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K. Wu
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MINI 33 - Radiotherapy and Complications (ID 164)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
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MINI33.04 - Acute Radiation Pneumonitis in Lung Cancer Treated with Volumetric Modulated Arc Therapy (ID 2634)
18:30 - 20:00 | Author(s): K. Wu
- Abstract
Background:
Thoracic radiotherapy plays an important role in the treatment of lung cancer. However, the safety of thoracic radiotherapy delivery is restricted to the risk of radiation pneumonitis(RP), which is the major dose limiting toxicity for patients undergoing thoracic radiotherapy. Few studies to date have assessed risk factors associated with the development of RP in lung cancer patients treated with volumetric modulated arc therapy (VMAT). This study aimed to report the RP incidence and clinical and dosimetric risk factors associated with RP in lung cancer patients treated with VMAT at a single institution.
Methods:
In this retrospective study, lung cancer patients treated with VMAT from 2013 through 2015 were reviewed. RP was graded according to Common Terminology Criteria for Adverse Events (CTCAE) version.4.0. Clinical factors and dosimetric parameters were evaluated using logistic multivariate regression for estimating the correlation with RP. The results were considered statistically significant when the p-value was<0.05.
Results:
Thoracic radiotherapy with VMAT was administered in 77 lung cancer patients. Of these patients, 58 were men and 19 were women, with a median age of 60 years (range 22-84 years); 25 patients received concurrent chemoradiotherapy, and the median radiation dose was 60Gy (range 45-64Gy). VMAT plans were performed with single arc in 9 patients, double in 55 patients, triple in 4 patients, and the mean (±SD) delivery time was 189.1s±42.0s. VMAT allowed us to respect most planning objectives on target volumes and organs at risk, for PTV V~95% ~= 96.8 ± 6.1%; for lung V~5~ = 41.3 ± 8.7%, V~10~ = 29.9 ± 7.1%, V~20~ = 20.9 ± 5.7%, mean dose=1150.9±277.6Gy. With regard to acute RP after thoracic radiotherapy, 10.4% were grade 1 (G1), 16.9% G2, 9.1% G3, 2.6% G5. The overall incidence rate of symptomatic RP (grade ≥ 2 by CTCAE) was 28.6% in the entire cohort. Based on the clinical data and dosimetric parameters analysis, factors predictive of symptomatic RP were lung volume receiving ≥10Gy (V~10~) [OR: 1.39, 95% CI 1.07–1.80, p=0.014], PS score[OR:5.44, 95% CI 1.29–23.08, p=0.021], concurrent chemotherapy[OR:3.85, 95% CI 1.07–13.86, p=0.039]and CRP changing level[OR:1.06, 95% CI 1.01–1.12, p=0.014].
Conclusion:
VMAT, a novel technique, provides a viable option for the thoracic radiotherapy of lung cancer with acceptable toxicities. However, for patients with higher V~10~, poorer PS score, greater increasing level of CRP and undergoing concurrent chemotherapy, VAMT technique should be administrated with cautions. Several molecular biomarkers have been reported that correlated with the development of RP, which will be tested in our further analysis.
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-033 - Pemetrexed plus Platinum as Adjuvant Therapy in Patients with Resected Lung Adenocarcinoma and Exploratory Biomarkers Analysis (ID 2524)
09:30 - 17:00 | Author(s): K. Wu
- Abstract
Background:
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death around the world. Currently, adjuvant platinum-based chemotherapy is recommended as the standard treatment for patients with completely resected stage IB-IIIA NSCLC. Pemetrexed, a multitargeted antifolate agent, has been shown to have definite activity in non-squamous NSCLC and has proven to be efficacious in the first-line metastatic NSCLC. Hence, the aim of this study was to evaluate the efficacy and toxicity of pemetrexed/ platinum in patients with completely resected lung adenocarcinoma and identify prognostic factors in this setting.
Methods:
A retrospective study was performed in patients with completely resected stage IB-IIIA lung adenocarcinoma who received pemetrexed and a platinum as adjuvant therapy. Generally, pemetrexed 500mg/m2 d1 and cisplatin 30mg/ m2 day1-3 were administrated every 21-28 days for 4 cycles. Study endpoints included overall survival (OS), progression-free survival (PFS) and treated-related toxicities. Immunohistochemical (IHC) was used to examine the protein expression of p53, thymidylate synthase (TS), dihydrofolate reductase (DHFR), Lipocalin 2 and nm23-H1 in surgical resection specimens of 23 patients. The associations between protein expression level and clinical outcome were evaluated using cox proportional hazards model.
Results:
Between Feb. 2012 and Jan.2014, 49 patients were treated with pemetrexed-based chemotherapy. Median age 57(range35-79, years), males 47%; stage IB 41%, II 18%, IIIA 41%; ever smokers 35%; lobectomy 92%, wedge resection 8%. The completion of 4-cycle chemotherapy was 67.3%. Grade 3+ hematologic and gastrointestinal toxicities were observed in 5 (10%) patients and 4 (8%) patients, respectively. The median PFS was 39.63 months (95%CI 26.55-52.71 months), and the median OS was unreachable. 1-, 2- and 3-year survival rates were 95.9%, 93.6%, 83.2%, respectively. 1-, 2- and 3-year PFS rates were 93.9%, 75.3% and 56.8%, respectively. Of 23 patients measured by IHC, 19 expressed TS, 9 expressed p53, 10 expressed DHFR, and none expressed Lipocalin 2 or nm23-H1. No significant correlations of these protein expression and clinical outcome were observed.
