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Brea E, Rotow J. Targeted Therapy for Non–Small Cell Lung Cancer. Hematol Oncol Clin North Am 2023; 37:575-594. [PMID: 37024384 DOI: 10.1016/j.hoc.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
This article provides an updated review of the management of oncogene-driven non-small cell lung cancer. The use of targeted therapies for lung cancer driven by EGFR, ALK, ROS1, RET, NTRK, HER2, BRAF, MET, and KRAS are discussed, both in the first-line setting and in the setting of acquired resistance.
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Affiliation(s)
- Elliott Brea
- Department of Medical Oncology, Dana-Farber Cancer Institute, SM353, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Julia Rotow
- Dana-Farber Cancer Institute, 450 Brookline Avenue, DA1240, Boston, MA 02215, USA.
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Miao E, Eichholz JE, Lebow ES, Flynn J, Zhang Z, Walch H, Hubbeling H, Beal K, Moss NS, Yu KK, Meng A, Kelly DW, Gomez DR, Li BT, Rimner A, Schultz N, Drilon A, Imber BS, Pike LRG. Characterization of Central Nervous System Clinico-Genomic Outcomes in ALK-Positive Non-Small Cell Lung Cancer Patients with Brain Metastases Treated with Alectinib. Lung Cancer 2023; 178:57-65. [PMID: 36780766 PMCID: PMC10065905 DOI: 10.1016/j.lungcan.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/11/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Highly effective brain-penetrant ALK-targeted tyrosine kinase inhibitors (TKIs) have been developed for the management of NSCLC patients with brain metastases (BM). Local therapy (LT) such as SRS or therapeutic craniotomy is increasingly being deferred for such patients. Herein we report detailed patient- and lesion-level intracranial outcomes and co-mutational genomic profiles from a cohort of NSCLC patients with BM treated with alectinib, with or without LT. METHODS We retrospectively reviewed ALK fusion-positive NSCLC patients with BMs who received alectinib at the diagnosis of BM from 1/2012 and 5/2021. Outcome variables included intracranial progression-free survival (iPFS), overall survival (OS), duration of TKI therapy, and CNS response rates. Genomic characteristics from tumor specimens were assessed with MSK-IMPACT, a next-generation sequencing (NGS)-based genomic profiling assay. RESULTS A total of 38 patients with 114 CNS lesions were included. Twelve of these patients also received contemporaneous LT (SRS, WBRT, or surgical resection). Maximal BM diameter in the TKI + LT group was greater (p < 0.003) but despite this difference, iPFS (TKI only, HR 1.21, 95 % CI 0.51-2.89; p = 0.66) and OS (TKI only, HR 5.99, 95 % CI 0.77-46.6; p = 0.052) were similar between groups and trended towards more favorable outcomes with the addition of LT. SMARCA4 co-alterations were associated with inferior OS (HR 8.76, 1.74-44.2; p = 0.009). CONCLUSIONS Our study demonstrated that patients with ALK fusion-positive NSCLC treated with TKI + LT had larger BM and higher likelihood of pre-treatment neurologic symptoms. Despite these differences, iPFS was similar between groups. Results should be interpreted with caution as our study was limited by an underpowered sample size. SMARCA4 co-alterations were associated with inferior OS and these findings warrant further investigation.
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Affiliation(s)
- Emily Miao
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States; Albert Einstein College of Medicine, Bronx, NY, United States
| | - Jordan E Eichholz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States; Biomarker Development Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Emily S Lebow
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Jessica Flynn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Henry Walch
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Harper Hubbeling
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Nelson S Moss
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Kenny K Yu
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Alicia Meng
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Daniel W Kelly
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States; Biomarker Development Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Bob T Li
- Memorial Sloan Kettering Cancer Center, New York, New York, United States; Biomarker Development Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States; Biomarker Development Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Nikolaus Schultz
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Alexander Drilon
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Brandon S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Luke R G Pike
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, United States; Biomarker Development Program, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
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Hendriks LE, Kerr KM, Menis J, Mok TS, Nestle U, Passaro A, Peters S, Planchard D, Smit EF, Solomon BJ, Veronesi G, Reck M. Oncogene-addicted metastatic non-small-cell lung cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023; 34:339-357. [PMID: 36872130 DOI: 10.1016/j.annonc.2022.12.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 01/24/2023] Open
Affiliation(s)
- L E Hendriks
- Department of Pulmonology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K M Kerr
- Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, UK
| | - J Menis
- Medical Oncology Department, University and Hospital Trust of Verona, Verona, Italy
| | - T S Mok
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - U Nestle
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - A Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - D Planchard
- Department of Medical Oncology, Thoracic Group, Gustave-Roussy Villejuif, France
| | - E F Smit
- Thoracic Oncology Service, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Pulmonary Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - B J Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - G Veronesi
- Faculty of Medicine and Surgery-Vita-Salute San Raffaele University, Milan, Italy; Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, Lung Clinic, Grosshansdorf, Germany
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Schoepflin ZR, Academia E, Osataphan SA, Rangachari D, Sharifi S, VanderLaan PA, Costa DB. ALK Deletion Exons 2 to 19: Case Report of a Rare ALK Inhibitor-Responsive Lung Cancer Driver Oncogene. JTO Clin Res Rep 2023; 4:100489. [PMID: 36994308 PMCID: PMC10040877 DOI: 10.1016/j.jtocrr.2023.100489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/28/2023] Open
Abstract
ALK internal deletions of nonkinase domain exons occur in 0.01% of lung cancers with ALK genomic aberrations. We report a lung adenocarcinoma with a previously undescribed somatic ALK deletion of exons 2 to 19 with dramatic and sustained (>23 mo) response to alectinib. Our and other reported cases with ALK nonkinase domain deletions (between introns and exons 1-19) can display positive results in nonsequencing-based lung cancer diagnostic tests (such as immunohistochemistry) used to screen for more common ALK rearrangements. This case report emphasizes that "ALK-driven" lung cancers should be expanded to encompass those harboring not only ALK rearrangements with other genes but also ALK nonkinase domain deletions.
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Affiliation(s)
- Zachary R. Schoepflin
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Emmeline Academia
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Soravis A. Osataphan
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Deepa Rangachari
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sheida Sharifi
- Department of Pathology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Paul A. VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel B. Costa
- Department of Medicine, Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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205
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Harada G, Yang SR, Cocco E, Drilon A. Rare molecular subtypes of lung cancer. Nat Rev Clin Oncol 2023; 20:229-249. [PMID: 36806787 PMCID: PMC10413877 DOI: 10.1038/s41571-023-00733-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/22/2023]
Abstract
Oncogenes that occur in ≤5% of non-small-cell lung cancers have been defined as 'rare'; nonetheless, this frequency can correspond to a substantial number of patients diagnosed annually. Within rare oncogenes, less commonly identified alterations (such as HRAS, NRAS, RIT1, ARAF, RAF1 and MAP2K1 mutations, or ERBB family, LTK and RASGRF1 fusions) can share certain structural or oncogenic features with more commonly recognized alterations (such as KRAS, BRAF, MET and ERBB family mutations, or ALK, RET and ROS1 fusions). Over the past 5 years, a surge in the identification of rare-oncogene-driven lung cancers has challenged the boundaries of traditional clinical grade diagnostic assays and profiling algorithms. In tandem, the number of approved targeted therapies for patients with rare molecular subtypes of lung cancer has risen dramatically. Rational drug design has iteratively improved the quality of small-molecule therapeutic agents and introduced a wave of antibody-based therapeutics, expanding the list of actionable de novo and resistance alterations in lung cancer. Getting additional molecularly tailored therapeutics approved for rare-oncogene-driven lung cancers in a larger range of countries will require ongoing stakeholder cooperation. Patient advocates, health-care agencies, investigators and companies with an interest in diagnostics, therapeutics and real-world evidence have already taken steps to surmount the challenges associated with research into low-frequency drivers.
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Affiliation(s)
- Guilherme Harada
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Soo-Ryum Yang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiliano Cocco
- Department of Biochemistry and Molecular Biology/Sylvester Comprehensive Cancer Center, University of Miami/Miller School of Medicine, Miami, FL, USA.
| | - Alexander Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Straehla JP, Reardon DA, Wen PY, Agar NYR. The Blood-Brain Barrier: Implications for Experimental Cancer Therapeutics. ANNUAL REVIEW OF CANCER BIOLOGY 2023; 7:265-289. [PMID: 38323268 PMCID: PMC10846865 DOI: 10.1146/annurev-cancerbio-061421-040433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
The blood-brain barrier is critically important for the treatment of both primary and metastatic cancers of the central nervous system (CNS). Clinical outcomes for patients with primary CNS tumors are poor and have not significantly improved in decades. As treatments for patients with extracranial solid tumors improve, the incidence of CNS metastases is on the rise due to suboptimal CNS exposure of otherwise systemically active agents. Despite state-of-the art surgical care and increasingly precise radiation therapy, clinical progress is limited by the ability to deliver an effective dose of a therapeutic agent to all cancerous cells. Given the tremendous heterogeneity of CNS cancers, both across cancer subtypes and within a single tumor, and the range of diverse therapies under investigation, a nuanced examination of CNS drug exposure is needed. With a shared goal, common vocabulary, and interdisciplinary collaboration, the field is poised for renewed progress in the treatment of CNS cancers.
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Affiliation(s)
- Joelle P Straehla
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Koch Institute for Integrative Cancer Research at MIT, Cambridge, Massachusetts, USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathalie Y R Agar
- Department of Neurosurgery and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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Zhai X, Wang T, Lin Y, Zhang J, Wang Y, Wang W, Zhou Q, Zhu D. Case report: Complete pathological admission in N3 unresectable locally advanced lung adenocarcinoma with a novel INTS10-ALK and EML4-ALK fusion after neoadjuvant crizotinib. Front Oncol 2023; 13:1104910. [PMID: 37064118 PMCID: PMC10095823 DOI: 10.3389/fonc.2023.1104910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundAlthough anaplastic lymphoma kinase tyrosine kinase inhibitors (ALK-TKIs) have impressive response in advanced lung adenocarcinoma with anaplastic lymphoma kinase (ALK) fusion, no guidelines point to the potential benefits of neoadjuvant ALK-TKIs for N3 unresectable locally advanced lung cancer. Current ongoing clinical trials mainly focus on the efficacy of neoadjuvant ALK-TKIs in resectable locally advanced lung cancer and ignore the role of neoadjuvant ALK-TKIs in N3 unresectable locally advanced lung cancer.Materials and methodsWe report a lung cancer case with a novel INTS10-ALK and EML4-ALK rearrangement that achieved complete pathologic response to neoadjuvant crizotinib. We conducted molecular pathologic analysis by using next-generation sequencing (NGS). Genomic DNA was extracted from formalin-fixed paraffin-embedded (FFPE) samples and profiled using a capture-based targeted sequencing panel consisting of 56 lung cancer-related genes.ResultsOur study reported a patient with stage IIIB-N3 lung adenocarcinoma with an unreported dual ALK rearrangement (INTS10-ALK and EML4-ALK) who received 5 months of crizotinib, followed by R0 right upper lobectomy, achieving complete pathological response (ypT0 ypN0). No recurrence of the tumor was found for 3 years postoperatively.ConclusionThe case supports the strategy of neoadjuvant ALK inhibitors for N3 unresectable locally advanced lung cancer, expanding the spectrum of treatment of stage IIIB-N3 lung cancer.
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Affiliation(s)
- Xiaoqian Zhai
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Wang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yiyun Lin
- Graduate School of Biomedical Sciences, MD Anderson Cancer Center UT Health, Houston, TX, United States
| | - Jiabi Zhang
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, United States
| | - Yuqing Wang
- Graduate School of Biomedical Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Weiya Wang
- Pathology Department, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Weiya Wang, ; Qinghua Zhou, ; Daxing Zhu,
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Weiya Wang, ; Qinghua Zhou, ; Daxing Zhu,
| | - Daxing Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Weiya Wang, ; Qinghua Zhou, ; Daxing Zhu,
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Takayasu H, Kata Y, Otsu Y, Inoue S, Kaneko T. ALK-Rearranged NSCLC With Concomitant HER2-Mutant Breast Cancer Patient Treated With Alectinib, Trastuzumab, and Pertuzumab: A Case Report. Cureus 2023; 15:e36711. [PMID: 37113357 PMCID: PMC10129291 DOI: 10.7759/cureus.36711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/28/2023] Open
Abstract
Multiple cancers are a common occurrence, and the choice of treatment can be a challenging decision. The current case report describes a 71-year-old woman with overlapping anaplastic lymphoma kinase (ALK)-rearranged lung adenocarcinoma and HER2-mutant breast cancer, who achieved improvement with concurrent use of the molecularly targeted agents Alectinib, Trastuzumab, and Pertuzumab. A 71-year-old woman was diagnosed with lung adenocarcinoma and brain metastases, and invasive ductal carcinoma of the right breast, HER2-mutant type. In March 2021, a biopsy confirmed the presence of the ALK fusion gene in lung cancer. In April 2021, he started Alectinib and showed shrinkage of lung cancer; in December 2021, a metastatic liver tumor was found, and a liver biopsy diagnosed liver metastasis of breast cancer. Therefore, Alectinib was discontinued in February 2022, and Trastuzumab, Pertuzumab, and Docetaxel were started as chemotherapy for breast cancer. She continued treatment with Trastuzumab and Pertuzumab, but in July 2022, she developed an increase in lung cancer. Her metastatic liver tumor continued shrinking, and she was started on Trastuzumab, Pertuzumab, and Alectinib. After six months of treatment, the patient showed a sustained reduction in both lung cancer, breast cancer, and brain metastases with no adverse events. ALK rearrangement lung cancer often develops in young women, and similarly, breast cancer often develops in women. Therefore, those cancers may occur simultaneously. In such cases, the choice of treatment can be difficult, as both cancers require different approaches. Alectinib has been shown to have a high response rate and prolonged progression-free survival in ALK-rearranged non-small cell lung cancer (NSCLC). Trastuzumab and Pertuzumab are commonly used for the treatment of HER2-mutant breast cancer and have been shown to significantly improve progression-free survival and overall survival. This case report provides evidence that the concurrent use of Alectinib, Trastuzumab, and Pertuzumab can be an effective treatment for patients with overlapping ALK-rearranged NSCLC and HER2-mutant breast cancer. It is important to consider concurrent treatment in patients with multiple cancers to optimize treatment outcomes and improve quality of life. However, further studies are needed to establish the safety and efficacy of this combination of drugs for the treatment of overlapping cancers.
