Sun, Jong-Mu; Han, Joungho; Ahn, Jin Seok; Park, Keunchil; Ahn, Myung-Ju
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
2011Aug ; 6 ( 8 ) :1392-9.
PMID : 21716147
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Sun, Jong-Mu -
Han, Joungho -
Ahn, Jin Seok -
Park, Keunchil -
Ahn, Myung-Ju -
ABSTRACT
INTRODUCTION: This study is to evaluate whether thymidylate synthase (TS) or thyroid transcription factor 1 (TTF1) protein expression can predict clinical outcomes for pemetrexed-based chemotherapy in patients with nonsquamous non-small cell lung cancer (NSCLC).
METHODS: Two hundred eighty-five consecutive patients with nonsquamous NSCLC treated with pemetrexed-based chemotherapy were immunohistochemically analyzed for the expressions of TS and TTF1.
RESULTS: TS and TTF1 expression were successfully analyzed in 193 and 284 cases, respectively. Tumors with TS-negativity or TTF1-positivity were more frequent in patients who were female, younger, had adenocarcinoma, or had never smoked. Higher response rates for pemetrexed-based chemotherapy were associated with TS-negativity (33.7% versus 14.1%, p = 0.002) and TTF1-positivity (28.1% versus 9.8%, p < 0.001). In univariate analysis, progression-free survival for pemetrexed-based chemotherapy was significantly longer in groups with adenocarcinoma (2.9 versus 1.4 months, p = 0.001), TS-negativity (4.1 versus 2.0 months, p = 0.001), and TTF1-positivity (3.8 versus 1.3 months, p < 0.001). In multivariate analysis, TS-negativity (hazard ratio [HR] = 0.70; 95% confidence interval [CI], 0.51-0.97) and TTF1-positivity (HR = 0.51; 95% CI, 0.35-0.73) were associated with longer progression-free survival. Patients with TTF1-positive tumors also had significantly longer overall survival times than patients with TTF1-negative tumors (25.4 versus 14.2 months, HR = 0.55; 95% CI, 0.39-0.77).
CONCLUSIONS: Low TS or high TTF1 protein expression was significantly associated with better clinical outcomes in nonsquamous NSCLC patients who were treated with pemetrexed-based chemotherapy. The predictive role of TS or TTF1 expression should be further validated in a prospective randomized study.
Adenocarcinoma/drug therapy/*metabolism/pathology; Aged; Antineoplastic Agents/therapeutic use; Carcinoma, Large Cell/drug therapy/*metabolism/pathology; Carcinoma, Non-Small-Cell Lung/drug therapy/*metabolism/pathology; DNA-Binding Proteins/*metabolism; Female; Glutamates/*therapeutic use; Guanine/*analogs & derivatives/therapeutic use; Humans; Immunoenzyme Techniques; Lung Neoplasms/drug therapy/*metabolism/pathology; Male; Neoplasm Staging; Survival Rate; Thymidylate Synthase/antagonists & inhibitors/*metabolism; Treatment Outcome
MESH
Adenocarcinoma/drug therapy/*metabolism/pathology, Aged, Antineoplastic Agents/therapeutic use, Carcinoma, Large Cell/drug therapy/*metabolism/pathology, Carcinoma, Non-Small-Cell Lung/drug therapy/*metabolism/pathology, DNA-Binding Proteins/*metabolism, Female, Glutamates/*therapeutic use, Guanine/*analogs & derivatives/therapeutic use, Humans, Immunoenzyme Techniques, Lung Neoplasms/drug therapy/*metabolism/pathology, Male, Neoplasm Staging, Pemetrexed, Survival Rate, Thymidylate Synthase/antagonists & inhibitors/*metabolism, Treatment Outcome
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