to weeks 24 and secondary endpoints were Change in HbA1c from baseline to weeks 12 Change from baseline in FPG & PPG at weeks 12 & 24.Significant reduction in HbA1c at the end of 12 and 24 weeks of Evogliptin therapy was - 0.9% and -1.45% respectively from the baseline of HbA1c 8.6% (p value &#60;0.001). At the end of 12 and 24 weeks of addition of Evogliptin, significant reduction in FBG were seen i.e -49.5 mg/dl and -90.7mg/dl respectively from base line of 182 mg/dl and reduction in PPG was -79.4mg/dl and -116.6mg/dl respectively from base line 277 mg/dl (p value &#60;0.001). Evogliptin was found to be effective when added to the patients who were uncontrolled on dual / triple oral anti-diabetic medications and even in treatment naïve patient. It effectively showed reduction in HbA1c, FBG and PPG and the end of 12 and 24 weeks when added to existing anti-diabetic medications & well tolerated in type 2 diabetes Indian patients.Small sample size and retrospective study

scholarly journals Comparison of Chief Complaints and Patient-Reported Symptoms of Treatment-Naive Lung Cancer Patients Before Surgery

2021 ◽  
Vol Volume 15 ◽  
pp. 1101-1106
Author(s):  
Yaqian Feng ◽  
Wei Dai ◽  
Yaqin Wang ◽  
Jia Liao ◽  
Xing Wei ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Lung Cancer Patients ◽  
Patient Reported ◽  
Chief Complaints ◽  
Treatment Naïve

scholarly journals US rheumatologists’ beliefs and knowledge about biosimilars: a survey

Rheumatology ◽  
2020 ◽  
Author(s):  
Allan Gibofsky ◽  
Dorothy McCabe
Keyword(s):  
Online Survey ◽  
Rating Scales ◽  
Reference Product ◽  
Plain Language ◽  
Biologic Treatment ◽  
Naive Patient ◽  
Tnf Α ◽  
Treatment Naïve ◽  
Definition Of ◽  
Additional Education

Abstract Objectives We sought to evaluate perceptions of biosimilar products among US rheumatologists who prescribe TNF-α inhibitors, given that 10 TNF-α inhibitor biosimilars and two rituximab biosimilars have Food and Drug Administration (FDA) approval. Methods A 19-question self-administered online survey was conducted from 6 May to 1 June 2019, and fielded by WebMD, LLC. Rheumatologists (n = 9050) who were members of Medscape.com and its partner panels were invited to participate. Likert and other rating scales were used to collect responses, which were summarized descriptively. Results Responses were obtained from 320 board-certified US rheumatologists, 85% of whom were fellows of the ACR. Nearly all respondents were familiar with the FDA definition of a biosimilar product and were aware that an infliximab biosimilar was FDA approved; fewer realized that adalimumab, etanercept and rituximab biosimilars were also FDA approved. Most respondents (84%) were aware that an approved biosimilar was not automatically deemed interchangeable by the FDA. Rheumatologists were more likely to initiate biosimilar treatment for a biologic treatment-naïve patient with RA (73%) than they were to switch to the biosimilar for a patient with RA doing well on the reference product (35%). Conclusions The results of this survey suggest that US rheumatologists have a good understanding and acceptance of biosimilar products, particularly for the initiation of treatment in biologic-naïve individuals. They were hesitant to switch from a reference product to a biosimilar for a patient doing well on the reference product. Additional education on biosimilars is required to help inform treatment decisions by rheumatologists. A plain language summary of this article has been uploaded as supplementary material, available at Rheumatology online.

Patient-reported outcomes in light of supportive medications in treatment-naïve lung cancer patients

2019 ◽  
Vol 28 (4) ◽  
pp. 1809-1816
Author(s):  
Johnny M. Hoang ◽  
Navneet Upadhyay ◽  
Dozie N. Dike ◽  
Jaekyu Lee ◽  
Michael L. Johnson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Patient Reported Outcomes ◽  
Lung Cancer Patients ◽  
Patient Reported ◽  
Treatment Naïve

“My Patient Was Diagnosed With Nontargetable Advanced Non–Small Cell Lung Cancer. What Now?” Diagnosis and Initial Treatment Options for Newly Diagnosed Patients With Advanced NSCLC