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Zheng ZR, Ku HY, Chen KC, Chiang CJ, Wang CL, Chen CY, Tsai CM, Huang MS, Yu CJ, Chen JS, Chou TY, Lee WC, Wang CC, Liu TW, Hsia JY, Chang GC. Association of smoking and ALK tyrosine-kinase inhibitors on overall survival in treatment-naïve ALK-positive advanced lung adenocarcinoma. Front Oncol 2023; 13:1063695. [PMID: 37007097 PMCID: PMC10064125 DOI: 10.3389/fonc.2023.1063695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
IntroductionAnaplastic lymphoma kinase (ALK) fusion mutation is more common in younger and never-smoking lung cancer patients. The association of smoking and ALK-tyrosine kinase inhibitors (TKIs) on overall survival (OS) of treatment-naïve ALK-positive advanced lung adenocarcinoma remains unclear in real-world.MethodsThis retrospective study evaluated all 33170 lung adenocarcinoma patients registered in the National Taiwan Cancer Registry from 2017 to 2019, of whom 9575 advanced stage patients had ALK mutation data.ResultsAmong the 9575 patients, 650 (6.8%) patients had ALK mutation with the median follow-up survival time 30.97 months (median age, 62 years; 125 [19.2%] were aged ≥75 years; 357 (54.9%) females; 179 (27.5) smokers, 461 (70.9%) never-smokers, 10 (1.5%) with unknown smoking status; and 544 (83.7%) with first-line ALK-TKI treatment). Overall, of 535 patients with known smoking status who received first-line ALK-TKI treatment, never-smokers and smokers had a median OS of 40.7 months (95% confidence interval (CI), 33.1-47.2 months) and 23.5 months (95% CI, 11.5-35.5 months) (P=0.015), respectively. Among never-smokers, those who received first-line ALK-TKI treatment had a median OS of 40.7 months (95% CI, 22.7-57.8 months), while those ALK-TKI not as first-line treatment had a median OS of 31.7 months (95% CI, 15.2-42.8 months) (P=0.23). In smokers, the median OS for these patients was 23.5 months (95% CI, 11.5-35.5 months) and 15.6 months (95% CI, 10.2-21.1 months) (P=0.026), respectively.Conclusions and relevanceFor patients with treatment-naïve advanced lung adenocarcinoma, the ALK test should be performed irrespective of smoking status and age. Smokers had shorter median OS than never-smokers among treatment-naïve-ALK-positive patients with first-line ALK-TKI treatment. Furthermore, smokers not receiving first-line ALK-TKI treatment had inferior OS. Further investigations for the first-line treatment of ALK-positive smoking advanced lung adenocarcinoma patients are needed.
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Affiliation(s)
- Zhe-Rong Zheng
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsiu-Ying Ku
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Miaoli, Taiwan
| | - Kun-Chieh Chen
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei, Taiwan
| | - Chih-Liang Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yi Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Ming Tsai
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Shyan Huang
- Division of Pulmonary Medicine, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, I-Shou University and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Jin-Shing Chen
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Teh-Ying Chou
- Graduate Institute of Clinical Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Pathology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital-LinKou, Taoyuan, Taiwan
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Miaoli, Taiwan
| | - Jiun-Yi Hsia
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
- *Correspondence: Gee-Chen Chang, ; Jiun-Yi Hsia,
| | - Gee-Chen Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
- *Correspondence: Gee-Chen Chang, ; Jiun-Yi Hsia,
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NSCLC in the Era of Targeted and Immunotherapy: What Every Pulmonologist Must Know. Diagnostics (Basel) 2023; 13:diagnostics13061117. [PMID: 36980426 PMCID: PMC10047174 DOI: 10.3390/diagnostics13061117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
The treatment of non-small cell lung cancer has dramatically changed over the last decade through the use of targeted therapies and immunotherapies. Implementation of these treatment regimens relies on detailed knowledge regarding each tumor’s specific genomic profile, underscoring the necessity of obtaining superior diagnostic tissue specimens. While these treatment approaches are commonly utilized in the metastatic setting, approval among earlier-stage disease will continue to rise, highlighting the importance of early and comprehensive biomarker testing at the time of diagnosis for all patients. Pulmonologists play an integral role in the diagnosis and staging of non-small cell lung cancer via sophisticated tissue sampling techniques. This multifaceted review will highlight current indications for the use of targeted therapies and immunotherapies in non-small cell lung cancer and will outline the quality of various diagnostic approaches and subsequent success of tissue biomarker testing. Pulmonologist-specific methods, including endobronchial ultrasound and guided bronchoscopy, will be examined as well as other modalities such as CT-guided transthoracic biopsy and more.
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Qiao S, Hao Y, Cai L, Duan X, Wang L, Zhou A, Zhu X. Prognostic value of cell-free DNA in cerebrospinal fluid from lung cancer patients with brain metastases during radiotherapy. Radiat Oncol 2023; 18:50. [PMID: 36906568 PMCID: PMC10007729 DOI: 10.1186/s13014-023-02239-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND During the last decades, radiotherapy (RT) for non-small cell lung cancer (NSCLC) with brain metastases (BM) has been developed. However, the lack of predictive biomarkers for therapeutic responses has limited the precision treatment in NSCLC-BM. PATIENTS AND METHODS In order to find the predictive biomarkers for RT, we investigated the influence of RT on the cell-free DNA (cfDNA) from cerebrospinal fluid (CSF) and the frequency of T cell subsets of NSCLC patients with BM. A total of 19 patients diagnosed as NSCLC with BM were enrolled. The CSF from 19 patients and matched plasma samples from 11 patients were collected before RT, during RT, and after RT. The cfDNA from CSF and plasma were extracted, and the cerebrospinal fluid tumor mutation burden (cTMB) was calculated after through next-generation sequencing. The frequency of T cell subsets in peripheral blood was using flow cytometry. RESULTS The detection rate of cfDNA was higher in CSF compared to plasma in the matched samples. The mutation abundance of cfDNA in CSF was decreased after RT. However, no significant difference was observed in cTMB before and after RT. Although the median intracranial progression-free survival (iPFS) has not yet been reached in patients with decreased or undetectable cTMB, there was a trend that these patients possessed longer iPFS compared to those with stable or increased cTMB (HR 0.28, 95% CI 0.07-1.18, P = 0.067). The proportion of CD4+T cells in peripheral blood was decreased after RT. CONCLUSION Our study indicates that cTMB can serve as a prognostic biomarker in NSCLC patients with BMs.
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Affiliation(s)
- Simiao Qiao
- Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, China
| | - Yuying Hao
- Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, China
| | - Linbo Cai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, 510515, China
| | - Xiaotong Duan
- Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, China
| | - Lijuan Wang
- Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, China
| | - Aidong Zhou
- Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, China
| | - Xiaoxia Zhu
- Department of Radiation Oncology, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Guangzhou, 510282, China.
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Meertens M, Muntinghe-Wagenaar MB, Sikkema BJ, Lopez-Yurda M, Retèl VP, Paats MS, Ter Heine R, Schuuring E, Timens W, Touw DJ, van Boven JFM, de Langen AJ, Hashemi SMS, Hendriks LEL, Croes S, van den Heuvel MM, Dingemans AMC, Mathijssen RHJ, Smit EF, Huitema ADR, Steeghs N, van der Wekken AJ. Therapeutic drug monitoring guided dosing versus standard dosing of alectinib in advanced ALK positive non-small cell lung cancer patients: Study protocol for an international, multicenter phase IV randomized controlled trial (ADAPT ALEC). Front Oncol 2023; 13:1136221. [PMID: 36969063 PMCID: PMC10035072 DOI: 10.3389/fonc.2023.1136221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/22/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundAlectinib is first-line therapy in patients with stage IV non-small cell lung carcinoma (NSCLC) and an anaplastic lymphoma kinase (ALK) fusion. A shorter median progression-free survival (mPFS) was observed when alectinib minimum plasma concentrations during steady state (Cmin,SS) were below 435 ng/mL. This may suggest that patients should have an alectinib Cmin,SS ≥ 435 ng/mL for a more favorable outcome. This potential target could be attained by using therapeutic drug monitoring (TDM), i.e. adjusting the dose based on measured plasma trough concentrations. Hypothetically, this will increase mPFS, but this has not yet been evaluated in a randomized controlled trial (RCT). Therefore, the ADAPT ALEC trial is designed, with the primary objective to prolong mPFS in NSCLC patients treated with alectinib by using TDM.MethodsADAPT ALEC is a multicenter, phase IV RCT, in which patients aged ≥ 18 years with advanced ALK positive (+) NSCLC eligible for alectinib in daily care are enrolled. Participants will be randomized (1:1 ratio) into intervention arm A (TDM) or B (control), stratified by brain metastases and prior ALK treatments. Starting dose in both arms is the approved flat fixed dose of alectinib 600 mg taken twice daily with food. In case of alectinib Cmin,SS < 435 ng/mL, arm A will receive increased doses of alectinib till Cmin,SS ≥ 435 ng/mL when considered tolerable. The primary outcome is mPFS, where progressive disease is defined according to RECIST v1.1 or all-cause death and assessed by CT-scans and MRI brain. Secondary endpoints are feasibility and tolerability of TDM, patient and physician adherence, overall response rate, median overall survival, intracranial PFS, quality of life, toxicity, alectinib-M4 concentrations and cost-effectiveness of TDM. Exploratory endpoints are circulating tumor DNA and body composition.DiscussionThe ADAPT ALEC will show whether treatment outcomes of patients with advanced ALK+ NSCLC improve when using TDM-guided dosing of alectinib instead of fixed dosing. The results will provide high quality evidence for deciding whether TDM should be implemented as standard of care and this will have important consequences for the prescribing of alectinib.Clinical trial registrationClinicalTrials.gov, identifier NCT05525338.
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Affiliation(s)
- Marinda Meertens
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - M. Benthe Muntinghe-Wagenaar
- Department of Pulmonology and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Barend J. Sikkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marta Lopez-Yurda
- Department of Biometrics, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Valesca P. Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Marthe S. Paats
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rob Ter Heine
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Ed Schuuring
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daan J. Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Adrianus. J. de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Sayed M. S. Hashemi
- Department of Pulmonary Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Lizza E. L. Hendriks
- Department of Respiratory Medicine, Maastricht University Medical Center, GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | - Sander Croes
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, CARIM School for Cardiovascular disease, Maastricht, Netherlands
| | | | - Anne-Marie C. Dingemans
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ron H. J. Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Egbert F. Smit
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Alwin D. R. Huitema
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Neeltje Steeghs
- Department of Clinical Pharmacology, Division of Medical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Anthonie J. van der Wekken
- Department of Pulmonology and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- *Correspondence: Anthonie J. van der Wekken,
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Bertaglia V, Morelli AM, Solinas C, Aiello MM, Manunta S, Denaro N, Tampellini M, Scartozzi M, Novello S. Infections in lung cancer patients undergoing immunotherapy and targeted therapy: An overview on the current scenario. Crit Rev Oncol Hematol 2023; 184:103954. [PMID: 36878396 DOI: 10.1016/j.critrevonc.2023.103954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Patients with a diagnosis of lung cancer are often vulnerable to infection, and the risk is increased by tumor-associated immunosuppression and the effects of the treatments. Historically, links between the risk of infection and cytotoxic chemotherapy due to neutropenia and respiratory syndromes are well established. The advent of tyrosine kinase inhibitors (TKIs) and immune-checkpoint inhibitors (ICIs) targeting the programmed cell death-1 (PD-1)/programmed cell death- ligand 1 (PD-L1) axis and cytotoxic T-lymphocyte antigen-4 (CTLA-4) have changed the treatment paradigm for lung cancer patients. Our understanding of the risk of infections while administrating these drugs is evolving, as are the biological mechanisms that are responsible. In this overview, we focus on the risk of infection with the use of targeted therapies and ICIs, summarizing current evidence from preclinical and clinical studies and discussing their clinical implications.
