Second-line Treatment Of Lung Cancer Research Articles

Synthesis of chitosan polyethylene glycol antibody complex for delivery of Imatinib in lung cancer cell lines.

Lung cancer is known as the most common cancer. Although the Ramucirumab antibody is a second-line treatment for lung cancer, the high interstitial fluid pressure limits the antibody's performance. In this way, Imatinib is a chemotherapeutic drug to reduce the interstitial fluid pressure. Up to now, unfortunately, both Ramucirumab and imatinib have not been reported in one nanosystem for cancer therapy. To fulfill this shortcoming, this paper aims to design a chitosan nanocarrier that loads imatinib and attaches to Ramucirumab for selective bonding to A549. Therefore, this paper aims to develop a polymeric nanosystem for non-small cell lung cancer (NSCLC) treatment. In first, the chitosan polyethylene glycol nanoparticle is synthesized, loaded with imatinib, and then targeted using Ramucirumab. Afterwards, the CS-PEG-Ab-Im by FTIR, TEM, DLS, zeta potential, and TGA techniques are characterized. The size of CS-PEG-Ab-Im was 25-30 nm, its surface charge was 13.1 mV, and the shape of CS-PEG-Ab-Im was nearly spherical and cylindrical. The therapeutic potential of CS-PEG-Ab-Im was assessed using the A549 cell line. According to the obtained results, the cell viability was 48% after 48 h of treatment of A549 cells using the IC50 concentration of CS-PEG-Ab-Im (100 nanomolar). Moreover, the apoptosis and cell cycle arrest percentages were increased by 3 and 6 times, respectively, as compared to free imatinib. Furthermore, the release rate of imatinib from CS-PEG-Ab-Im in an acidic medium was 17% during 1 h, indicating five times the imatinib release in the natural medium. Eventually, the result of flow cytometry indicates the more apoptotic effect of nanosystem to free imatinib and CS-PEG-Ab. Besides, cell arresting result exhibits the CS-PEG-Ab-Im and causes cell arrested at G1 by %8.17. Thus, it can be concluded that CS-PEG-Ab-Im can be an ideal nanosystem in NSCLC treatment.

Efficacy and safety of anlotinib in the treatment of lung cancer.

e21129 Background: Anlotinib was approved by the National Medical Products Administration (NMPA) on 5/8/18 and 8/30/19 for the third-line treatment of patients with advanced NSCLC and SCLC. But in the real world, Anlotinib is also used in the second-line treatment of lung cancer. This study aims to evaluate the efficacy of using Anlotinib in the second-line or further treatment of lung cancer in the real-world. Methods: We conducted a retrospective case-control study of NSCLC/SCLC patients at our center from 1/1/19 to 6/30/20. Patient demographic, clinicopathologic, therapeutic and outcomes data were collected. Kaplan-Meier curve and Cox proportional hazards were utilized. Results: Of 167 patients were enrolled in this study, 106 were in Anlotinib group and 61 were in chemotherapy group. The analysis found that pathological types, ECOG PS, and therapeutic were independent factors affecting PFS and OS in lung cancer patients (P < 0.05- can be a specific value). There was a significant difference in DCR between the anlotinib group and chemotherapy group(P < 0.05), and the anlotinib group was better than chemotherapy group in mPFS (4.1 vs 3.1 months, P = 0.001) and mOS (7.682 vs 6,386 months, P = 0.011). Among the second-line treatment patients, ORR, DCR and PFS were no difference between Anlotinib group and chemotherapy group (P > 0.05). The Anlotinib group was significantly better than Chemotherapy group in mOS (10.083vs6.737 months, P = 0.026). In third-line and further treatment patients, therapeutic and ECOG PS were independent factors of PFS and OS (P < 0.05), and pathological type was an independent factor of OS (P < 0.001). There was a significant difference in DCR between anlotinib group and chemotherapy group (P = 0.011). The mPFS (3.8vs2.5 months, P < 0.001) and mOS (7.407vs5.412 months, P = 0.023) are significantly better than chemotherapy group. In terms of adverse events, the incidence of hypertension (32.80%vs9.84%) and hand-foot syndrome (28.30%vs14.75%) in anlotinib group was higher than that in chemotherapy group, but the incidence of leukopenia (4.72%vs37.7) %), fatigue (14.15%vs34.42%), anorexia (16.04%vs39.34%) and other adverse events was lower than chemotherapy group, and the incidence of III-IV adverse events is low. Conclusions: Compared with using chemotherapy alone, the second-line and further treatment of Anlotinib can significantly elevate the survival of lung cancer patients, and the safety and tolerability are better.

Accelerated second-line or maintenance chemotherapy versus treatment at disease progression in NSCLC

For many decades, the use of chemotherapy as second-line therapy in non-small-cell lung cancer relied upon disease progression. Several studies have shown that four to six cycles of chemotherapy administered as front-line therapy treatment offers a survival advantage to patients; however, further chemotherapy beyond this initial treatment was more associated with side effects and no benefit in survival. Until 2009, second-line treatment for lung cancer was well established for three therapeutic agents: docetaxel, pemetrexed and erlotinib. Currently, the timeframe to use these agents has been challenged by two large randomized clinical trials in which pemetrexed (JMEN trial) and erlotinib (Sequential Tarceva in Unresectable NSCLC [SATURN] trial) were used as ‘maintenance’ therapy and shown to impact progression-free survival and overall survival. This review focuses on the actual dilemma that medical oncologists face in clinical practice in terms of when and to whom maintenance therapy should be applied or if the ‘watch and wait’ approach prior to start second-line therapy is still advisable.

Lung cancer.

Is any one combination therapy for metastatic non-small cell lung cancer (NSCLC) superior to other regimens for metastatic NSCLC? The answer is "probably no." More than 4,000 patients with advanced NSCLC participated in randomized trials presented at the 37th Annual Meeting of the American Society of Clinical Oncology. TAX326 was the only study in which the investigational arm (cisplatin/docetaxel) showed a statistically significant difference in survival compared with the reference standard (cisplatin/vinorelbine). We did learn, however, that what we administer may make some difference: cisplatin might be superior to carboplatin, and patients treated with nonplatinum chemotherapy regimens have a trend toward poorer survival than those who receive platinum doublets. Although there is still no clear best regimen for advanced NSCLC, we may now know how much chemotherapy to give: a randomized study presented found that four cycles produces as much survival benefit as treating until progression. The most significant abstracts presented at this year's lung cancer session involved the use of novel agents with unique mechanisms of action. The median survival in the large, randomized trials of chemotherapy in advanced NSCLC remains a bleak 9 months. ISIS 3521, an antisense oligonucleotide that targets protein kinase C, was found to produce a near doubling of survival when combined with carboplatin and paclitaxel. OSI-774, an epidermal growth factor receptor tyrosine kinase inhibitor, was shown to have impressive single agent activity in the second-line treatment of lung cancer. The future of lung cancer therapy will involve combining these novel agents with active chemotherapy regimens in an effort to improve outcome. While we appear to have reached a plateau in what we can accomplish with various combinations of cytotoxic chemotherapy in metastatic NSCLC, in locally-advanced disease new chemotherapy combinations can achieve remarkable results when combined with radiation therapy. The Southwest Oncology Group presented unprecedented phase II data on the use of cisplatin and etoposide with concurrent radiation therapy followed by consolidation docetaxel in patients with stage IIIB NSCLC.