A Multi-Center Real-World Experience of IMpower150 in Oncogene Driven Tumors and CNS Metastases

Comparative Survival Analysis of Anti-Angiogenic Agent Plus Immunochemotherapy in NSCLC Patients After Frontline EGFR-TKI Treatment: A Retrospective Cohort Study

Advanced-stage EGFR-mutated lung non-small cell lung cancer (NSCLC) challenges current treatment paradigms, particularly after frontline EGFR-TKI therapy failure. This study investigates the survival impact of combined anti-angiogenic agent and immunochemotherapy (AICT) for this population. We retrospectively analyzed NSCLC patients at National Cheng Kung University Hospital from January 2010 to December 2022, focusing on those who had disease progression beyond frontline EGFR-TKI treatments. Survival outcomes were assessed through progression-free survival (PFS) and overall survival post-TKI failure (OSpTKI). Propensity score was employed to match patients, with Kaplan-Meier curve and multivariable Cox regression analysis determining the survival benefits. Analyses were also performed for subgroups based on PD-L1 level, treatment lines, and regimens. A total of 412 patients were enrolled, with 27 receiving AICT. Compared to patients who did not receive AICT, those who received AICT had longer PFS (5.9 vs. 3.9 months, p = 0.024) and longer OSpTKI (17.9 vs. 11.9 months, p = 0.018). The observed survival advantage in PFS and OSpTKI was consistent in both the original cohort (for PFS: hazard ratio [HR] = 0.59, 95% confidence interval [CI] = 0.39-0.90, p = 0.014; for OSpTKI: HR = 0.41, 95% CI = 0.24-0.69, p < 0.001) and after propensity score matching (for PFS: HR = 0.56, 95% CI = 0.35-0.98, p = 0.014; for OSpTKI: HR = 0.45, 95% CI = 0.26-0.79, p = 0.006). In the subgroup analyses, patients with PD-L1 ≥ 1%, those who received AICT as a second-line therapy, or those treated in conjunction with pemetrexed showed a PFS benefit. AICT improves survival outcomes in advanced-stage EGFR-mutated NSCLC, advocating for its integration into treatment regimens.

PD-L1 and VEGF dual blockade enhances anti-tumor effect on brain metastasis in hematogenous metastasis model

Immunotherapy improves survival outcomes in cancer patients, but there is still an unmet clinical need in the treatment of brain metastases. Here, we used a mouse model to investigate the antitumor effect of programmed death-ligand 1 (PD-L1) and vascular endothelial growth factor (VEGF) dual blockade on metastatic brain tumors and evaluated immune responses during treatment. After establishing hematogenous brain metastasis by transplanting murine bladder carcinoma MBT2 cells stably expressing secNLuc reporter via the internal carotid artery of C3H/HeNCrl mice, we observed the formation of metastases not only in the brain parenchyma but also in the ventricles. The observed pathological areas showed that metastases in the ventricle were histologically larger than that in the brain parenchyma. Regarding the total tumor burden in the whole brain as revealed by Nluc activities, the combination of anti-PD-L1 antibody and anti-VEGF antibody showed a stronger anti-tumor effect than each single agent. Anti-PD-L1 antibody alone enhanced CD8+ T cell priming in regional lymph nodes, increased the proportion of activated CD8+ T cells in whole brain, and increased the density of CD8+ cells in the brain parenchyma. Furthermore, anti-VEGF antibody alone decreased microvessel density (MVD) in ventricular metastases, and the combination treatment increased intratumoral CD8+ cell density in the brain parenchyma and ventricular metastases. These results suggest that PD-L1 blockade enhanced cancer immunity not only in brain metastases lesions but also in the regional lymph nodes of the metastases, and that the addition of VEGF blockade increased the antitumor effect by increasing the infiltration of activated CD8+ T cell and decreasing MVD.

Chemotherapy for patients with EGFR-mutated NSCLC after progression on EGFR-TKI's: Exploration of efficacy of unselected treatment in a multicenter cohort study

OBJECTIVES

In patients with Epidermal Growth Factor Receptor (EGFR)-mutated non-small cell lung (NSCLC) chemotherapy remains standard of care after progression on EGFR-tyrosine kinase inhibitors (TKIs). With the development of anti-angiogenic agents and immune checkpoint inhibitors the landscape of systemic regimens has changed significantly. This cohort study aims to evaluate the efficacy of chemotherapy regimens after progression on EGFR-TKI in a European population.

MATERIAL AND METHODS

All consecutive patients treated with chemotherapy after progression on EGFR-TKI for EGFR-mutated NSCLC, were identified in two tertiary centers in the Netherlands. Data on best response, progression free survival (PFS) and overall survival (OS) were extracted from medical records.

RESULTS

In total, 171 lines of chemotherapy were identified: platinum/pemetrexed (PP, n = 95), carboplatin/paclitaxel/bevacizumab/atezolizumab (CPBA, n = 32), paclitaxel/bevacizumab (PB, n = 36) and carboplatin/paclitaxel/bevacizumab (CPB, n = 8). Of the 171 lines, 106 were given as first-line after EGFR-TKI. Median PFS did not differ significantly between the first-line regimens (p = 0.50), with the highest PFS in PP (5.2 months [95% CI 4.5-5.9]) and CPBA (5.9 months [95% CI 3.8-80]). The majority of the PB group (n = 32) received this regimen in a second- or later line with a median PFS of 4.9 months (95% CI 3.3-6.6). First-line regimens had a median OS of 15.3 months (95% CI 11.6-18.9) with no significant difference between regimens (p = 0.85).

CONCLUSION

After progression on EGFR-TKI, patients with EGFR-mutated NSCLC show substantial benefit on different chemotherapy regimens. In particular, favorable outcomes were seen in patients treated with PP and CPBA as first-line chemotherapy, and PB in further lines of chemotherapy.

Leveraging Molecular and Immune-Based Therapies in Leptomeningeal Metastases

Leptomeningeal metastases represent an aggressive stage of cancer with few durable treatment options. Improved understanding of cancer biology, neoplastic reliance on oncogenic driver mutations, and complex immune system interactions have resulted in an explosion in cancer-directed therapy in the last two decades to include small molecule inhibitors and immune checkpoint inhibitors. Most of these therapeutics are underexplored in patients with leptomeningeal metastases, limiting extrapolation of extracranial and even intracranial efficacy outcomes to the unique leptomeningeal space. Further confounding our interpretation of drug activity in the leptomeninges is an incomplete understanding of drug penetration through the blood-cerebrospinal fluid barrier of the choroid plexus. Nevertheless, a number of retrospective studies and promising prospective trials provide evidence of leptomeningeal activity of several small molecule and immune checkpoint inhibitors and underscore potential areas of further therapeutic development for patients harboring leptomeningeal disease.