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Affiliation(s)
- Valentina Bertaglia
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Torino, Italy
| | - Anna Maria Morelli
- Medical Oncology, ASL TO3 Ospedale degli Infermi, 10098 Rivoli, Torino, Italy
| | - Cinzia Solinas
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, 09042 Monserrato, Cagliari, Italy.
| | - Marco Maria Aiello
- Medical Oncology, AOU Policlinico Vittorio Emanuele di Catania, 95100 Catania, Italy
| | - Silvia Manunta
- Medical Oncology, Ospedale Civile di Alghero, 07041 Alghero, Italy
| | - Nerina Denaro
- Oncology Department, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Marco Tampellini
- Medical Oncology, ASL TO3 Ospedale degli Infermi, 10098 Rivoli, Torino, Italy
| | - Mario Scartozzi
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, 09042 Monserrato, Cagliari, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, 10043 Orbassano, Torino, Italy
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214
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Cannone G, Comacchio GM, Pasello G, Faccioli E, Schiavon M, Dell’Amore A, Mammana M, Rea F. Precision Surgery in NSCLC. Cancers (Basel) 2023; 15:cancers15051571. [PMID: 36900362 PMCID: PMC10000462 DOI: 10.3390/cancers15051571] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is still one of the leading causes of death worldwide. This is mostly because the majority of lung cancers are discovered in advanced stages. In the era of conventional chemotherapy, the prognosis of advanced NSCLC was grim. Important results have been reported in thoracic oncology since the discovery of new molecular alterations and of the role of the immune system. The advent of new therapies has radically changed the approach to lung cancer for a subset of patients with advanced NSCLC, and the concept of incurable disease is still changing. In this setting, surgery seems to have developed a role of rescue therapy for some patients. In precision surgery, the decision to perform surgical procedures is tailored to the individual patient; taking into consideration not only clinical stage, but also clinical and molecular features. Multimodality treatments incorporating surgery, immune checkpoint inhibitors, or targeted agents are feasible in high volume centers with good results in terms of pathologic response and patient morbidity. Thanks to a better understanding of tumor biology, precision thoracic surgery will facilitate optimal and individualized patient selection and treatment, with the goal of improving the outcomes of patients affected by NSCLC.
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Affiliation(s)
- Giorgio Cannone
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-3479197786
| | - Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV IRCCS, 35128 Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy
| | - Andrea Dell’Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University Hospital of Padova, 35128 Padova, Italy
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215
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Lococo F, Cancellieri A, Chiappetta M, Leonetti A, Cardillo G, Zanelli F, Mangiameli G, Toschi L, Guggino G, Romano F, Leuzzi G, Proto C, Spaggiari L, De Marinis F, Vita E, Ampollini L, Margaritora S, Tiseo M, Bria E. Salvage surgery after first-line Alectinib for locally-advanced/metastatic ALK-rearranged NSCLC: pathological response and peri-operative results. Clin Lung Cancer 2023:S1525-7304(23)00044-X. [PMID: 37061413 DOI: 10.1016/j.cllc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/20/2023] [Accepted: 03/05/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND The role of salvage surgery after tyrosine kinase inhibitors in advanced oncogene-addicted non-small cell lung cancer is largely unexplored. PATIENTS We aimed to describe the pathological features and surgical early-outcomes of Anaplastic Lymphome Kinase anaplastic lymphome kinase positive non-small cell lung cancer patients undergoing surgery after first-line alectinib treatment. We retrospectively collected and analyzed multicentric data of 10 patients treated with alectinib for advanced-stage anaplastic lymphome kinase positive lung adenocarcinoma who underwent anatomical surgical resection from January 2020 to Decemeber 2021. All patients were treatment naive and received alectinib (600 mg twice daily). Surgery was always proposed after multidisciplinary discussion. The primary endpoints were pathological response and surgical feasibility (technical intraoperative complications, postoperative outcomes). RESULTS Alectinib was received for a mean of 212 days before surgery (42-415 days) and was generally interrupted about one week before surgery (range: 0-32 days) with no patient experienced grade 4 toxicity. All patients received an R0 resection with surgery consisting of lobectomy in 8 cases with bilobectomy and (left) pneumonectomy in 1 case each. Intra-operative difficulties were described in 7 cases (70%), mostly due to perivascular fibrosis or thickening of mediastinal lymph nodal tissues. Major and minor complications occurred in 0 and 3 cases (30%), respectively. A pathological complete response and major pathological response (defined as 0% and < 10% viable tumor cells, respectively) were observed in 50% and 90% of cases, respectively. Despite short follow-up, only one tumor recurrence was observed (in the only patient who did not resume alectinib after surgery). INTERPRETATION Despite some technical intraoperative difficulties, salvage surgery was safe and feasible after Alectinib for advanced lung adenocarcinoma.
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216
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García-Pardo M, Chang A, Schmid S, Dong M, Brown MC, Christiani D, Tindel HA, Brennan P, Chen C, Zhang J, Ryan BM, Zaridze D, Schabath MB, Leal LF, Reis RM, Tardon A, Fernández-Tardon G, Shete SS, Andrew A, Brenner H, Xu W, Hung RJ, Liu G. Respiratory and Cardiometabolic Comorbidities and Stages I to III NSCLC Survival: A Pooled Analysis From the International Lung Cancer Consortium. J Thorac Oncol 2023; 18:313-323. [PMID: 36396063 PMCID: PMC10463560 DOI: 10.1016/j.jtho.2022.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/14/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION We explored the association of respiratory and cardiometabolic comorbidities with NSCLC overall survival (OS) and lung cancer-specific survival (LCSS), by stage, in a large, multicontinent NSCLC pooled data set. METHODS On the basis of patients pooled from 11 International Lung Cancer Consortium studies with available respiratory and cardiometabolic comorbidity data, adjusted hazard ratios (aHRs) were estimated using Cox models for OS. LCSS was evaluated using competing risk Grey and Fine models and cumulative incidence functions. Logistic regression (adjusted OR [aOR]) was applied to assess factors associated with surgical resection. RESULTS OS analyses used patients with NSCLC with respiratory health or cardiometabolic health data (N = 16,354); a subset (n = 11,614) contributed to LCSS analyses. In stages I to IIIA NSCLC, patients with respiratory comorbidities had worse LCCS (stage IA aHR = 1.51, confidence interval [CI]: 1.17-1.95; stages IB-IIIA aHR = 1.20, CI: 1.06-1.036). In contrast, patients with stages I to IIIA NSCLC with cardiometabolic comorbidities had a higher risk of death from competing (non-NSCLC) causes (stage IA aHR = 1.34, CI: 1.12-1.69). The presence of respiratory comorbidities was inversely associated with having surgical resection (stage IA aOR = 0.54, CI: 0.35-0.83; stages IB-IIIA aOR = 0.57, CI: 0.46-0.70). CONCLUSIONS The presence of either cardiometabolic or respiratory comorbidities is associated with worse OS in stages I to III NSCLC. Patients with respiratory comorbidities were less likely to undergo surgery and had worse LCSS, whereas patients with cardiometabolic comorbidities had a higher risk of death from competing causes. As more treatment options for stages I to III NSCLC are introduced into the practice, accounting for cardiometabolic and respiratory comorbidities becomes essential in trial interpretation and clinical management.
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Affiliation(s)
- Miguel García-Pardo
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | - Amy Chang
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sabine Schmid
- Department of Medical Oncology, University Hospital Berne, Berne, Switzerland
| | - Mei Dong
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Catherine Brown
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Christiani
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hilary Aurora Tindel
- Division of Internal Medicine & Public Health and Vanderbilt Ingram Cancer Center (VICC), Vanderbilt University Medical Centre, Nashville, Tennessee
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Chu Chen
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jie Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Brid M Ryan
- Laboratory of Human Carcinogenesis, Centre for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - David Zaridze
- Russian N.N. Blokhin Cancer Research Centre, Moscow, Russia
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Leticia Ferro Leal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil; Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal
| | - Adonina Tardon
- IUOPA, University of Oviedo and ISPA (Health Research Institute of the Principality of Asturias) and CIBERESP, Asturias, Spain
| | - Guillermo Fernández-Tardon
- IUOPA, University of Oviedo and ISPA (Health Research Institute of the Principality of Asturias) and CIBERESP, Asturias, Spain
| | - Sanjay S Shete
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Hermann Brenner
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Network of Aging Research, Heidelberg University, Heidelberg, Germany
| | - Wei Xu
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rayjean J Hung
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Canada
| | - Geoffrey Liu
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Clinical outcome of patients with isolated central nervous system progression on first-line pertuzumab and trastuzumab treatment for HER2-positive metastatic breast cancer in a real-life cohort. Breast Cancer 2023; 30:329-341. [PMID: 36630013 DOI: 10.1007/s12282-022-01427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND More than 10% of HER2-positive metastatic breast cancer (mBC) will develop Central Nervous System (CNS) metastases as first and isolated site of relapse on trastuzumab and pertuzumab first-line therapy. However, few clinical data are available to guide the best strategy in this setting. METHODS Patients experiencing isolated CNS progression on trastuzumab and pertuzumab first-line therapy were retrospectively identified from the French Epidemiological Strategy and Medical Economics (ESME) real-life database between 2008 and 2016. RESULTS Among 995 patients treated with first-line trastuzumab and pertuzumab for HER2-positive mBC, 132 patients (13%) experienced isolated CNS progression with a median time of 12 months after mBC diagnosis. Twelves patients did not receive any treatment and were excluded from the analysis. Among the 120 patients considered, 76 (63%) received CNS-directed local therapy, 73 (60%) continued trastuzumab and pertuzumab, whereas 47 (39%) started another systemic treatment. After a median follow-up of 21 months, there was no difference in progression-free survival for patient who continued trastuzumab-pertuzumab or switched to another systemic treatment. In multivariate analysis, trastuzumab-pertuzumab continuation was associated with longer OS (HR 0,28 IC 95%: 0,14-0,54 p < 0,001). mOS was not reached (95% 37.6-NE) and was 23.2 months (95% CI 15.5-53.6) in patients who continued trastuzumab and pertuzumab therapy and in patients who switched for another systemic therapy, respectively. CONCLUSION In this real-life cohort, trastuzumab-pertuzumab continuation after local treatment for isolated CNS progression did not negatively impact PFS and OS. Prospective trials and assessment of new strategies are warranted in this specific situation.
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218
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Schneider JL, Lin JJ, Shaw AT. ALK-positive lung cancer: a moving target. NATURE CANCER 2023; 4:330-343. [PMID: 36797503 PMCID: PMC10754274 DOI: 10.1038/s43018-023-00515-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 01/10/2023] [Indexed: 02/18/2023]
Abstract
Anaplastic lymphoma kinase (ALK) is a potent oncogenic driver in lung cancer. ALK tyrosine kinase inhibitors yield significant benefit in patients with ALK fusion-positive (ALK+) lung cancers; yet the durability of response is limited by drug resistance. Elucidation of on-target resistance mechanisms has facilitated the development of next-generation ALK inhibitors, but overcoming ALK-independent resistance mechanisms remains a challenge. In this Review, we discuss the molecular underpinnings of acquired resistance to ALK-directed therapy and highlight new treatment approaches aimed at inducing long-term remission in ALK+ disease.
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Affiliation(s)
- Jaime L Schneider
- Massachusetts General Hospital Cancer Center and Department of Medicine, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jessica J Lin
- Massachusetts General Hospital Cancer Center and Department of Medicine, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alice T Shaw
- Massachusetts General Hospital Cancer Center and Department of Medicine, Boston, MA, USA.
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA.
