IU Indianapolis ScholarWorks :: Browsing by Subject "lung cancer"

Browsing by Subject "lung cancer"

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Abemaciclib in Combination with Single-Agent Options in Patients with Stage IV Non–Small Cell Lung Cancer: A Phase Ib Study
(AACR, 2018-11) Kim, Edward S.; Kelly, Karen; Paz-Ares, Luis G.; Garrido, Pilar; Jalal, Shadia; Mahadevan, Daruka; Gutierrez, Martin; Provencio, Mariano; Schaefer, Eric; Shaheen, Monte; Johnston, Erica L.; Turner, P. Kellie; Kambhampati, Siva Rama Prasad; Beckmann, Richard; Hossain, Anwar; John, William J.; Goldman, Jonathan W.; Medicine, School of Medicine
Purpose: Abemaciclib, a dual inhibitor of cyclin-dependent kinases 4 and 6, has demonstrated preclinical activity in non–small cell lung cancer (NSCLC). A multicenter, nonrandomized, open-label phase Ib study was conducted to test safety, MTD, pharmacokinetics, and preliminary antitumor activity of abemaciclib in combination with other therapies for treatment in patients with metastatic NSCLC. Patients and Methods: An initial dose escalation phase was used to determine the MTD of twice-daily oral abemaciclib (150, 200 mg) plus pemetrexed, gemcitabine, or ramucirumab, followed by an expansion phase for each drug combination. Pemetrexed and gemcitabine were administered according to label. The abemaciclib plus ramucirumab study examined two dosing schedules. Results: The three study parts enrolled 86 patients; all received ≥1 dose of combination therapy. Across arms, the most common treatment-emergent adverse events were fatigue, diarrhea, neutropenia, decreased appetite, and nausea. The trial did not identify an abemaciclib MTD for the combination with pemetrexed or gemcitabine but did so for the combination of abemaciclib with days 1 and 8 ramucirumab (8 mg/kg). Plasma sample analysis showed that abemaciclib did not influence the pharmacokinetics of the combination agents and the combination agents did not affect abemaciclib exposure. The disease control rate was 57% for patients treated with abemaciclib–pemetrexed, 25% for abemaciclib–gemcitabine, and 54% for abemaciclib–ramucirumab. Median progression-free survival was 5.55, 1.58, and 4.83 months, respectively. Conclusions: Abemaciclib demonstrated an acceptable safety profile when dosed on a continuous twice-daily schedule in combination with pemetrexed, gemcitabine, or ramucirumab. Abemaciclib exposures remained consistent with those observed in single-agent studies.
Acceptance and Commitment Therapy for Symptom Interference in Advanced Lung Cancer and Caregiver Distress: A Pilot Randomized Trial
(Elsevier, 2019) Mosher, Catherine E.; Secinti, Ekin; Hirsh, Adam T.; Hanna, Nasser; Einhorn, Lawrence H.; Jalal, Shadia I.; Durm, Gregory; Champion, Victoria L.; Johns, Shelley A.; Psychology, School of Science
Context Advanced lung cancer patients typically have a poor prognosis and many symptoms that interfere with functioning, contributing to high rates of emotional distress in both patients and family caregivers. There remains a need for evidence-based interventions to improve functional outcomes and distress in this population. Objectives This pilot trial examined the feasibility and preliminary efficacy of telephone-based Acceptance and Commitment Therapy (ACT) for symptomatic, advanced lung cancer patients and their distressed family caregivers. Primary outcomes were patient symptom interference with functioning and patient and caregiver distress. Methods Symptomatic, advanced lung cancer patients and distressed caregivers (n = 50 dyads) were randomly assigned to six sessions of ACT or an education/support condition. Patients completed measures of symptom interference and measures assessing the severity of fatigue, pain, sleep disturbance, and breathlessness. Patients and caregivers completed measures of distress and illness acceptance and struggle. Results The eligibility screening rate (51%) and retention rate (76% at six weeks postintervention) demonstrated feasibility. No group differences were found with respect to patient and caregiver outcomes. Both groups showed a small, significant decrease in struggle with the illness over the study period, but did not show meaningful change in other outcomes. Conclusion Findings suggest that telephone-based ACT is feasible for many advanced lung cancer patients and caregivers, but may not substantially reduce symptom interference and distress. Low baseline levels of certain symptoms may have contributed to null findings. Next steps include applying ACT to specific, clinically meaningful symptom interference and varying intervention dose and modality.
