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Khokhar B, Chiang B, Iglay K, Reynolds K, Rodriguez-Ormaza N, Spalding W, Freedland E. QT-Interval Prolongation, Torsades de Pointes, and Heart Failure With EGFR Tyrosine Kinase Inhibitors in Non-Small Cell Lung Cancer: Systematic Review. Clin Lung Cancer 2024; 25:285-318. [PMID: 38553324 DOI: 10.1016/j.cllc.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 06/01/2024]
Abstract
A systematic literature review was conducted to determine the incidence and mortality of QT-interval prolongation (QTp), torsades de pointes (TdP), and heart failure (HF) in patients with non-small cell lung cancer (NSCLC) who received epidermal growth factor receptor (EGFR) TKIs. Of 296 identified publications, 95 met eligibility criteria and were abstracted for QTp/TdP and HF outcomes (QTp/TdP: 83 publications, including 5 case study publications; HF: 79 publications, including 6 case study publications [involving 8 patients]). QTp incidence ranged from 0% to 27.8% in observational studies and from 0% to 11% in clinical trials, with no deaths due to QTp. There were no TdP events or deaths due to TdP. The incidence of HF ranged from 0% to 8%, and HF mortality rates ranged from 0% to 4%. Patients receiving treatment with EGFR TKIs should be monitored for signs of QTp, TdP, and HF per prescribing information. Standardized definitions and methods to improve monitoring of QTp, TdP, and HF-related events are needed in patients with NSCLC.
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Affiliation(s)
- Bilal Khokhar
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Lexington, MA.
| | - Beatrice Chiang
- Global Patient Safety Evaluation, Takeda Development Center Americas, Inc., Lexington, MA
| | - Kristy Iglay
- Real-world Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, NC
| | - Kamika Reynolds
- Real-world Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nidia Rodriguez-Ormaza
- Real-world Evidence and Patient Outcomes, CERobs Consulting, LLC, Wrightsville Beach, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - William Spalding
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Lexington, MA
| | - Eric Freedland
- Global Patient Safety Evaluation, Takeda Development Center Americas, Inc., Lexington, MA
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Pilz MJ, Seyringer S, Al-Naesan I, King MT, Bottomley A, Norman R, Schlosser L, Hell T, Gamper EM. Cancer-Specific Health Utilities: Evaluation of Core Measurement Properties of the EORTC QLU-C10D in Lung Cancer Patients-Data from Four Multicentre LUX-Lung Trials, Applying Six Country Tariffs. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00484-9. [PMID: 38696019 DOI: 10.1007/s41669-024-00484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Cost-utility analysis generally requires valid preference-based measures (PBMs) to assess the utility of patient health. While generic PBMs are widely used, disease-specific PBMs may capture additional aspects of health relevant for certain patient populations. This study investigates the construct and concurrent criterion validity of the cancer-specific European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Utility-Core 10 dimensions (QLU-C10D) in non-small-cell lung cancer patients. METHODS We retrospectively analysed data from four multicentre LUX-Lung trials, all of which had administered the EORTC Quality of Life Questionnaire (QLQ-C30) and the EQ-5D-3L. We applied six country-specific value sets (Australia, Canada, Italy, the Netherlands, Poland, and the United Kingdom) to both instruments. Criterion validity was assessed via correlations between the instruments' utility scores. Correlations of divergent and convergent domains and Bland-Altman plots investigated construct validity. Floor and ceiling effects were assessed. RESULTS The comparison of the EORTC QLU-C10D and EQ-5D-3L produced homogenous results for five of the six country tariffs. High correlations of utilities (r > 0.7) were found for all country tariffs except for the Netherlands. Moderate to high correlations of converging domain pairs (r from 0.472 to 0.718) were found with few exceptions, such as the Social Functioning-Usual Activities domain pair (max. r = 0.376). For all but the Dutch tariff, the EORTC QLU-C10D produced consistently lower utility values compared to the EQ-5D-3L (x̄ difference from - 0.082 to 0.033). Floor and ceiling effects were consistently lower for the EORTC QLU-C10D (max. 4.67% for utilities). CONCLUSIONS The six country tariffs showed good psychometric properties for the EORTC QLU-C10D in lung cancer patients. Criterion and construct validity was established. The QLU-C10D showed superior measurement precision towards the upper and lower end of the scale compared to the EQ-5D-3L, which is important when cost-utility analysis seeks to measure health change across the severity spectrum.