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219
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Nishino M, Wei Z, Mazzola E, Hino T, Tseng SC, Sanchez ME, Hatabu H, Johnson BE, Awad MM. Tumor Volume Nadir in Patients With ALK-Rearranged Non-Small-Cell Lung Cancer Treated With Alectinib. JCO Precis Oncol 2023; 7:e2200603. [PMID: 36893377 DOI: 10.1200/po.22.00603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
PURPOSE Patients with oncogene-driven advanced non-small-cell lung cancer (NSCLC) treated with effective targeted therapy demonstrate characteristic tumor volume dynamics with initial response, nadir, and subsequent regrowth. This study investigated tumor volume nadir and time to nadir in patients with ALK-rearranged advanced NSCLC treated with alectinib. MATERIALS AND METHODS In patients with advanced ALK-rearranged NSCLC treated with alectinib monotherapy, tumor volume dynamics were evaluated on serial computed tomography (CT) scans using a previously validated CT tumor measurement technique. A linear regression model was built to predict tumor volume nadir. Time-to-event analyses were performed to evaluate time to nadir. RESULTS Among 45 patients who experienced initial volume decrease, 37 patients (25 with tumor regrowth and 12 without regrowth but >6 months follow-up) were studied for nadir volume (Vp). The linear model to predict tumor volume nadir was built using the baseline tumor volume (V0): V0-Vp = .696 × V0 + 5,326 (P < 2 × 10-16; adjusted R2 = 0.86). The percent volume changes at nadir (median, -90.9%, mean, -85.3%) showed larger decrease in patients who were treated with alectinib as first-line therapy than in the ≥2nd-line group and were independent of V0 and clinical variables. Time to nadir had a median of 11.5 months and was longer in the first-line group (P = .04). CONCLUSION The tumor nadir volume in patients with ALK-rearranged advanced NSCLC treated with alectinib can be predicted by the liner regression model and consists of approximately 30% of the baseline volume minus 5 cm3, providing additional insights into precision therapy monitoring and potential guides for local ablative therapy to prolong disease control.
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Affiliation(s)
- Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Zihan Wei
- Department of Data Science, Dana-Farber Cancer Institute, Boston MA
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston MA
| | - Takuya Hino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Shu-Chi Tseng
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Michelle E Sanchez
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Bruce E Johnson
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Mark M Awad
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
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Gene-Olaciregui N, Perez-Somarriba M, Santa-María V, Cruz O, Gómez-González S, Castañeda A, Suñol M, Rovira C, Muchart J, Hinojosa J, La Madrid AM, Lavarino C. Clinical and Molecular Evolution of an ALK-Driven Infant-Type Hemispheric Glioma Treated Sequentially With Second- and Third-Generation Anaplastic Lymphoma Kinase Inhibitors. JCO Precis Oncol 2023; 7:e2200547. [PMID: 36996378 DOI: 10.1200/po.22.00547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Affiliation(s)
- Nagore Gene-Olaciregui
- Laboratory of Molecular Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Marta Perez-Somarriba
- Neuro Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
- Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Vicente Santa-María
- Neuro Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ofelia Cruz
- Neuro Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Soledad Gómez-González
- Laboratory of Developmental Tumor Biology, Institut de Recerca Sant Joan de Déu, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Alicia Castañeda
- Pediatric Solid Tumor Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mariona Suñol
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Carlota Rovira
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jordi Muchart
- Department of Radiology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - José Hinojosa
- Department of Neurosurgery, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Andrés Morales La Madrid
- Neuro Oncology Unit, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Cinzia Lavarino
- Laboratory of Molecular Oncology, Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
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Zhong J, Bai H, Wang Z, Duan J, Zhuang W, Wang D, Wan R, Xu J, Fei K, Ma Z, Zhang X, Wang J. Treatment of advanced non-small cell lung cancer with driver mutations: current applications and future directions. Front Med 2023; 17:18-42. [PMID: 36848029 DOI: 10.1007/s11684-022-0976-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/05/2022] [Indexed: 03/01/2023]
Abstract
With the improved understanding of driver mutations in non-small cell lung cancer (NSCLC), expanding the targeted therapeutic options improved the survival and safety. However, responses to these agents are commonly temporary and incomplete. Moreover, even patients with the same oncogenic driver gene can respond diversely to the same agent. Furthermore, the therapeutic role of immune-checkpoint inhibitors (ICIs) in oncogene-driven NSCLC remains unclear. Therefore, this review aimed to classify the management of NSCLC with driver mutations based on the gene subtype, concomitant mutation, and dynamic alternation. Then, we provide an overview of the resistant mechanism of target therapy occurring in targeted alternations ("target-dependent resistance") and in the parallel and downstream pathways ("target-independent resistance"). Thirdly, we discuss the effectiveness of ICIs for NSCLC with driver mutations and the combined therapeutic approaches that might reverse the immunosuppressive tumor immune microenvironment. Finally, we listed the emerging treatment strategies for the new oncogenic alternations, and proposed the perspective of NSCLC with driver mutations. This review will guide clinicians to design tailored treatments for NSCLC with driver mutations.
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Affiliation(s)
- Jia Zhong
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hua Bai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianchun Duan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Zhuang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Di Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Rui Wan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiachen Xu
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Kailun Fei
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zixiao Ma
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xue Zhang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Suthapot P, Chiangjong W, Chaiyawat P, Choochuen P, Pruksakorn D, Sangkhathat S, Hongeng S, Anurathapan U, Chutipongtanate S. Genomics-Driven Precision Medicine in Pediatric Solid Tumors. Cancers (Basel) 2023; 15:cancers15051418. [PMID: 36900212 PMCID: PMC10000495 DOI: 10.3390/cancers15051418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
Over the past decades, several study programs have conducted genetic testing in cancer patients to identify potential genetic targets for the development of precision therapeutic strategies. These biomarker-driven trials have demonstrated improved clinical outcomes and progression-free survival rates in various types of cancers, especially for adult malignancies. However, similar progress in pediatric cancers has been slow due to their distinguished mutation profiles compared to adults and the low frequency of recurrent genomic alterations. Recently, increased efforts to develop precision medicine for childhood malignancies have led to the identification of genomic alterations and transcriptomic profiles of pediatric patients which presents promising opportunities to study rare and difficult-to-access neoplasms. This review summarizes the current state of known and potential genetic markers for pediatric solid tumors and provides perspectives on precise therapeutic strategies that warrant further investigations.
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Affiliation(s)
- Praewa Suthapot
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Department of Biomedical Science and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wararat Chiangjong
- Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Parunya Chaiyawat
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pongsakorn Choochuen
- Department of Biomedical Science and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Dumnoensun Pruksakorn
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Surasak Sangkhathat
- Department of Biomedical Science and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Suradej Hongeng
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Usanarat Anurathapan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
- Correspondence: (U.A.); or (S.C.)
| | - Somchai Chutipongtanate
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Correspondence: (U.A.); or (S.C.)
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De Castro J, Insa A, Collado-Borrell R, Escudero-Vilaplana V, Martínez A, Fernandez E, Sullivan I, Arrabal N, Carcedo D, Manzaneque A. Economic burden of locoregional and metastatic relapses in resectable early-stage non-small cell lung cancer in Spain. BMC Pulm Med 2023; 23:69. [PMID: 36809990 PMCID: PMC9942326 DOI: 10.1186/s12890-023-02356-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND There are scarce data of the costs of non-small cell lung cancer (NSCLC) recurrence in Spain. The objective of this study is to assess the economic burden of disease recurrence, for both locoregional and/or metastatic relapses, after appropriate early-stage NSCLC treatment in Spain. MATERIALS AND METHODS A two-round consensus panel of Spanish oncologists and hospital pharmacists was conducted to collect information on patient's flow, treatments, use of healthcare resources and sick leaves in patients with relapsed NSCLC. A decision-tree model was developed to calculate the economic burden of disease recurrence after appropriate early-stage NSCLC. Both direct and indirect costs were considered. Direct costs included drug acquisition and healthcare resources costs. Indirect costs were estimated using the human-capital approach. Unit costs were obtained from national databases (euros of 2022). A multi-way sensitivity analysis was performed to provide a range to the mean values. RESULTS Among a cohort of 100 patients with relapsed NSCLC, 45 patients would have locoregional relapse (36.3 would eventually progress to metastasis and 8.7 would be considered in remission) and 55 patients would have metastatic relapse. Over time, 91.3 patients would experience a metastatic relapse (55 as first relapse and 36.6 after previous locoregional relapse). The overall cost incurred by the 100-patients cohort is €10,095,846 (€9,336,782 direct costs, €795,064 indirect costs). The average cost of a locoregional relapse is €25,194 (€19,658 direct costs, €5536 indirect costs), while the average cost a patient with metastasis who receives up to 4 lines of treatment is €127,167 (€117,328 direct, €9839 indirect). CONCLUSIONS To our knowledge, this is the first study that specifically quantifies the cost of relapse in NSCLC in Spain. Our findings shown that the overall cost of a relapse after appropriate treatment of early-stage NSCLC patients is substantial, and it increases considerably in the metastatic relapse setting, mainly due to the high cost and long duration of first-line treatments.
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Affiliation(s)
- Javier De Castro
- grid.81821.320000 0000 8970 9163Hospital Universitario La Paz, Madrid, Spain
| | - Amelia Insa
- grid.411308.fHospital Clínico Universitario de Valencia, Valencia, Spain
| | - Roberto Collado-Borrell
- grid.410526.40000 0001 0277 7938Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Alex Martínez
- grid.411083.f0000 0001 0675 8654Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | | | - Ivana Sullivan
- grid.413396.a0000 0004 1768 8905Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Natalia Arrabal
- grid.476717.40000 0004 1768 8390Roche Farma S.A., Madrid, Spain
| | | | - Alba Manzaneque
- grid.414875.b0000 0004 1794 4956Hospital Universitari Mútua Terrassa, Barcelona, Spain
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Development and validation of a decision model for the evaluation of novel lung cancer treatments in the Netherlands. Sci Rep 2023; 13:2349. [PMID: 36759641 PMCID: PMC9911639 DOI: 10.1038/s41598-023-29286-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
Recent discoveries in molecular diagnostics and drug treatments have improved the treatment of patients with advanced (inoperable) non-squamous non-small cell lung cancer (NSCLC) from solely platinum-based chemotherapy to more personalized treatment, including targeted therapies and immunotherapies. However, these improvements come at considerable costs, highlighting the need to assess their cost-effectiveness in order to optimize lung cancer care. Traditionally, cost-effectiveness models for the evaluation of new lung cancer treatments were based on the findings of the randomized control trials (RCTs). However, the strict RCT inclusion criteria make RCT patients not representative of patients in the real-world. Patients in RCTs have a better prognosis than patients in a real-world setting. Therefore, in this study, we developed and validated a diagnosis-treatment decision model for patients with advanced (inoperable) non-squamous NSCLC based on real-world data in the Netherlands. The model is a patient-level microsimulation model implemented as discrete event simulation with five health events. Patients are simulated from diagnosis to death, including at most three treatment lines. The base-model (non-personalized strategy) was populated using real-world data of patients treated with platinum-based chemotherapy between 2008 and 2014 in one of six Dutch teaching hospitals. To simulate personalized care, molecular tumor characteristics were incorporated in the model based on the literature. The impact of novel targeted treatments and immunotherapies was included based on published RCTs. To validate the model, we compared survival under a personalized treatment strategy with observed real-world survival. This model can be used for health-care evaluation of personalized treatment for patients with advanced (inoperable) NSCLC in the Netherlands.
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225
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Scorsetti M, Navarria P, Cozzi L, Clerici E, Bellu L, Franceschini D, Marzo AM, Franzese C, Torri V, Reggiori G, Lobefalo F, Raspagliesi L, Attuati L, Pessina F, Franzini A, Picozzi P, Tomatis S. Radiosurgery of limited brain metastases from primary solid tumor: results of the randomized phase III trial (NCT02355613) comparing treatments executed with a specialized or a C-arm linac-based platform. Radiat Oncol 2023; 18:28. [PMID: 36750848 PMCID: PMC9906937 DOI: 10.1186/s13014-023-02216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Comparative prospective data regarding different radiosurgery (SRS) modalities for treating brain metastases (BMs) from solid tumors are not available. To investigate with a single institute phase III randomized trial whether SRS executed with linac (Arm-B) is superior to a dedicated multi-source gamma-ray stereotactic platform (Arm-A). METHODS Adults patients with 1-4 BMs from solid tumors up to 30 mm in maximum diameter were randomly assigned to arms A and B. The primary endpoint was cumulative incidence of symptomatic (grade 2-3) radionecrosis (CIRN). Secondary endpoints were local progression cumulative incidence (CILP), distant brain failure, disease-free survival (DFS), and overall survival (OS). RESULTS A total of 251 patients were randomly assigned to Arm-A (121) or Arm-B (130). The 1-year RN cumulative incidence was 6.7% in whole cohort, 3.8% (95% CI 1.9-7.4%) in Arm-B, and 9.3% (95% CI 6.2-13.8%) in the Arm-A (p = 0.43). CIRN was influenced by target volume irradiated only for the Arm-A (p << 0.001; HR 1.36 [95% CI 1.25-1.48]). Symptomatic RN occurred in 56 cases at a median time of 10.3 months (range 1.15-54.8 months), 27 in the Arm-B at a median time of 15.9 months (range 4.9-54.8 months), and 29 in the Arm-A at a median time of 6.9 months (1.2-32.3 months), without statistically significant differences between the two arms. No statistically significant differences were recorded between the two arms in CILP, BDF, DFS or OS. The mean beam-on time to deliver SRS was 49.0 ± 36.2 min in Arm-A, and 3.1 ± 1.6 min in Arm-B. CONCLUSIONS Given the technical differences between the treatment platforms investigated in this single-institution study, linac-based SRS (Arm-B) did not lead to significantly lower grade 2-3 RN rates versus the multi-source gamma-ray system (Arm-A) in a population of patients with limited brain metastases of small volume. No significant difference in local control was observed between both arms. For Arm-B, the treatment delivery time was significantly lower than for Arm-A. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02355613.
