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Melosky B, Wheatley-Price P, Juergens RA, Sacher A, Leighl NB, Tsao MS, Cheema P, Snow S, Liu G, Card PB, Chu Q. The rapidly evolving landscape of novel targeted therapies in advanced non-small cell lung cancer. Lung Cancer 2021; 160:136-151. [PMID: 34353680 DOI: 10.1016/j.lungcan.2021.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 01/15/2023]
Abstract
Lung cancer is a highly heterogeneous disease often driven by well-characterized driver mutations. Although the best studied are common alterations in the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) oncogenes, rapid advances in molecular characterization has led to the development of novel therapeutics that inhibit additional oncogenic alterations in advanced NSCLC. The literature search identified 62 eligible phase I/II clinical trials or integrated analyses of assessing novel targeted agents against the following molecular alterations: ROS1-rearranged, BRAF V600E-mutant, NTRK-rearranged, MET-altered, uncommon EGFR-mutant, RET-rearranged, HER2-positive, KRAS G12C-mutant and NRG1-rearranged. This rapidly evolving field has produced many new targeted treatment options and promising outcomes have led to the FDA approval of seven novel agents for use in ROS1-rearranged, BRAF V600E-mutant, NTRK-rearranged, MET exon 14 skipping-mutant or RET-rearranged advanced NSCLC. Research continues at a rapid pace, with a number of phase III trials underway to fully evaluate new promising agents under development for improving outcomes in patients with NSCLC harboring distinct molecular subtypes. This review will provide a comprehensive summary of existing data as well as a user-friendly guide on the current status of novel targeted therapy in oncogene-driven advanced NSCLC.
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Affiliation(s)
- Barbara Melosky
- Medical Oncology, BCCA - 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada.
| | - Paul Wheatley-Price
- Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Box 511, Ottawa, ON, K1H 8L6, Canada
| | - Rosalyn A Juergens
- Juravinski Cancer Centre, McMaster University, 699 Concession Street, Hamilton, ON, L8V5C2, Canada
| | - Adrian Sacher
- Princess Margaret Cancer Centre, University of Toronto, 101 College Street, Toronto, ON, M5G1L7, Canada
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University of Toronto, 7-913 700 University Avenue, Toronto, ON, M5G1Z5, Canada
| | - Ming-Sound Tsao
- Princess Margaret Cancer Centre, University of Toronto, 101 College Street, Toronto, ON, M5G1L7, Canada
| | - Parneet Cheema
- William Osler Health System, University of Toronto, 101 Humber College Blvd, Etobicoke, ON, M9V 1R8, Canada
| | - Stephanie Snow
- QEII Health Sciences Centre, Dalhousie University, 1276 South Park Street Halifax, NS, B3H 2Y9, Canada
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University of Toronto, 101 College Street, Toronto, ON, M5G1L7, Canada
| | - Paul B Card
- Kaleidoscope Strategic Inc., 146 Marion St., Toronto, ON, M6R 1E7, Canada
| | - Quincy Chu
- Cross Cancer Institute, University of Alberta, 11560 University Ave, 2nd Floor, Edmonton, AB, T6G 1Z2, Canada
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Paz-Ares L, Barlesi F, Siena S, Ahn MJ, Drilon A, Conley A, Rolfo C, Wolf J, Seto T, Doebele R, Kapre A, Chen D, McCallum S, Osborne S, Demetri G. Patient-reported outcomes from STARTRK-2: a global phase II basket study of entrectinib for ROS1 fusion-positive non-small-cell lung cancer and NTRK fusion-positive solid tumours. ESMO Open 2021; 6:100113. [PMID: 33930659 PMCID: PMC8100628 DOI: 10.1016/j.esmoop.2021.100113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) are increasingly relevant endpoints in clinical trials, contributing to our understanding of risk-benefit profiles, in addition to efficacy and safety data. We investigated the impact of entrectinib on patient-reported symptoms, functioning, and health-related quality of life. PATIENTS AND METHODS STARTRK-2 is a phase II basket study in patients with locally advanced/metastatic neurotrophic receptor tyrosine kinase 1/2/3 (NTRK1/2/3) and ROS proto-oncogene 1 (ROS1) fusion-positive solid tumours. PROs (prespecified secondary endpoint) were evaluated using the European Organization for Research and Treatment of Cancer quality-of-life questionnaire (QLQ-C30), lung cancer module (QLQ-LC13), and colorectal cancer module (QLQ-CR29), and the EuroQoL 5-Dimension 3-Level instruments, completed before cycle 1 day 1 and each subsequent 4-week cycle of entrectinib dosing, and the end of treatment. Adverse events and treatment-related symptoms were assessed in the safety analysis (SA)-PRO population. Tumour-related symptoms, functioning, and global health status were assessed in the efficacy analysis (EA)-PRO population. Data cut-offs: 31 October 2018 NTRK cohort; 01 May 2019 ROS1 cohort. RESULTS SA-PRO populations comprised patients with NTRK fusion-positive solid tumours (N = 88) or ROS1 fusion-positive non-small-cell lung cancer (N = 180) who received one or more doses of entrectinib, completed PRO questionnaires on cycle 1 day 1 and answered one or more questions on-study. EA-PRO populations (N = 71) and (N = 145), respectively, comprised SA-PRO patients with measurable baseline disease. Moderate-to-high baseline global health status scores were maintained in EA-PRO populations during treatment. Role and physical functioning scores were moderate-to-high at baseline, with trends towards clinical improvement during treatment. Both cohorts reported low-to-moderate symptom burden at baseline, which was maintained or trended towards clinically meaningful improvement. Symptoms commonly associated with cancer treatment (e.g. nausea, fatigue) remained stable or improved during treatment. All SA-PRO patients experienced one or more adverse events, most frequently constipation or diarrhoea. CONCLUSIONS PRO findings were consistent with the favourable safety profile of entrectinib, and further reinforce the positive benefit-risk profile of this treatment, indicating minimal overall treatment burden.
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Affiliation(s)
- L Paz-Ares
- Medical Oncology Department, Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Clinical Research Unit, Universidad Complutense & Ciberonc, Madrid, Spain.
| | - F Barlesi
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - S Siena
- Medical Oncology Department, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
| | - M-J Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - A Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Weill Cornell Medical College, New York, USA
| | - A Conley
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, USA
| | - C Rolfo
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, USA
| | - J Wolf
- Department I of Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - T Seto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - R Doebele
- Division of Medical Oncology, University of Colorado, Aurora, USA
| | - A Kapre
- Department of Patient-Centered Outcomes Research, Genentech, Inc., South San Francisco, USA
| | - D Chen
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - S McCallum
- Medication Safety and Risk Management, Genentech, Inc., South San Francisco, USA
| | - S Osborne
- PDMA Operations (Biometrics), F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - G Demetri
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Ludwig Center at Harvard Medical School, Boston, USA
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