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Affiliation(s)
- Micha J Pilz
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Simone Seyringer
- Department of Nuclear Medicine, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Imad Al-Naesan
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Madeleine T King
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Richard Norman
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Lisa Schlosser
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
| | - Tobias Hell
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
| | - Eva Maria Gamper
- Department of Nuclear Medicine, Medical University of Innsbruck, 6020, Innsbruck, Austria.
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Zafar A, Khan MJ, Abu J, Naeem A. Revolutionizing cancer care strategies: immunotherapy, gene therapy, and molecular targeted therapy. Mol Biol Rep 2024; 51:219. [PMID: 38281269 PMCID: PMC10822809 DOI: 10.1007/s11033-023-09096-8] [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: 08/18/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
Despite the availability of technological advances in traditional anti-cancer therapies, there is a need for more precise and targeted cancer treatment strategies. The wide-ranging shortfalls of conventional anticancer therapies such as systematic toxicity, compromised life quality, and limited to severe side effects are major areas of concern of conventional cancer treatment approaches. Owing to the expansion of knowledge and technological advancements in the field of cancer biology, more innovative and safe anti-cancerous approaches such as immune therapy, gene therapy and targeted therapy are rapidly evolving with the aim to address the limitations of conventional therapies. The concept of immunotherapy began with the capability of coley toxins to stimulate toll-like receptors of immune cells to provoke an immune response against cancers. With an in-depth understating of the molecular mechanisms of carcinogenesis and their relationship to disease prognosis, molecular targeted therapy approaches, that inhibit or stimulate specific cancer-promoting or cancer-inhibitory molecules respectively, have offered promising outcomes. In this review, we evaluate the achievement and challenges of these technically advanced therapies with the aim of presenting the overall progress and perspective of each approach.
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Affiliation(s)
- Aasma Zafar
- Department of Biosciences, COMSATS University, Islamabad, 45550, Pakistan
| | | | - Junaid Abu
- Hazm Mebaireek General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Aisha Naeem
- Qatar University Health, Qatar University, P.O. Box 2713, Doha, Qatar.
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Guven DC, Yekeduz E, Erul E, Yazgan SC, Sahin TK, Karatas G, Aksoy S, Erman M, Yalcin S, Urun Y, Kilickap S. The benefit of treatment beyond progression with immune checkpoint inhibitors: a multi-center retrospective cohort study. J Cancer Res Clin Oncol 2023; 149:3599-3606. [PMID: 35960374 DOI: 10.1007/s00432-022-04268-8] [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: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Treatment beyond progression (TBP) with immune checkpoint inhibitors (ICIs) is an evolving field due to the limitations of conventional imaging in response evaluation. However, real-life data on the benefit of TBP is scarce, especially from the limited resource settings and patients treated in the later lines. Therefore, we aimed to investigate the survival benefit of TBP with ICIs in patients with advanced tumors from a limited resource setting. METHODS For this multi-center retrospective cohort study, we included 282 patients treated with ICIs and had radiological progression according to RECIST 1.1 criteria. We evaluated post-progression survival according to the use of TBP (TBP and non-TBP groups) with univariate and multivariate analyses. RESULTS The cohort's median age was 61, and 84.4% were treated in the second or later lines. 82 (29.1%) of 282 patients continued on ICIs following the initial progression. In multivariate analyses, patients in the TBP group had improved post-progression survival compared to non-TBP (13.18 vs. 4.63 months, HR: 0.500, 95% CI: 0.349-0.717, p < 0.001). The benefit of the TBP was independent of the tumor type, treatment line, and age. Furthermore, TBP with ICIs remained associated with improved post-progression survival (HR: 0.600, 95% CI: 0.380-0.947, p = 0.028) after excluding the patients with no further treatment after progression in the non-TBP arm. CONCLUSIONS In this study, we observed that patients receiving ICIs beyond progression had considerably longer survival. Continuation of ICIs after progression should be considered a reasonable management option for patients with advanced cancer, specifically for patients with limited alternative options.