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Affiliation(s)
- Marta Scorsetti
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Luca Cozzi
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Elena Clerici
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Luisa Bellu
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Davide Franceschini
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Antonio Marco Marzo
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Ciro Franzese
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Valter Torri
- grid.4527.40000000106678902Oncology Department, IRCCS Istituto Mario Negri, Milan, Italy
| | - Giacomo Reggiori
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Francesca Lobefalo
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
| | - Luca Raspagliesi
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Luca Attuati
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Federico Pessina
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy ,grid.452490.eDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Italy
| | - Andrea Franzini
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Piero Picozzi
- grid.417728.f0000 0004 1756 8807Neurosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan Italy
| | - Stefano Tomatis
- grid.417728.f0000 0004 1756 8807Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan Italy
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Biological and Genetic Mechanisms of COPD, Its Diagnosis, Treatment, and Relationship with Lung Cancer. Biomedicines 2023; 11:biomedicines11020448. [PMID: 36830984 PMCID: PMC9953173 DOI: 10.3390/biomedicines11020448] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronic adult diseases, with significant worldwide morbidity and mortality. Although long-term tobacco smoking is a critical risk factor for this global health problem, its molecular mechanisms remain unclear. Several phenomena are thought to be involved in the evolution of emphysema, including airway inflammation, proteinase/anti-proteinase imbalance, oxidative stress, and genetic/epigenetic modifications. Furthermore, COPD is one main risk for lung cancer (LC), the deadliest form of human tumor; formation and chronic inflammation accompanying COPD can be a potential driver of malignancy maturation (0.8-1.7% of COPD cases develop cancer/per year). Recently, the development of more research based on COPD and lung cancer molecular analysis has provided new light for understanding their pathogenesis, improving the diagnosis and treatments, and elucidating many connections between these diseases. Our review emphasizes the biological factors involved in COPD and lung cancer, the advances in their molecular mechanisms' research, and the state of the art of diagnosis and treatments. This work combines many biological and genetic elements into a single whole and strongly links COPD with lung tumor features.
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227
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Pruis MA, Veerman GDM, Hassing HC, Lanser DAC, Paats MS, van Schaik RHN, Mathijssen RHJ, Manintveld O, Dingemans AMC. Cardiac Toxicity of Alectinib in Patients With ALK+ Lung Cancer: Outcomes of Cardio-Oncology Follow-Up. JACC CardioOncol 2023; 5:102-113. [PMID: 36875894 PMCID: PMC9982223 DOI: 10.1016/j.jaccao.2022.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 01/18/2023] Open
Abstract
Background Anaplastic lymphoma kinase (ALK) translocations in metastatic non-small cell lung cancer (3% to 7%) predict for response to ALK-inhibitors (eg, alectinib, first line), resulting in a 5-year survival rate of ∼60% and median progression-free survival of 34.8 months. Although the overall toxicity rate of alectinib is acceptable, unexplained adverse events, including edema and bradycardia, may indicate potential cardiac toxicity. Objectives This study's aim was to investigate the cardiotoxicity profile and exposure-toxicity relationship of alectinib. Methods Between April 2020 and September 2021, 53 patients with ALK-positive non-small cell lung cancer treated with alectinib were included. Patients starting with alectinib after April 2020 underwent a cardiac work-up at start, at 6 months and at 1 year at the cardio-oncology outpatients' clinic. Patients already receiving alectinib >6 months underwent 1 cardiac evaluation. Bradycardia, edema, and severe alectinib toxicity (grade ≥3 and grade ≥2 adverse events leading to dose modifications) data were collected. Alectinib steady-state trough concentrations were used for exposure-toxicity analyses. Results Left ventricular ejection fraction remained stable in all patients who underwent an on-treatment cardiac evaluation (n = 34; median 62%; IQR: 58%-64%). Twenty-two patients (42%) developed alectinib-related bradycardia (6 symptomatic bradycardia). One patient underwent a pacemaker implantation for severe symptomatic bradycardia. Severe toxicity was significantly associated with a 35% higher alectinib mean Ctrough (728 vs 539 ng/mL, SD = 83 ng/mL; 1-sided P = 0.015). Conclusions No patients showed signs of a diminished left ventricular ejection fraction. Alectinib caused more bradycardia than previously reported (42%) with some instances of severe symptomatic bradycardia. Patients with severe toxicity generally had an elevated exposure above the therapeutic threshold.
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Key Words
- AE, adverse event
- ALK, anaplastic lymphoma kinase
- CV, cardiovascular
- ECG, electrocardiogram
- IVC, inferior vena cava
- LVEF, left ventricular ejection fraction
- MET, mesenchymal epithelial transition
- NSCLC, non-small cell lung cancer
- OV, outpatient visit
- PK, pharmacokinetic
- TKI, tyrosine kinase inhibitor
- alectinib
- anaplastic lymphoma kinase
- bradycardia
- cardio-oncology
- non-small cell lung cancer
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Affiliation(s)
- Melinda A Pruis
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands.,Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - G D Marijn Veerman
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - H Carlijne Hassing
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Daan A C Lanser
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Marthe S Paats
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Olivier Manintveld
- Department of Cardiology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
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Naso J, Lo YC, Sholl LM. Updates in pathology and molecular diagnostics to inform the evolving landscape of thoracic surgery and oncology. J Surg Oncol 2023; 127:244-257. [PMID: 36630101 DOI: 10.1002/jso.27184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
The pathologic assessment of lung cancers provides essential guidance to the surgeon and oncologist who are considering the best treatment strategies for patients with both early and advanced-stage disease. The management of patients with lung cancer is predicated first and foremost on access to an accurate diagnosis, even when the sample size is limited, as is often the case with use of modern, minimally invasive sampling techniques. Once the diagnosis and disease stage are established, predictive biomarker testing may be essential, particularly for those patients with nonsmall cell lung carcinoma (NSCLC) being considered for immunotherapy or genomic biomarker-driven targeted therapy. This review will discuss the best practices for the diagnosis of NSCLC using morphology and immunohistochemistry, thus providing the surgeon with needed information to understand and critically evaluate pathology reports. Controversial and evolving topics including tumor spread through airspaces, evaluation of multiple tumors, and staging based on invasive tumor size will be addressed. Clinical genomic profiling in NSCLC is driven by published guidelines and reflects evidence based on clinical trials and regulatory approvals. In this fast-moving space, surgeons should be aware of the critical immunohistochemical and genomic biomarkers that drive systemic therapy decisions and anticipate when such testing will be required, both to ensure adequate sampling and to advise the pathologist when tumor material will be required for biomarker analysis. The basic approaches to and sample requirements for molecular biomarker testing will be addressed. As biomarker testing moves exclusively from advanced-stage patients into earlier stage disease, the surgeon should be aware of the relevant markers and work with the pathologist and oncologist to ensure that this information is available to facilitate timely access to therapies not just in the advanced setting, but in consideration of neoadjuvant and adjuvant care.
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Affiliation(s)
- Julia Naso
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ying-Chun Lo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Kinoshita F, Oku Y, Takamori S, Fujishita T, Toyozawa R, Ito K, Shoji F, Okamoto T. Necitumumab plus gemcitabine and cisplatin in previously treated lung squamous cell carcinoma. Invest New Drugs 2023; 41:168-172. [PMID: 36331673 DOI: 10.1007/s10637-022-01312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The efficacy and safety of the anti-EGFR antibody necitumumab combined with gemcitabine and cisplatin (N + GC) in the first-line treatment of advanced lung squamous cell carcinoma (LSCC) have been proven. However, the efficacy and safety of N + GC in the second line or later treatment remain unclear. METHODS Eleven patients who received N + GC for advanced-stage or recurrent LSCC were enrolled. We retrospectively assessed the patients' clinical characteristics and efficacy and safety of treatment. RESULTS The median patient age was 73 years (range, 63-77 years). The cohort included nine (81.8%) men and two (18.2%) women. Two (18.2%) patients had postoperative recurrence, and one (9.1%), three (27.3%), one (9.1%), and four (36.4%) patients were diagnosed with stage IIIA, IIIB, IVA, and IVB disease, respectively. Concerning the best overall response, partial response was achieved in five (45.5%) patients, four (36.4%) patients displayed stable disease, and two (18.2%) patients were not evaluable. Median progression-free survival was 6.8 months (range, 1.4-10.3 months). The grade 3 or higher neutropenia, thrombocytopenia, and anemia occurred in six (54.5%), three (27.3%), and two (18.2%) patients, respectively. Additionally, grade 3 skin reaction, rash, lung infection, duodenal ulcer, and febrile neutropenia were observed in one (9.1%) patient each. Two (18.2%) patients required treatment interruption because of adverse events. CONCLUSION N + GC displayed good efficacy in the second line or later treatment among patients with LSCC. This study suggested that N + GC is a useful option even after second-line treatment of advanced-stage or recurrent LSCC, although the management of adverse events is essential.
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Affiliation(s)
- Fumihiko Kinoshita
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan.
| | - Yuka Oku
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan
| | - Takatoshi Fujishita
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan
| | - Kensaku Ito
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan
| | - Fumihiro Shoji
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, 811-1395, Fukuoka, Japan
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230
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Moffat GT, Davidson CM, Gregg R. Advanced secondary lung adenocarcinoma, ALK mutated, from treatment of childhood osteopetrosis. Pediatr Blood Cancer 2023; 70:e29922. [PMID: 35969185 DOI: 10.1002/pbc.29922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 01/09/2023]
Affiliation(s)
| | - Christopher M Davidson
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Richard Gregg
- Department of Oncology, Queen's University, Kingston, Ontario, Canada.,Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada
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231
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Riudavets M, Planchard D. An update on lorlatinib: a novel first line treatment for ALK-positive advanced lung cancer. Expert Opin Pharmacother 2023; 24:291-299. [PMID: 36542835 DOI: 10.1080/14656566.2022.2161880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis of ALK-rearranged non-small cell lung cancer (NSCLC), but these patients will eventually develop resistance and progression of disease after 10 months of first-generation and more than 30 months after second-generation TKIs. Lorlatinib is a third-generation highly selective ALK-TKI capable of inducing significant and durable CNS responses and overcoming known ALK resistance mutations. AREAS COVERED This review summarizes the mechanism of action, efficacy, and safety of lorlatinib in ALK-positive NSCLC. The authors provide their expert opinions on the use of this drug, including its future prospects. EXPERT OPINION Lorlatinib has shown good efficacy and safety in ALK-positive NSCLC patients progressing to first- and second-generation ALK-TKIs. The phase III trial CROWN evaluating lorlatinib as first-line therapy has provided promising results; however, the comparing arm was crizotinib, supplanted now by second-generation agents. Whether lorlatinib can replace them as upfront strategy is a relevant question that still remains open. In our opinion, longer follow-up and face-to-face studies are required to determine which is the best treatment sequence strategy. The advent of liquid biopsy will contribute to treatment tailoring according to the genomic profile at progression.
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Affiliation(s)
- Mariona Riudavets
- Cancer Medicine Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - David Planchard
- Cancer Medicine Department, Gustave Roussy Cancer Campus, Villejuif, France
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Tamiya Y, Matsumoto S, Zenke Y, Yoh K, Ikeda T, Shibata Y, Kato T, Nishino K, Nakamura A, Furuya N, Miyamoto S, Kuyama S, Nomura S, Ikeno T, Udagawa H, Sugiyama E, Nosaki K, Izumi H, Sakai T, Hashimoto N, Goto K. Large-scale clinico-genomic profile of non-small cell lung cancer with KRAS G12C: Results from LC-SCRUM-Asia study. Lung Cancer 2023; 176:103-111. [PMID: 36634571 DOI: 10.1016/j.lungcan.2022.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION KRAS G12C is an oncogenic driver mutation, accounting for approximately 14% of Caucasian patients with non-small cell lung cancer (NSCLC). Recently, several KRAS G12C-targeted drugs have been developed; however, the clinico-genomic characteristics of NSCLC patients with KRAS G12C remain unclear. MATERIALS AND METHODS Based on the large-scale prospective lung cancer genomic screening project (LC-SCRUM-Asia) database, the clinico-genomic characteristics and therapeutic outcomes of NSCLC patients with KRAS G12C were evaluated. RESULTS From March 2015 to March 2021, 10,023 NSCLC patients were enrolled in LC-SCRUM-Asia. KRAS mutations were detected in 1258 patients (14 %), including G12C in 376 (4.0 %), G12D in 289 (3.1 %) and G12V in 251 (2.7 %). The proportions of males and smokers were higher in patients with KRAS G12C than in those with KRAS non-G12C mutations (males: 73 % vs 63 %, p < 0.001; smokers: 89 % vs 76 %, p < 0.001). KRAS G12C-positive tumors showed a higher tumor mutation burden (TMB) (mean, 8.1 mut/Mb, p < 0.001) and a higher percentage of tumors with programmed cell death ligand-1 (PD-L1) expression ≥50 % (52 %, p = 0.08). The overall survival in patients with KRAS G12C (median, 24.6 months) was not different between patients with other mutation subtypes (G12V: 18.2 months, p = 0.23; G12D: 20.6 months, p = 0.65; other KRAS mutations: 18.3 months, p = 0.20). Among KRAS-mutated patients who received immune checkpoint inhibitors (ICIs), the progression-free survival in G12C-positive patients (median, 3.4 months) was similar to that in G12V-positive patients (4.2 months, p = 0.90), but significantly longer than that in G12D- (2.0 months, p = 0.02) and other KRAS mutation-positive patients (2.5 months, p = 0.02). CONCLUSIONS The frequencies of KRAS G12C were lower in Asian than in Caucasian NSCLC patients. Among the KRAS-mutated NSCLC patients, G12C-positive tumors showed increased immunogenicity, such as high TMB and high PD-L1 expression, and potential sensitivity to ICIs.