Conclusion:
The regimen of pemetrexed/platinum showed lower incidence rates of toxicities and promising treatment outcomes in patients with completely resected stage IB-IIIA lung adenocarcinoma. However,no prognostic biomarker was identified in our study, which may be related to the small sample size.
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P1.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 212)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.03-012 - Combined Effects of SAHA and Cisplatin on Radiation Sensitivity and Cancer Cell Invasion in NSCLC (ID 538)
09:30 - 17:00 | Author(s): K. Wu
- Abstract
Background:
Lung cancer is a leading cause of cancer mortality worldwide. In an effort to improve local control of the disease and to increase survival, concurrent chemoradiotherapy has been explored as a therapeutic option. Of them, cisplatin-based chemoradiotherapy is currently used as first line therapy for non-small-cell lung cancer (NSCLC). However, the chemotherapeutic agents cannot be administered for most patients at full doses safely with radical doses of thoracic radiation, and thus further optimizations of chemotherapy regimen to be given with radiation are needed.
Methods:
We examined the effects of suberoylanilide hydroxamic acid (SAHA) and cisplatin on DNA damage repairs using U2OS reporter cells and in vivo end-joining assay, and determined the combination effects of SAHA and cisplatin on various cell lines, primary tumor tissues and in vivo xenograft in response to irradiation. We also investigated the potential differentiation effect of SAHA and its consequent effect on cancer cell invasion in cisplatin-treated cancer cells.
Results:
Our data demonstrated that SAHA and cisplatin compromised distinct DNA damage repair pathways. Treatment with SAHA enhanced synergistic radiosensitization effects of cisplatin in NSCLC cells, and induced prolonged persistence of γ-H2A.X nuclear foci in irradiated primary NSCLC tumor tissues treated with cisplatin. SAHA combined with cisplatin also significantly increased inhibitory effect of ionizing radiation on tumor growth in mouse xenograft model. In addition, we showed here that SAHA could induce differentiation in stem cell-like cancer cell population, reduce tumorogenesity and decrease the invasion/migration capabilities of human lung cancer H460 cells.
Conclusion:
Our results suggest a potential clinical impact for SAHA as a radiosensitizer and as a part of chemoradiotherapy regimen for NSCLC. The strategy may also benefit those patients with high risk of cancer metastasis.
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-053 - Characterization of Invasive Cancer Cells and Potential Therapeutic Effect of Suberoylanilide Hydroxamic Acid on Human Lung Cancer Metastasis (ID 223)
09:30 - 17:00 | Author(s): K. Wu
- Abstract
Background:
Lung cancer is a worldwide problem andthe leading cause of death among all malignancies. Despite tremendous progresses in diagnosis and treatment, the overall treatment outcomes for lung cancer patients remain poor, and metastatic lung cancer is responsible for more than ninety percent of lung cancer related deaths. However, the details for lung cancer invasion and thereafter metastasis remain unclear. In this study, we characterized the biological features of invasive human lung cancer cells, and investigated the potential therapeutic effects of Suberoylanilide Hydroxamic Acid (SAHA) on invasive cancer cell subpopulation.
Methods:
Boyden-type cell invasion chambers were used for isolation of cancer cell subpopulations with high invasiveness (H-INV) and low invasiveness (L-INV) from human lung cancer H460 cells. The potential enrichment of stem cell-like cancer cells in H-INV cells and the resistances of H-INV cells to chemotherapy and radiation treatment were investigated. We also tested the effects of SAHA on the differentiation of cancer stem cell and its consequences on cancer cell invasion and the sensitivities to radio/chemotherapies in H-INV cells. Furthermore, microarray for message RNA was performed for identification of gene expression profiling for invasive cancer cells.
Results:
Comparing to L-INV cells, H-INV cells are with enrichments of stem cell-like cancer cells, with increased positive staining of putative stem cell markers such as CD24[low]/CD44[+] and OCT3/4, and more tumorigenic. H-INV cells are also more resistant to treatments of chemotherapeutic agents and ionizing radiation. Treatment with SAHA can induce differentiation of stem cell-like cell in H-INV cells, causing reduced cancer cell invasion and increased sensitivity to chemo/radiotherapy in cells. With mRNA microarray assay, we identified 453 genes differentially expressed in H-INV versus L-INV, and five of these genes have been further tested for their significances in paired primary and metastatic lung tumors.
Conclusion:
Our study suggested putative roles of cancer stem cell in lung cancer invasion and migration. Study also showed that invasive lung cancer cells are resistant to most of first-line and second-line chemotherapeutic agents and radiotherapy, indicating novel therapeutic strategies are needed for the treatment of metastatic lung cancer. Of this setting, SAHA may serve as a chemotherapeutic agent for benefiting lung cancer patients. The candidate genes identified in this study may also have clinic impact as potential metastatic predictors for diagnosis and prognosis for human lung cancer.