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Affiliation(s)
- Deniz Can Guven
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey.
| | - Emre Yekeduz
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Enes Erul
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sati Coskun Yazgan
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Taha Koray Sahin
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokturk Karatas
- Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Suayib Yalcin
- Department of Medical Oncology, Hacettepe University Cancer Institute, Sihhiye, 06100, Ankara, Turkey
| | - Yuksel Urun
- Department of Medical Oncology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Saadettin Kilickap
- Faculty of Medicine, Istinye University, Istanbul, Turkey
- Medical Oncology Unit, Liv Hospital Ankara, Ankara, Turkey
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Leone GM, Candido S, Lavoro A, Vivarelli S, Gattuso G, Calina D, Libra M, Falzone L. Clinical Relevance of Targeted Therapy and Immune-Checkpoint Inhibition in Lung Cancer. Pharmaceutics 2023; 15:pharmaceutics15041252. [PMID: 37111737 PMCID: PMC10142433 DOI: 10.3390/pharmaceutics15041252] [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: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Lung cancer (LC) represents the second most diagnosed tumor and the malignancy with the highest mortality rate. In recent years, tremendous progress has been made in the treatment of this tumor thanks to the discovery, testing, and clinical approval of novel therapeutic approaches. Firstly, targeted therapies aimed at inhibiting specific mutated tyrosine kinases or downstream factors were approved in clinical practice. Secondly, immunotherapy inducing the reactivation of the immune system to efficiently eliminate LC cells has been approved. This review describes in depth both current and ongoing clinical studies, which allowed the approval of targeted therapies and immune-checkpoint inhibitors as standard of care for LC. Moreover, the present advantages and pitfalls of new therapeutic approaches will be discussed. Finally, the acquired importance of human microbiota as a novel source of LC biomarkers, as well as therapeutic targets to improve the efficacy of available therapies, was analyzed. Therapy against LC is increasingly becoming holistic, taking into consideration not only the genetic landscape of the tumor, but also the immune background and other individual variables, such as patient-specific gut microbial composition. On these bases, in the future, the research milestones reached will allow clinicians to treat LC patients with tailored approaches.