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Affiliation(s)
- Yutaro Tamiya
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - Yoshitaka Zenke
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kiyotaka Yoh
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takaya Ikeda
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuji Shibata
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Shogo Nomura
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takashi Ikeno
- Clinical Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hibiki Udagawa
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Eri Sugiyama
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiroki Izumi
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tetsuya Sakai
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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First-line crizotinib therapy is effective for a novel SEC31A-anaplastic lymphoma kinase fusion in a patient with stage IV lung adenocarcinoma: a case report and literature reviews. Anticancer Drugs 2023; 34:294-301. [PMID: 36730620 DOI: 10.1097/cad.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Anaplastic lymphoma kinase (ALK) fusion was found in 3-7% of all patients with nonsmall cell lung cancer. The efficacy of ALK-tyrosine kinase inhibitor (ALK-TKI) in EML4-ALK has been extensively studied, whereas little evidence is available on its efficacy in rare ALK fusions. Here, we report the performance of crizotinib in a 50-year-old male lung adenocarcinoma patient with a novel rare SEC31A-ALK fusion. Computed tomography (CT) scan revealed multiple patchy high-density shadows in both lungs. The larger ones are located near the spine in the right lung lower lobe (55 × 34 mm) and the left hilar region (45 × 26 mm), with multiple enlarged mediastinal and axillary lymph nodes. Biopsy by bronchoscopy revealed invasive adenocarcinoma. The pathological stage of T4N3M1b (clinical stage: IVA) was confirmed. Next-generation sequencing revealed SEC31A: exon20~ALK: exon20 fusion, ABCB1 amplification, FGF19 amplification, DAXX p.S213L, MUTYH p.R19*(germline mutation and pathogenic) with tumor mutational burden at 3.2 mutations/Mb, microsatellite stable, proficient mismatch repair and PD-L1 positive [immunohistochemistry, tumor proportion score(TPS) 1-49% (TPS = 25%)]. Based on these findings, crizotinib was recommended for the first-line treatment at 250 mg twice daily. The first CT assessment after 2-month therapy showed partial response (PR) for the two larger lesions, multiple shadows and nodules in both lungs and the mediastinal and axillary lymph nodes. Crizotinib at 250 mg twice a day was applied in the following 9 months. Assessment at every 3 months (up to 1-year after diagnosis) showed further absorption for all lesions (continuous PR). We reported a novel rare ALK fusion SEC31A: EXON20~ALK: exon20 and showed the effectiveness of crizotinib against the fusion. This study provided strong evidence for the efficacy of ALK-TKI for rare ALK fusion.
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234
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Nagasaka M, Ou SHI. CROWN 2022 Second Interim Updates: When Will Be the Coronation of Lorlatinib? J Thorac Oncol 2023; 18:139-142. [PMID: 36460598 DOI: 10.1016/j.jtho.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/02/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Misako Nagasaka
- Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, California; Division of Neurology, Department of Internal Medicine, St. Marianna University, Kawasaki, Kanagawa, Japan
| | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California Irvine School of Medicine, Orange, California.
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Allmann V, Dyntar D, Lehnick D, Dressler M, Zeidler K, Niederberger P, Godau J, Diebold J, Gautschi O. Overall survival and role of programmed death ligand 1 expression in patients with metastatic non-small-cell lung cancer and immunotherapy: an observational study from central Switzerland. Swiss Med Wkly 2023; 153:40039. [PMID: 36787492 DOI: 10.57187/smw.2023.40039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND In clinical trials, therapy with immune checkpoint inhibitors has improved the survival of patients with metastatic non-small-cell lung cancer (NSCLC). These trials were important for drug approval and for defining new treatment standards but the effect of checkpoint inhibitors in patients treated outside of clinical trials is not well known. The goal of this study was to assess the effect of immunotherapy on the overall survival of patients with metastatic NSCLC in the region of central Switzerland. MATERIALS AND METHODS The study included 274 patients with histologically confirmed metastatic (stage IV) NSCLC in central Switzerland in the years 2015 to 2018. Patients with NSCLC and actionable driver mutations were excluded. Patients with checkpoint inhibitor treatment (immuno-oncology [IO] group, n = 122) were compared with patients without checkpoint inhibitor treatment (no-IO group, n = 152). Baseline demographics, disease characteristics and therapies applied were collected retrospectively. The primary endpoint was median overall survival calculated either from diagnosis or from the start of checkpoint inhibitor therapy to death or data cut-off (21 July 2021). We used the Kaplan-Meier method and an adjusted Cox proportional-hazards regression model. The expression of programmed-death ligand 1 (PD-L1) on tumour cells was used for exploratory analysis. RESULTS Patients had a median age of 68.4 years, most were male (61.7%) and more than half were current or former smokers (65%). A test for PD-L1 expression was available for 55.8% of the tumours. Patients in the IO group were younger than patients in the no-IO group. Among the 122 patients in the IO group, the median overall survival was 15 months (95% confidence interval [CI] 12-20). In the no-IO group, the median overall survival was 4 months (95% CI 3-7) with chemotherapy and 2 months (95% CI 1-2) with best supportive care. Patients with high (≥50%) PD-L1 expression and checkpoint inhibitor therapy had a slightly longer overall survival than patients with low PD-L1 and checkpoint inhibitor therapy. CONCLUSION These results suggest that treatment with checkpoint inhibitors improves overall survival in patients with metastatic NSCLC and that PD-L1 expression could have a predictive value in patients treated outside of clinical trials. Further studies are needed to study the magnitude of the benefit of checkpoint inhibitors according to molecular NSCLC subtype.
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Affiliation(s)
| | - Daniela Dyntar
- Cancer Registry of Central Switzerland, Cantonal Hospital Lucerne, Switzerland
| | - Dirk Lehnick
- Biostatistics and Methodology, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Marco Dressler
- Department of Medical Oncology, Clinic Hirslanden St Anna, Lucerne, Switzerland
| | - Kristin Zeidler
- Department of Medical Oncology, Cantonal Hospital Nidwalden, Stans, Switzerland
| | | | - Jeanne Godau
- Department of Medical Oncology, Cantonal Hospital Uri, Altdorf, Switzerland
| | - Joachim Diebold
- Institute of Pathology, Cantonal Hospital Lucerne, Switzerland
| | - Oliver Gautschi
- University of Bern and Cantonal Hospital of Lucerne, Switzerland
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Leiva O, Bohart I, Ahuja T, Park D. Off-Target Effects of Cancer Therapy on Development of Therapy-Induced Arrhythmia: A Review. Cardiology 2023; 148:324-334. [PMID: 36702116 PMCID: PMC10614257 DOI: 10.1159/000529260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Advances in cancer therapeutics have improved overall survival and prognosis in this patient population; however, this has come at the expense of cardiotoxicity including arrhythmia. SUMMARY Cancer and its therapies are associated with cardiotoxicity via several mechanisms including inflammation, cardiomyopathy, and off-target effects. Among cancer therapies, anthracyclines and tyrosine kinase inhibitors (TKIs) are particularly known for their pro-arrhythmia effects. In addition to cardiomyopathy, anthracyclines may be pro-arrhythmogenic via reactive oxygen species (ROS) generation and altered calcium handling. TKIs may mediate their cardiotoxicity via inhibition of off-target tyrosine kinases. Ibrutinib-mediated inhibition of CSK may be responsible for the increased prevalence of atrial fibrillation. Further investigation is warranted to further elucidate the mechanisms behind arrhythmias in cancer therapies. KEY MESSAGES Arrhythmias are a common cardiotoxicity of cancer therapies. Cancer therapies may induce arrhythmias via off-target effects. Understanding the mechanisms underlying arrhythmogenesis associated with cancer therapies may help design cancer therapies that can avoid these toxicities.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Isaac Bohart
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Tania Ahuja
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - David Park
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA
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Misawa K, Nakamichi S, Iida H, Nagano A, Mikami E, Tozuka T, Matsumoto M, Miyanaga A, Noro R, Kubota K, Yamaguchi H, Seike M. Alectinib-Induced Severe Hemolytic Anemia in a Patient with ALK-Positive Non-Small Cell Lung Cancer: A Case Report. Onco Targets Ther 2023; 16:65-69. [PMID: 36718244 PMCID: PMC9884059 DOI: 10.2147/ott.s398375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Alectinib is a selective anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor as standard therapy for ALK-rearranged non-small cell lung cancer (NSCLC). Hemolytic anemia is considered as a rare but significant adverse event with alectinib. Here, we report a case of a 73-year-old female with lung adenocarcinoma, harbouring an ALK fusion gene, who received alectinib as second-line therapy and developed gradually progressive grade 4 (6.4 g/dL) drug-induced hemolytic anemia (DIHA) after complete response. We discontinued alectinib and performed a blood transfusion for the severe anemia. The anemia improved with no recurrence of lung adenocarcinoma over 10 months. Regular hematologic monitoring and the possibility of DIHA should be considered in case of progressive hemolytic anemia during alectinib treatment.
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Affiliation(s)
- Kazuhito Misawa
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan,Correspondence: Shinji Nakamichi, Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan, Tel +81-3-3822-2131, Email
| | - Hiroki Iida
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Atsuhiro Nagano
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Erika Mikami
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Masaru Matsumoto
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Rintaro Noro
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Kaoru Kubota
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Hiroki Yamaguchi
- Department of Hematology, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
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Comparative Efficacy of ALK Inhibitors for Treatment-Naïve ALK-Positive Advanced Non-Small Cell Lung Cancer with Central Nervous System Metastasis: A Network Meta-Analysis. Int J Mol Sci 2023; 24:ijms24032242. [PMID: 36768562 PMCID: PMC9917367 DOI: 10.3390/ijms24032242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Central nervous system (CNS) metastases and acquired resistance complicate the treatment of anaplastic lymphoma kinase (ALK) rearrangement-positive (ALK-p) advanced non-small cell lung cancer (NSCLC). Thus, this review aimed to provide a comprehensive overview of brain metastasis, acquired resistance, and prospects for overcoming these challenges. A network meta-analysis of relevant phase III randomized controlled trials was performed to compare the efficacies of multiple ALK inhibitors by drug and generation in overall patients with ALK-p untreated advanced NSCLC and a subgroup of patients with CNS metastases. The primary endpoint was progression-free survival (PFS). Generation-specific comparison results showed that third-generation ALK inhibitors were significantly more effective than second-generation ALK inhibitors in prolonging the PFS of the subgroup of patients with CNS metastases. Drug-specific comparison results demonstrated that lorlatinib was the most effective in prolonging PFS, followed by brigatinib, alectinib, ensartinib, ceritinib, crizotinib, and chemotherapy. While lorlatinib was superior to brigatinib for PFS in the overall patient population, no significant difference between the two was found in the subgroup of patients with CNS metastases. These results can serve as a foundation for basic, clinical, and translational research and guide clinical oncologists in developing individualized treatment strategies for patients with ALK-p, ALK inhibitor-naive advanced NSCLC.