Barriers to mental health service use among distressed family caregivers of lung cancer patients
(Wiley, 2015) Mosher, Catherine E.; Given, B. A.; Ostroff, J. S.; Department of Psychology, School of Science
Although family caregivers of patients with lung and other cancers show high rates of psychological distress, they underuse mental health services. This qualitative study aimed to identify barriers to mental health service use among 21 distressed family caregivers of lung cancer patients. Caregivers had not received mental health services during the patient's initial months of care at a comprehensive cancer centre in New York City. Thematic analysis of interview data was framed by Andersen's model of health service use and Corrigan's stigma theory. Results of our analysis expand Andersen's model by providing a description of need variables (e.g. psychiatric symptoms), enabling factors (e.g. finances), and psychosocial factors associated with caregivers' non-use of mental health services. Regarding psychosocial factors, caregivers expressed negative perceptions of mental health professionals and a desire for independent management of emotional concerns. Additionally, caregivers perceived a conflict between mental health service use and the caregiving role (e.g. prioritising the patient's needs). Although caregivers denied stigma associated with service use, their anticipated negative self-perceptions if they were to use services suggest that stigma may have influenced their decision to not seek services. Findings suggest that interventions to improve caregivers' uptake of mental health services should address perceived barriers.
Bronchoscopic treatment of inoperable nonsmall cell lung cancer
(ERS, 2020-12) Kniese, Christopher M.; Musani, Ali I.; Medicine, School of Medicine
Patients with unresectable lung cancer range from those with early-stage or pre-invasive disease with comorbidities that preclude surgery to those with advanced stage disease in whom surgery is contraindicated. In such cases, a multidisciplinary approach to treatment is warranted, and may involve medical specialties including medical oncology, radiation oncology and interventional pulmonology. In this article we review bronchoscopic approaches to surgically unresectable lung cancer, including photodynamic therapy, brachytherapy, endoscopic ablation techniques and airway stenting. Current and past literature is reviewed to provide an overview of the topic, including a highlight of potential emerging approaches.
Circulating Antibodies to Linear Peptide Antigens Derived from ANXA1 and FOXP3 in Lung Cancer
(IIAR, 2017-06) Wang, Weili; Zhong, Wen; Chen, Cairen; Meng, Qingyong; Wei, Jun; Radiation Oncology, School of Medicine
Background: Our previous studies revealed that concentrations of circulating antibodies to annexin A1 (ANXA1) and forkhead-box P3 (FOXP3) increased significantly in patients with non-small cell lung cancer (NSCLC). This study was thus undertaken to replicate our initial findings with different sample sets. Patients and Methods: Antibodies were tested in 108 patients with NSCLC and 216 controls, who were divided into the discovery (49 vs. 108) and validation (60 vs. 108) group based on the time of enrolment. Results: Analysis of the discovery group showed a significant increase in circulating anti-ANXA1 IgG levels in the patient group compared with the control group (p=0.005) but the validation group simply exhibited a trend toward an increase in IgG levels in NSCLC (p=0.238), generating a combined p-value of 0.009. Conclusion: The findings of this study support the notion that circulating IgG antibodies to ANXA1 could be used as a biomarker for early diagnosis of NSCLC but failed to replicate such findings for FOXP3.