2018 ◽  
pp. 696-707 ◽  
Author(s):  
Melissa Johnson ◽  
Nathan A. Pennell ◽  
Hossein Borghaei
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Treatment Options ◽  
The United States ◽  
Small Cell ◽  
Small Cell Lung ◽  
Platinum Based Chemotherapy ◽  
Treatment Naïve ◽  
Novel Therapeutic Strategies

Although lung cancer remains the leading cause of cancer-related mortality in the United States and worldwide, the rate at which Americans are dying from lung cancer is declining. Improving survival can be explained, in large part, by a growing understanding of the heterogeneous biology of non–small cell lung cancer (NSCLC) as well as recent successes of novel therapeutic strategies more effective and tolerable than platinum-based chemotherapy. We now recognize distinct subtypes of NSCLC, defined by molecular profiling and immunohistochemistry, with different treatment algorithms, including targeted small molecular inhibitors and immunotherapy for each. Both biomarker selection and preferred frontline strategies continue to evolve rapidly, making it difficult for many practitioners to keep up. In this review, we will first describe the recommended initial workup for a patient with advanced or metastatic NSCLC in 2018; next, we present an algorithm to aid oncologists in the selection of the most appropriate therapy for treatment-naive patients with NSCLC, and finally, we offer a look into future treatment options through a discussion of ongoing clinical trials.

scholarly journals Neoadjuvant nivolumab plus ipilimumab in resectable non-small cell lung cancer

2020 ◽  
Vol 8 (2) ◽  
pp. e001282 ◽  
Author(s):  
Joshua E Reuss ◽  
Valsamo Anagnostou ◽  
Tricia R Cottrell ◽  
Kellie N Smith ◽  
Franco Verde ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Predictive Biomarkers ◽  
Small Cell ◽  
Pathologic Response ◽  
Small Cell Lung ◽  
Treatment Naïve ◽  
Cancer Tumor ◽  
Disease Free

BackgroundWe conducted the first trial of neoadjuvant PD-1 blockade in resectable non-small cell lung cancer (NSCLC), finding nivolumab monotherapy to be safe and feasible with an encouraging rate of pathologic response. Building on these results, and promising data for nivolumab plus ipilimumab (anti-CTLA-4) in advanced NSCLC, we expanded our study to include an arm investigating neoadjuvant nivolumab plus ipilimumab.MethodsPatients with resectable stage IB (≥4 cm)–IIIA (American Joint Committee on Cancer Tumor Node Metastases seventh edition), histologically confirmed, treatment-naïve NSCLC received nivolumab 3 mg/kg intravenously plus ipilimumab 1 mg/kg intravenously 6 weeks prior to planned resection. Nivolumab 3 mg/kg was given again approximately 4 and 2 weeks preoperatively. Primary endpoints were safety and feasibility with a planned enrollment of 15 patients. Pathologic response was a key secondary endpoint.ResultsWhile the treatment regimen was feasible per protocol, due to toxicity, the study arm was terminated early by investigator consensus after 9 of 15 patients were enrolled. All patients received every scheduled dose of therapy and were fit for planned surgery; however, 6 of 9 (67%) experienced treatment-related adverse events (TRAEs) and 3 (33%) experienced grade ≥3 TRAEs. Three of 9 patients (33%) had biopsy-confirmed tumor progression precluding definitive surgery. Of the 6 patients who underwent resection, 3 are alive and disease-free, 2 experienced recurrence and are actively receiving systemic treatment, and one died postoperatively due to acute respiratory distress syndrome. Two patients who underwent resection had tumor pathologic complete responses (pCRs) and continue to remain disease-free over 24 months since surgery. Pathologic response correlated with pre-treatment tumor PD-L1 expression, but not tumor mutation burden. Tumor KRAS/STK11 co-mutations were identified in 5 of 9 patients (59%), of whom two with disease progression precluding surgery had tumor KRAS/STK11/KEAP1 co-mutations.ConclusionsThough treatment was feasible, due to toxicity the study arm was terminated early by investigator consensus. In light of this, and while the long-term disease-free status of patients who achieved pCR is encouraging, further investigation of neoadjuvant nivolumab plus ipilimumab in patients with resectable NSCLC requires the identification of predictive biomarkers that enrich for response.

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