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Krämer AS, Adeberg S, Kronsteiner D, König L, Schunn F, Bozorgmehr F, Christopoulos P, Eichkorn T, Schiele A, Hahnemann L, Rieken S, Debus J, Shafie RAE. Upfront and Repeated Stereotactic Radiosurgery in Patients With Brain Metastases From NSCLC. Clin Lung Cancer 2023; 24:269-277. [PMID: 36803615 DOI: 10.1016/j.cllc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Approximately 40% of non-small-cell lung cancer (NSCLC) patients develop brain metastases (BM). Stereotactic radiosurgery (SRS) instead of whole-brain radiotherapy (WBRT) is increasingly administered as an upfront treatment to patients with a limited number of BM. We present outcomes and validation of prognostic scores for these patients treated with upfront SRS. METHODS We retrospectively analyzed 199 patients with a total of 268 SRS courses for 539 brain metastases. Median patient age was 63 years. For larger BM, dose reduction to 18 Gy or hypofractionated SRS in 6 fractions was applied. We analyzed the BMV-, the RPA-, the GPA- and the lung-mol GPA score. Cox proportional hazards models with univariate and multivariate analyses were fitted for overall survival (OS) and intracranial progression-free survival (icPFS). RESULTS Sixty-four patients died, 7 of them of neurological causes. Thirty eight patients (19,3%) required a salvage WBRT. Median OS was 38, 8 months (IQR: 6-NA). In univariate analysis as well as multivariate analysis, the Karnofsky performance scale index (KPI) ≥90% (P = 0, 012 and P = 0, 041) remained as independent prognostic factor for longer OS. All 4 prognostic scoring indices could be validated for OS assessment (BMV P = 0, 007; RPA P = 0, 026; GPA P = 0, 003; lung-mol GPA P = 0, 05). CONCLUSION In this large cohort of NSCLC patients with BM treated with upfront and repeated SRS, OS was markedly favourable, in comparison to literature. Upfront SRS is an effective treatment approach in those patients and can decidedly reduce the impact of BM on overall prognosis. Furthermore, the analysed scores are useful prognostic tools for OS prediction.
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Affiliation(s)
- Anna S Krämer
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany.
| | - Sebastian Adeberg
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Dorothea Kronsteiner
- Institut für Medizinische Biometrie (IMB), Universitätsklinikum Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Laila König
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Fabian Schunn
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | | | | | - Tanja Eichkorn
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Annabella Schiele
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Laura Hahnemann
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Stefan Rieken
- Universitätsmedizin Göttingen, Klinik für Strahlentherapie und Radioonkologie, Göttingen, Lower Saxony, Germany
| | - Jürgen Debus
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany
| | - Rami A El Shafie
- Universitätsklinikum Heidelberg, Abteilung RadioOnkologie und Strahlentherapie, Heidelberg, Baden-Württemberg, Germany; Universitätsmedizin Göttingen, Klinik für Strahlentherapie und Radioonkologie, Göttingen, Lower Saxony, Germany
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240
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Corcoran RB. Line by Line: Distinct Patterns of Anti-EGFR Antibody Resistance by Line of Therapy. J Clin Oncol 2023; 41:436-438. [PMID: 36480767 DOI: 10.1200/jco.22.01922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ryan B Corcoran
- Massachusetts General Hospital Cancer Center and Department of Medicine Harvard Medical School, Boston, MA
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241
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Goyal L, Meric-Bernstam F, Hollebecque A, Valle JW, Morizane C, Karasic TB, Abrams TA, Furuse J, Kelley RK, Cassier PA, Klümpen HJ, Chang HM, Chen LT, Tabernero J, Oh DY, Mahipal A, Moehler M, Mitchell EP, Komatsu Y, Masuda K, Ahn D, Epstein RS, Halim AB, Fu Y, Salimi T, Wacheck V, He Y, Liu M, Benhadji KA, Bridgewater JA. Futibatinib for FGFR2-Rearranged Intrahepatic Cholangiocarcinoma. N Engl J Med 2023; 388:228-239. [PMID: 36652354 DOI: 10.1056/nejmoa2206834] [Citation(s) in RCA: 122] [Impact Index Per Article: 122.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Alterations in fibroblast growth factor receptor 2 (FGFR2) have emerged as promising drug targets for intrahepatic cholangiocarcinoma, a rare cancer with a poor prognosis. Futibatinib, a next-generation, covalently binding FGFR1-4 inhibitor, has been shown to have both antitumor activity in patients with FGFR-altered tumors and strong preclinical activity against acquired resistance mutations associated with ATP-competitive FGFR inhibitors. METHODS In this multinational, open-label, single-group, phase 2 study, we enrolled patients with unresectable or metastatic FGFR2 fusion-positive or FGFR2 rearrangement-positive intrahepatic cholangiocarcinoma and disease progression after one or more previous lines of systemic therapy (excluding FGFR inhibitors). The patients received oral futibatinib at a dose of 20 mg once daily in a continuous regimen. The primary end point was objective response (partial or complete response), as assessed by independent central review. Secondary end points included the response duration, progression-free and overall survival, safety, and patient-reported outcomes. RESULTS Between April 16, 2018, and November 29, 2019, a total of 103 patients were enrolled and received futibatinib. A total of 43 of 103 patients (42%; 95% confidence interval, 32 to 52) had a response, and the median duration of response was 9.7 months. Responses were consistent across patient subgroups, including patients with heavily pretreated disease, older adults, and patients who had co-occurring TP53 mutations. At a median follow-up of 17.1 months, the median progression-free survival was 9.0 months and overall survival was 21.7 months. Common treatment-related grade 3 adverse events were hyperphosphatemia (in 30% of the patients), an increased aspartate aminotransferase level (in 7%), stomatitis (in 6%), and fatigue (in 6%). Treatment-related adverse events led to permanent discontinuation of futibatinib in 2% of the patients. No treatment-related deaths occurred. Quality of life was maintained throughout treatment. CONCLUSIONS In previously treated patients with FGFR2 fusion or rearrangement-positive intrahepatic cholangiocarcinoma, the use of futibatinib, a covalent FGFR inhibitor, led to measurable clinical benefit. (Funded by Taiho Oncology and Taiho Pharmaceutical; FOENIX-CCA2 ClinicalTrials.gov number, NCT02052778.).
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Affiliation(s)
- Lipika Goyal
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Funda Meric-Bernstam
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Antoine Hollebecque
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Juan W Valle
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Chigusa Morizane
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Thomas B Karasic
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Thomas A Abrams
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Junji Furuse
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Robin K Kelley
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Philippe A Cassier
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Heinz-Josef Klümpen
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Heung-Moon Chang
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Li-Tzong Chen
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Josep Tabernero
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Do-Youn Oh
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Amit Mahipal
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Markus Moehler
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Edith P Mitchell
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Yoshito Komatsu
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Kunihiro Masuda
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Daniel Ahn
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Robert S Epstein
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Abdel-Baset Halim
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Yao Fu
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Tehseen Salimi
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Volker Wacheck
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Yaohua He
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Mei Liu
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - Karim A Benhadji
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
| | - John A Bridgewater
- From the Department of Medicine, Stanford University School of Medicine, and the Stanford Cancer Center, Palo Alto (L.G.), and the University of California, San Francisco, San Francisco (R.K.K.) - both in California; the Mass General Cancer Center, Harvard Medical School (L.G.), and Dana-Farber Cancer Institute (T.A.A.) - both in Boston; the University of Texas M.D. Anderson Cancer Center, Houston (F.M.-B.); the Drug Development Department, Gustave Roussy, Villejuif (A.H.), and Centre Léon Bérard, Lyon (P.A.C.) - both in France; the University of Manchester and the Christie NHS Foundation Trust, Manchester (J.W.V.), and University College London Cancer Institute, London (J.A.B.) - both in the United Kingdom; National Cancer Center Hospital, Tokyo (C.M.), Kanagawa Cancer Center, Yokohama (J.F.), Hokkaido University Hospital Cancer Center, Sapporo (Y.K.), and Tohoku University Graduate School of Medicine, Sendai (K.M.) - all in Japan; the Hospital of the University of Pennsylvania (T.B.K.) and Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital (E.P.M.) - both in Philadelphia; Amsterdam University Medical Center, University of Amsterdam, Amsterdam (H.-J.K.); Asan Medical Center, University of Ulsan College of Medicine (H.-M.C.), and Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine (D.-Y.O.) - both in Seoul, South Korea; the National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan (L.-T.C.); Vall d'Hebron Hospital Campus and Vall d'Hebron Institute of Oncology, University of Vic-Central University of Catalonia, Baselga Oncologic Institute, Hospital Quiron, Barcelona (J.T.); Mayo Clinic, Rochester, MN (A.M.); Johannes Gutenberg-Mainz University Medical Center, Mainz, Germany (M.M.); Mayo Clinic, Phoenix, AZ (D.A.); Epstein Health, Woodcliff Lake, NJ (R.S.E.); Taiho Oncology, Princeton, NJ (A.-B.H., T.S., V.W., Y.H., M.L., K.A.B.); and Ilumina, San Diego, CA (Y.F.)
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Isaka Y, Sasaki A, Saito A, Motomura Y, Ando Y, Nakamura Y. Exceptional response to alectinib for duodenal carcinoma with ALK fusion: A case report and literature review. Front Oncol 2023; 12:1064944. [PMID: 36713517 PMCID: PMC9878825 DOI: 10.3389/fonc.2022.1064944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Patients with advanced duodenal carcinoma usually have a poor prognosis due to limited effective chemotherapy options. The study for genotype-directed therapy in patients with duodenal carcinoma is progressing. However, no clinical data assessing the efficacy of molecularly targeted therapy are presently available. We report the case of a 64-year-old woman who was diagnosed with anaplastic lymphocyte kinase (ALK) fusion-positive advanced duodenal carcinoma. Echinoderm microtubule associated protein like-4 (EML4)-ALK rearrangement was detected by comprehensive genomic profiling after resistance to first-line chemotherapy. The patient received alectinib, an ALK inhibitor, with marked shrinkage in primary tumor and liver metastases. She is currently being treated with alectinib for 6 months or more. This is the first report of the efficacy of alectinib in a patient with duodenal carcinoma harboring ALK fusion. Additionally, this case report suggests that the practical use of next-generation sequencing may expand optimal treatment choices in rare solid tumors, including duodenal carcinoma.
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Affiliation(s)
- Yuri Isaka
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Akinori Sasaki
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Akira Saito
- Department of Pathology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Yasuaki Motomura
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Yayoi Ando
- Clinical Research Support Office, National Cancer Center Hospital Chuou, Tokyo, Japan
| | - Yoshiaki Nakamura
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan,*Correspondence: Yoshiaki Nakamura,
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243
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Roberts TJ, Kesselheim AS, Avorn J. Variation in Use of Lung Cancer Targeted Therapies Across State Medicaid Programs, 2020-2021. JAMA Netw Open 2023; 6:e2252562. [PMID: 36696113 PMCID: PMC10187487 DOI: 10.1001/jamanetworkopen.2022.52562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/02/2022] [Indexed: 01/26/2023] Open
Abstract
Importance Targeted therapies for EGFR (OMIM 131550)- and ALK (OMIM 105590)-altered metastatic non-small cell lung cancer (NSCLC) substantially improve outcomes for some patients. However, use of these therapies is lower among Medicaid patients, and access to oncology care varies across state Medicaid programs. Evidence is lacking on how use of targeted therapies for metastatic NSCLC varies across state Medicaid programs. Objectives To characterize state-level variation in the use of targeted therapies among Medicaid patients with metastatic NSCLC and to describe factors associated with this variation. Design, Setting, and Participants This cross-sectional study used publicly available data from the Medicaid Drug Utilization Database from 2020 and 2021 and peer-reviewed data on NSCLC incidence, the prevalence of EGFR and ALK alterations, and expected treatment durations to estimate expected use of targeted therapies for EGFR- and ALK-altered NSCLC in 33 states. Exposures State-specific Medicaid programs and state policies and characteristics. Main Outcomes and Measures The primary outcome was the estimated proportion of person-time of Medicaid patients with EGFR- or ALK-altered NSCLC associated with receipt of targeted therapy in each state Medicaid program. Nested linear regression models examined associations between the observed variation and state policies and characteristics. Results There were an estimated 3461 person-years in which EGFR- and ALK-targeted therapies were indicated in 2020 and 2021. During these years, only 2281 person-years of EGFR- and ALK-targeted therapies were dispensed to Medicaid patients, suggesting that an estimated 66% of Medicaid patients with EGFR- and ALK-altered metastatic disease received indicated targeted therapies across all states. Rates of targeted therapy use ranged from 18% in Arkansas to 113% in Massachusetts; 30 of 33 states (91%) had lower rates of targeted therapy use than expected. The observed variation across state Medicaid programs was associated with Medicaid policies, the density of oncologists, and state gross domestic product per capita. Conclusions and Relevance This study suggests that rates of targeted therapy use among Medicaid patients with EGFR- and ALK-altered NSCLC were lower than expected and varied across state Medicaid programs. State policies and characteristics were associated with the observed variation, indicating where interventions could improve access to treatment and outcomes for patients with NSCLC.