Coping Skills Practice and Symptom Change: A Secondary Analysis of a Pilot Telephone Symptom Management Intervention for Lung Cancer Patients and their Family Caregivers
(Elsevier, 2018) Winger, Joseph G.; Rand, Kevin L.; Hanna, Nasser; Jalal, Shadia I.; Einhorn, Lawrence H.; Birdas, Thomas J.; Ceppa, DuyKhanh P.; Kesler, Kenneth A.; Champion, Victoria L.; Mosher, Catherine E.; Psychology, School of Science
Context Little research has explored coping skills practice in relation to symptom outcomes in psychosocial interventions for cancer patients and their family caregivers. Objectives To examine associations of coping skills practice to symptom change in a telephone symptom management (TSM) intervention delivered concurrently to lung cancer patients and their caregivers. Methods This study was a secondary analysis of a randomized pilot trial. Data were examined from patient-caregiver dyads (n=51 dyads) that were randomized to the TSM intervention. Guided by social cognitive theory, TSM involved four weekly sessions where dyads were taught coping skills including: a mindfulness exercise, guided imagery, pursed lips breathing, cognitive restructuring, problem solving, emotion-focused coping, and assertive communication. Symptoms were assessed, including patient and caregiver psychological distress and patient pain interference, fatigue interference, and distress related to breathlessness. Multiple regression analyses examined associations of coping skills practice during the intervention to symptoms at 6 weeks post-intervention. Results For patients, greater practice of assertive communication was associated with less pain interference (β=-0.45, p=0.02) and psychological distress (β=-0.36, p=0.047); for caregivers, greater practice of guided imagery was associated with less psychological distress (β=-0.30, p=0.01). Unexpectedly, for patients, greater practice of a mindfulness exercise was associated with higher pain (β=0.47, p=0.07) and fatigue interference (β=0.49, p=0.04); greater practice of problem solving was associated with higher distress related to breathlessness (β=0.56, p=0.01) and psychological distress (β=0.36, p=0.08). Conclusion Findings suggest the effectiveness of TSM may have been reduced by competing effects of certain coping skills. Future interventions should consider focusing on assertive communication training for patients and guided imagery for caregivers.
Development of a Patient Centered Outcome Questionnaire for Advanced Lung Cancer Patients
(2020-05) Krueger, Ellen F.; Mosher, Catherine; Hirsh, Adam; McGrew, John
Symptom research with advanced lung cancer patients has primarily focused on symptom severity, frequency, and distress; yet, little is known about advanced lung cancer patients’ priorities and success criteria for symptom improvement. To address these gaps in the literature, this study examined these outcomes using a modified Patient Centered Outcomes Questionnaire (PCOQ), which has largely been used with adults with chronic pain. Advanced lung cancer patients (N = 102) were recruited from the Indiana University Simon Cancer Center to participate in a one-time self-report survey, including demographic and medical questionnaires, symptom treatment history, standardized measures of symptom severity and quality of life, and the modified PCOQ focused on eight common symptoms in advanced lung cancer. Cancer information was collected from medical records. My primary aim was to evaluate the construct validity of the PCOQ. As hypothesized, symptom severity ratings on the PCOQ were positively correlated with standardized assessments of the same symptoms as well as functional status. Greater severity of most symptoms on the PCOQ was also correlated with worse quality of life, and greater severity of four symptoms was correlated with having more medical comorbidities. Positive, moderate correlations were found between the severity and importance of seeing improvement in cough, fatigue, sleep problems, and pain on the PCOQ. Patients considered low levels of symptom severity to be acceptable following symptom treatment; no differences were found across the eight symptoms. Latent profile analysis identified four patient subgroups based on the importance of seeing improvement in each of the symptoms: (1) those who rated all symptoms as low in importance (n = 12); (2) those who rated bronchial symptoms and sleep problems as low in importance and all other symptoms as moderately important (n = 29); (3) those who rated nausea and emotional distress as low in importance and all other symptoms as moderately important (n = 23); and (4) those who rated all symptoms as highly important (n = 33). These subgroups were unrelated to demographic and clinical factors, except for functional status. Findings suggest that symptom severity and importance are related yet distinct aspects of the advanced lung cancer symptom experience. Furthermore, patients have heterogeneous priorities for symptom management, which has implications for tailoring treatment.