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Affiliation(s)
- Gian Marco Leone
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Saverio Candido
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Research Center for Prevention, Diagnosis and Treatment of Cancer, University of Catania, 95123 Catania, Italy
| | - Alessandro Lavoro
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Silvia Vivarelli
- Department of Biomedical and Dental Sciences, Morphological and Functional Imaging, Section of Occupational Medicine, University of Messina, 98125 Messina, Italy
| | - Giuseppe Gattuso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Massimo Libra
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy
- Research Center for Prevention, Diagnosis and Treatment of Cancer, University of Catania, 95123 Catania, Italy
| | - Luca Falzone
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", 80131 Naples, Italy
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Nishino M, Lu J, Hino T, Vokes NI, Jänne PA, Hatabu H, Johnson BE. Prediction Model for Tumor Volume Nadir in EGFR -mutant NSCLC Patients Treated With EGFR Tyrosine Kinase Inhibitors. J Thorac Imaging 2023; 38:82-87. [PMID: 34524205 PMCID: PMC8920948 DOI: 10.1097/rti.0000000000000615] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE In patients with advanced non-small cell lung cancer (NSCLC) and oncogenic driver mutations treated with effective targeted therapy, a characteristic pattern of tumor volume dynamics with an initial regression, nadir, and subsequent regrowth is observed on serial computed tomography (CT) scans. We developed and validated a linear model to predict the tumor volume nadir in EGFR -mutant advanced NSCLC patients treated with EGFR tyrosine kinase inhibitors (TKI). MATERIALS AND METHODS Patients with EGFR -mutant advanced NSCLC treated with EGFR-TKI as their first EGFR-directed therapy were studied for CT tumor volume kinetics during therapy, using a previously validated CT tumor measurement technique. A linear regression model was built to predict tumor volume nadir in a training cohort of 34 patients, and then was validated in an independent cohort of 84 patients. RESULTS The linear model for tumor nadir prediction was obtained in the training cohort of 34 patients, which utilizes the baseline tumor volume before initiating therapy (V 0 ) to predict the volume decrease (mm 3 ) when the nadir volume (V p ) was reached: V 0 -V p =0.717×V 0 -1347 ( P =2×10 -16 ; R2 =0.916). The model was tested in the validation cohort, resulting in the R2 value of 0.953, indicating that the prediction model generalizes well to another cohort of EGFR -mutant patients treated with EGFR-TKI. Clinical variables were not significant predictors of tumor volume nadir. CONCLUSION The linear model was built to predict the tumor volume nadir in EGFR -mutant advanced NSCLC patients treated with EGFR-TKIs, which provide an important metrics in treatment monitoring and therapeutic decisions at nadir such as additional local abrasive therapy.
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Affiliation(s)
- Mizuki Nishino
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215
- Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115
| | - Junwei Lu
- Department of Biostatistics, Harvard Chan School of Public Health
| | | | - Natalie I. Vokes
- Department of Medical Oncology, Dana Farber Cancer Institute and Department of Medicine, Brigham and Women’s Hospital, 450 Brookline Ave, Boston, MA, 02215
| | - Pasi A. Jänne
- Department of Medical Oncology, Dana Farber Cancer Institute and Department of Medicine, Brigham and Women’s Hospital, 450 Brookline Ave, Boston, MA, 02215
| | - Hiroto Hatabu
- Department of Imaging, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215
- Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115
| | - Bruce E. Johnson
- Department of Medical Oncology, Dana Farber Cancer Institute and Department of Medicine, Brigham and Women’s Hospital, 450 Brookline Ave, Boston, MA, 02215
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Aggarwal H, Ndirangu K, Winfree KB, Muehlenbein CE, Zhu E, Tongbram V, Thom H. A network meta-analysis of immunotherapy-based treatments for advanced nonsquamous non-small cell lung cancer. J Comp Eff Res 2023; 12:e220016. [PMID: 36621905 PMCID: PMC10288959 DOI: 10.2217/cer-2022-0016] [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: 01/27/2022] [Accepted: 09/29/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction: In the absence of head-to-head trials comparing immunotherapies for advanced nonsquamous non-small-cell lung cancer (NsqNSCLC), a network meta-analysis (NMA) was conducted to compare the relative efficacy of these treatments. Materials & methods: A systematic literature review of randomized controlled trials evaluating first-line-to-progression and second-line treatments for advanced NsqNSCLC informed Bayesian NMAs for overall survival (OS) and progression-free survival (PFS) end points. Results: Among first-line-to-progression treatments, pembrolizumab + pemetrexed + platinum showed the greatest OS benefit versus other regimens and a PFS benefit versus all but three regimens. Among second-line treatments, an OS benefit was seen for atezolizumab, nivolumab and pembrolizumab versus docetaxel. Conclusion: Pembrolizumab + pemetrexed + platinum showed the maximum OS benefit in the first-line setting. In the second-line setting, anti-PD-1/anti-PD-L1 monotherapies were better than docetaxel.