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Affiliation(s)
- Thomas J. Roberts
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jerry Avorn
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham & Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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244
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Real-world ALK Testing Trends in Patients With Advanced Non-Small-Cell Lung Cancer in the United States. Clin Lung Cancer 2023; 24:e39-e49. [PMID: 36376172 DOI: 10.1016/j.cllc.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/15/2022] [Accepted: 09/29/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Patients with non-small-cell lung cancer (NSCLC) whose tumors harbor anaplastic lymphoma kinase (ALK) rearrangements can be treated with ALK tyrosine kinase inhibitors. We assessed real-world ALK biomarker testing and treatment patterns of patients with NSCLC in the United States. PATIENTS AND METHODS Data were extracted from the Flatiron Health electronic health record-derived deidentified database for patients aged ≥18 years with stage IIIB or IV NSCLC and ≥2 clinic visits between January 2011 and December 2019. RESULTS Among 60,025 eligible patients, tumors from 36,691 (61.1%) patients were tested for ALK rearrangements, and 1042 (2.8%) tested positive (ALK+). From 2011 to 2019, ALK testing rates increased from 33.1% to 73.0%; testing via fluorescence in situ hybridization declined from 68.3% to 32.1% while next-generation sequencing increased from <1% to 52.2%. Although tissue samples were more commonly used than blood (85.1% vs. 13.5% of tests), blood sample testing increased from 0.1% in 2011 to 28.2% in 2019. Median (interquartile range) time from diagnosis of advanced NSCLC to first ALK+ test result was 23 (13-43) days, including laboratory processing time of 9 (6-14) days. For the 24.7% of patients with an ALK+ test result who began treatment before receiving the positive result, chemotherapy was initiated most often overall until 2018 when immuno-oncology agents became most common. CONCLUSION Although ALK testing in NSCLC increased over time, testing rates among eligible patients did not reach 100% during the study period. Treatment decisions for some patients with NSCLC may have been made without important, guideline-recommended biomarker data.
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245
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Gürsoy P. Avascular necrosis during alectinib treatment: Case report. J Oncol Pharm Pract 2023; 29:242-245. [PMID: 35635227 DOI: 10.1177/10781552221102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CASE REPORT We present our patient who used alectinib due to anaplastic lymphoma kinase positivity and developed avascular necrosis in the femoral head. MANAGEMENT AND OUTCOME In our patient who had been taking alectinib for a long time due to anaplastic lymphoma kinase positivity, avascular necrosis of the femoral head was detected as a result of the examination performed due to hip pain. Due to the responsıbılıty of the disease, her treatment contınued by making profit and loss account. DISCUSSION Femoral head avascular necrosis can be seen with tyrosine kinase inhibitors, although it is very rare. This is the case in the literature to develop avascular necrosis due to alectinib. We think that femoral head necrosis may develop in the patient group using alectinib and care should be taken in this regard.
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Affiliation(s)
- Pınar Gürsoy
- Department Medical Oncology, Ege University School of Medicine, Izmir, Turkey
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246
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Schmid S, Cheng S, Chotai S, Garcia M, Zhan L, Hueniken K, Balaratnam K, Khan K, Patel D, Grant B, Raptis R, Brown MC, Xu W, Moriarty P, Shepherd FA, Sacher AG, Leighl NB, Bradbury PA, Liu G. Real-World Treatment Sequencing, Toxicities, Health Utilities, and Survival Outcomes in Patients with Advanced ALK-Rearranged Non-Small-Cell Lung Cancer. Clin Lung Cancer 2023; 24:40-50. [PMID: 36270866 DOI: 10.1016/j.cllc.2022.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This real-world analysis describes treatment patterns, sequencing and clinical effectiveness, toxicities, and health utility outcomes in advanced-stage, incurable ALK-positive NSCLC patients across five different ALK-TKIs. MATERIALS AND METHODS Clinicodemographic, treatment, and toxicity data were collected retrospectively in patients with advanced-stage ALK-positive NSCLC at Princess Margaret Cancer Centre. Patient-reported symptoms, toxicities, and health utilities were collected prospectively. RESULTS Of 148 ALK-positive NSCLC patients seen July 2009-May 2021, median age was 58.9 years; 84 (57%) were female; 112 (76%) never-smokers; 54 (47%) Asian and 40 (35%) white; 139 (94%) received at least one ALK-TKI: crizotinib (n = 74; 54%) and alectinib (n = 61; 44%) were administered mainly as first-line ALK-TKI, ceritinib, brigatinib and lorlatinib were administered primarily after previous ALK-TKI failure. Median overall survival (OS) was 54.0 months; 31 (21%) patients died within two years of advanced-stage diagnosis. Treatment modifications were observed in 35 (47%) patients with crizotinib, 19 (61%) with ceritinib, 41 (39%) with alectinib, 9 (41%) with brigatinib and 8 (30%) with lorlatinib. Prevalence of dose modifications and self-reported toxicities were higher with early versus later generation ALK-TKIs (P<.05). The presence of early treatment modification was not negatively associated with progression-free survival (PFS) and OS analyses. CONCLUSION Serial ALK-TKI sequencing approaches are viable therapeutic options that can extend quality of life and quantity-of-life, though a fifth of patients died within two years. No best single sequencing approach could be determined. Clinically relevant toxicities occurred across all ALK-TKIs. Treatment modifications due to toxicity may not necessarily compromise outcomes, allowing multiple approaches to deal with ALK-TKI toxicities.
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Affiliation(s)
- Sabine Schmid
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada; Inselspital Berne, University of Berne, Switzerland
| | - Sierra Cheng
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Simren Chotai
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Miguel Garcia
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Luna Zhan
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Katrina Hueniken
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Karmugi Balaratnam
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Khaleeq Khan
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Devalben Patel
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Benjamin Grant
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Roula Raptis
- Applied Health Research Centre, Unity Health, Toronto, Canada
| | - M Catherine Brown
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Wei Xu
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Frances A Shepherd
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Adrian G Sacher
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Natasha B Leighl
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Geoffrey Liu
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada.
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Jia K, Ren S. Neurocognitive Adverse Events of Lorlatinib: On the Way to Precise Prediction? J Thorac Oncol 2023; 18:26-28. [PMID: 36543433 DOI: 10.1016/j.jtho.2022.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Keyi Jia
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
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Kelner M, Carvalho da Silva B, Montella T, Aguiar PN, Lopes G, Ferreira CG, De Marchi P. Discrepancies Between the Cost of Advanced Lung Cancer Treatment and How Much Is Reimbursed by the Brazilian Public Healthcare System. Value Health Reg Issues 2023; 33:1-6. [PMID: 36162194 DOI: 10.1016/j.vhri.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/08/2022] [Accepted: 08/09/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Lung cancer is the leading cause of cancer-related death worldwide, and most patients are diagnosed of advanced disease. Molecular-targeted therapy and immunotherapy increase survival among these patients. In this study, we compared the cost of the best treatments available with the amount reimbursed by the Brazilian public healthcare system (Sistema Único de Saúde [SUS]) to treat advanced lung cancer. METHODS The authors divided lung cancer into 10 subtypes according to histology and molecular profile. A panel of experts defined the best treatment sequencing for each subtype. The authors considered only drug costs retrieved from the Brazilian Health Regulatory Agency official data. The progression-free survival of each regimen was considered as treatment duration. The cost estimate included all postprogression therapies weighted by each subtype proportional frequency. The amount reimbursed by SUS was the sum of the monthly budget accumulated during the estimated treatment duration and then for the proportional frequency of each subtype. RESULTS The budget reimbursed by SUS for treating each advanced lung cancer case in Brazil is R$8000.00 in average whereas the cost estimate for the best treatment available is R$729 454.00 per case, which represents a difference of 9118%. The budget impact to ensure the reimbursement needed to acquire the best treatments available was estimated in near R$13 billion annually. CONCLUSIONS The cost estimate of the best treatment available for advanced lung cancer in Brazil is much higher than the amount reimbursed by SUS. This budgetary gap leads to a major access barrier that may compromise the survival outcomes of SUS users.
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Affiliation(s)
| | | | | | | | - Gilberto Lopes
- Oncoclinicas, Rio de Janeiro, Brazil; Miller School of Medicine and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Pedro De Marchi
- Oncoclinicas, Rio de Janeiro, Brazil; Grupo Translacional de Oncologia Toracica, Barretos Cancer Hospital, São Paulo, Brazil.
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Shi Y. Landscape of the clinical development of China innovative anti-lung cancer drugs. CANCER PATHOGENESIS AND THERAPY 2023; 1:67-75. [PMID: 38328605 PMCID: PMC10846302 DOI: 10.1016/j.cpt.2022.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/18/2022] [Accepted: 10/08/2022] [Indexed: 02/09/2024]
Abstract
Even today, lung cancer remains one of the most frequently diagnosed cancers and the leading cause of cancer-related deaths worldwide. Throughout the past decades, remarkable advances have been made in the research and development of anti-lung cancer drugs in China. Since the first registered Chinese clinical trial on May 2, 2006, many potent anti-lung cancer drugs have been developed and approved by the China Food and Drug Administration and the National Medical Product Administration of China. Among them, the most advance were observed in the development of targeted agents and immunotherapeutic agents such as epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) icotinib, aumolertinib, and furmonertinib, anaplastic lymphoma kinase (ALK)-TKI ensartinib, programmed cell death-1 (PD-1) monoclonal antibodies (mAbs) camrelizumab, sintilimab, and tislelizumab, and programmed cell death-ligand 1 (PD-L1) mAb sugemalimab, which have made huge breakthrough in recent years. Some other investigational innovative drug also demonstrated promising efficacy and acceptable safety profiles. Results from clinical studies on these China innovative drugs have led to changes in clinical practice guidelines and considerably improved the outcomes for patients with lung cancer. Thus, in this review, we aim to provide further insight into the clinical development and achievement of China innovative anti-lung cancer drugs.
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Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing 100021, China
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Malapelle U, Pepe F, Pisapia P, Altimari A, Bellevicine C, Brunnström H, Bruno R, Büttner R, Cirnes L, De Andrea CE, de Biase D, Dumur CI, Ericson Lindquist K, Fontanini G, Gautiero E, Gentien D, Hofman P, Hofman V, Iaccarino A, Lozano MD, Mayo-de-Las-Casas C, Merkelbach-Bruse S, Pagni F, Roman R, Schmitt FC, Siemanowski J, Roy-Chowdhuri S, Tallini G, Tresserra F, Vander Borght S, Vielh P, Vigliar E, Vita GAC, Weynand B, Rosell R, Molina Vila MA, Troncone G. Reference standards for gene fusion molecular assays on cytological samples: an international validation study. J Clin Pathol 2023; 76:47-52. [PMID: 34429353 DOI: 10.1136/jclinpath-2021-207825] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 02/05/2023]
Abstract
AIMS Gene fusions assays are key for personalised treatments of advanced human cancers. Their implementation on cytological material requires a preliminary validation that may make use of cell line slides mimicking cytological samples. In this international multi-institutional study, gene fusion reference standards were developed and validated. METHODS Cell lines harbouring EML4(13)-ALK(20) and SLC34A2(4)-ROS1(32) gene fusions were adopted to prepare reference standards. Eight laboratories (five adopting amplicon-based and three hybridisation-based platforms) received, at different dilution points two sets of slides (slide A 50.0%, slide B 25.0%, slide C 12.5% and slide D wild type) stained by Papanicolaou (Pap) and May Grunwald Giemsa (MGG). Analysis was carried out on a total of 64 slides. RESULTS Four (50.0%) out of eight laboratories reported results on all slides and dilution points. While 12 (37.5%) out of 32 MGG slides were inadequate, 27 (84.4%) out of 32 Pap slides produced libraries adequate for variant calling. The laboratories using hybridisation-based platforms showed the highest rate of inadequate results (13/24 slides, 54.2%). Conversely, only 10.0% (4/40 slides) of inadequate results were reported by laboratories adopting amplicon-based platforms. CONCLUSIONS Reference standards in cytological format yield better results when Pap staining and processed by amplicon-based assays. Further investigation is required to optimise these standards for MGG stained cells and for hybridisation-based approaches.
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Affiliation(s)
| | - Francesco Pepe
- Public Health, University of Naples Federico II, Naples, Italy
| | | | - Annalisa Altimari
- Molecular Pathology, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | | | - Hans Brunnström
- Clinical Sciences Lund, Division of Pathology, Lund University, Lund, Sweden
| | - Rossella Bruno
- Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | | | | | - Dario de Biase
- Pharmacy and Biotechnology (FaBiT), Molecular Pathology Laboratory, University of Bologna, Bologna, Italy
| | | | | | - Gabriella Fontanini
- Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - David Gentien
- Translational Research Department, Genomics Platform, Curie Institute Hospital Group, Paris, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, University Hospital Centre Nice Pasteur Hospital, Nice, France
| | - Veronique Hofman
- Laboratory of Clinical and Experimental Pathology, University Hospital Centre Nice Pasteur Hospital, Nice, France
| | | | | | | | | | - Fabio Pagni
- Medicine and Surgery, San Gerardo Hospital, Monza, Italy
| | - Ruth Roman
- Oncology, Quirón Dexeus University Hospital, Barcelona, Spain
| | | | | | - Sinchita Roy-Chowdhuri
- Pathology, Division of Pathology/Lab Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Giovanni Tallini
- Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Sara Vander Borght
- Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | - Philippe Vielh
- Pathology, Medipath and American Hospital of Paris, Paris, France
| | - Elena Vigliar
- Public Health, University of Naples Federico II, Naples, Italy
| | | | - Birgit Weynand
- Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, Leuven, Belgium
| | - Rafael Rosell
- Oncology, Hospital Municipal de Badalona, Barcelona, Spain
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