Development of a Short Version of the Cataldo Lung Cancer Stigma Scale
(Taylor and Francis, 2015) Carter-Harris, Lisa; Hall, Lynne A.; IU School of Nursing
Lung cancer stigma is an important phenomenon experienced by many lung cancer patients that can be a barrier to medical help-seeking behavior. The purpose of this study was to shorten the Cataldo Lung Cancer Stigma Scale (CLCSS). The original 31-item scale had excellent internal consistency reliability but item redundancy. The majority of lung cancer patients are diagnosed at an advanced stage, and patient burden with survey completion may be higher in this population. To reduce patient burden with participation in lung cancer stigma-related research, a psychometrically sound short measure of lung cancer stigma is valuable. Factor analysis was used to evaluate the dimensionality of the CLCSS. Results were used to shorten the measure to 21 items. The shortened scale showed strong evidence of internal consistency reliability (Cronbach's alpha =.93). Results also indicate the scale is three dimensional with reliable subscales: stigma and blame, social isolation, and discrimination.
Differentiation between immune checkpoint inhibitor‐related and radiation pneumonitis in lung cancer by CT radiomics and machine learning
(Wiley, 2022) Cheng, Jun; Pan, Yi; Huang, Wei; Huang, Kun; Cui, Yanhai; Cui, Yanhai; Hong, Wenhui; Wang, Lingling; Ni, Dong; Tan, Peixin; Biostatistics, School of Public Health
Purpose Consolidation immunotherapy after completion of chemoradiotherapy has become the standard of care for unresectable locally advanced non-small cell lung cancer and can induce potentially severe and life-threatening adverse events, including both immune checkpoint inhibitor-related pneumonitis (CIP) and radiation pneumonitis (RP), which are very challenging for radiologists to diagnose. Differentiating between CIP and RP has significant implications for clinical management such as the treatments to pneumonitis and the decision to continue or restart immunotherapy. The purpose of this study is to differentiate between CIP and RP by a CT radiomics approach. Methods We retrospectively collected the CT images and clinical information of patients with pneumonitis who received immune checkpoint inhibitor (ICI) only (n = 28), radiotherapy (RT) only (n = 31), and ICI+RT (n = 14). Three kinds of radiomic features (intensity histogram, gray-level co-occurrence matrix (GLCM) based, and bag-of-words features) were extracted from CT images, which characterize tissue texture at different scales. Classification models, including logistic regression, random forest, and linear SVM, were first developed and tested in patients who received ICI or RT only with 10-fold cross validation and further tested in patients who received ICI+RT using clinicians’ diagnosis as a reference. Results Using 10-fold cross validation, the classification models built on the intensity histogram features, GLCM based features, and bag-of-words features achieved an area under curve (AUC) of 0.765, 0.848, and 0.937, respectively. The best model was then applied to the patients receiving combination treatment, achieving an AUC of 0.896. Conclusions This study demonstrates the promising potential of radiomic analysis of CT images for differentiating between CIP and RP in lung cancer, which could be a useful tool to attribute the cause of pneumonitis in patients who receive both ICI and RT.
Immunotherapy in Lung Cancer: Current Landscape and Future Directions
(Frontiers, 2022-02-08) Mamdani, Hirva; Matosevic, Sandro; Khalid, Ahmed Bilal; Durm, Gregory; Jalal, Shadia I.; Medicine, School of Medicine
Over the past decade, lung cancer treatment has undergone a major paradigm shift. A greater understanding of lung cancer biology has led to the development of many effective targeted therapies as well as of immunotherapy. Immune checkpoint inhibitors (ICIs) have shown tremendous benefit in the treatment of non-small cell lung cancer (NSCLC) and are now being used as first-line therapies in metastatic disease, consolidation therapy following chemoradiation in unresectable locally advanced disease, and adjuvant therapy following surgical resection and chemotherapy in resectable disease. Despite these benefits, predicting who will respond to ICIs has proven to be difficult and there remains a need to discover new predictive immunotherapy biomarkers. Furthermore, resistance to ICIs in lung cancer is frequent either because of a lack of response or disease progression after an initial response. The utility of ICIs in the treatment of small cell lung cancer (SCLC) remains limited to first-line treatment of extensive stage disease in combination with chemotherapy with modest impact on overall survival. It is thus important to explore and exploit additional targets to reap the full benefits of immunotherapy in the treatment of lung cancer. Here, we will summarize the current state of immunotherapy in lung cancer, discuss novel targets, and explore the intersection between DNA repair defects and immunotherapy.

Browsing by Subject "lung cancer"

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