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Affiliation(s)
- Himani Aggarwal
- Eli Lilly & Company, 893 S Delaware Street Indianapolis, IN 46225, USA
| | | | | | | | - Emily Zhu
- Eli Lilly & Company, 893 S Delaware Street Indianapolis, IN 46225, USA
| | | | - Howard Thom
- Health Economics Bristol (HEB), Bristol Medical School, University of Bristol, 1-5 Whiteladies Road Clifton Bristol, BS8 1NU, United Kingdom
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Du Z, Sun J, Zhang Y, Hesilaiti N, Xia Q, Cui H, Fan N, Xu X. Structure-Guided Strategies of Targeted Therapies for Patients with EGFR-Mutant Non-Small Cell Lung Cancer. Biomolecules 2023; 13:biom13020210. [PMID: 36830579 PMCID: PMC9953181 DOI: 10.3390/biom13020210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/24/2023] Open
Abstract
Oncogenic mutations within the EGFR kinase domain are well-established driver mutations in non-small cell lung cancer (NSCLC). Small-molecule tyrosine kinase inhibitors (TKIs) specifically targeting these mutations have improved treatment outcomes for patients with this subtype of NSCLC. The selectivity of these targeted agents is based on the location of the mutations within the exons of the EGFR gene, and grouping mutations based on structural similarities has proved a useful tool for conceptualizing the heterogeneity of TKI response. Structure-based analysis of EGFR mutations has influenced TKI development, and improved structural understanding will inform continued therapeutic development and further improve patient outcomes. In this review, we summarize recent progress on targeted therapy strategies for patients with EGFR-mutant NSCLC based on structure and function analysis.
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Affiliation(s)
- Zhenfang Du
- Department of Genetic and Developmental Biology, School of Medicine, Southeast University, Nanjing 210003, China
- Correspondence: ; Tel.: +86-025-83792462
| | - Jinghan Sun
- School of Life Science and Technology, Southeast University, Nanjing 210018, China
| | | | - Nigaerayi Hesilaiti
- Department of Genetic and Developmental Biology, School of Medicine, Southeast University, Nanjing 210003, China
| | - Qi Xia
- Department of Genetic and Developmental Biology, School of Medicine, Southeast University, Nanjing 210003, China
| | - Heqing Cui
- Department of Radiotherapy, Nanjing Chest Hospital, Nanjing Medical University Affiliated Brain Hospital, Nanjing 210029, China
| | - Na Fan
- Department of Respiratory Medicine and Critical Care Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China
| | - Xiaofang Xu
- Department of Thoracic Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou 310022, China
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Marin-Acevedo JA, Pellini B, Kimbrough EO, Hicks JK, Chiappori A. Treatment Strategies for Non-Small Cell Lung Cancer with Common EGFR Mutations: A Review of the History of EGFR TKIs Approval and Emerging Data. Cancers (Basel) 2023; 15:cancers15030629. [PMID: 36765587 PMCID: PMC9913773 DOI: 10.3390/cancers15030629] [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: 12/19/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023] Open
Abstract
The development of targeted therapies over the past two decades has led to a dramatic change in the management of EGFR-mutant non-small cell lung cancer (NSCLC). While there are currently five approved EGFR tyrosine kinase inhibitors (TKIs) for treating EGFR-mutant NSCLC in the first-line setting, therapy selection after progression on EGFR TKIs remains complex. Multiple groups are investigating novel therapies and drug combinations to determine the optimal therapy and treatment sequence for these patients. In this review, we summarize the landmark trials and history of the approval of EGFR TKIs, their efficacy and tolerability, and the role of these therapies in patients with central nervous system metastasis. We also briefly discuss the mechanisms of resistance to EGFR TKIs, ongoing attempts to overcome resistance and improve outcomes, and finalize by offering treatment sequencing recommendations.
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Affiliation(s)
- Julian A. Marin-Acevedo
- Division of Medical Oncology, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Bruna Pellini
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
- Correspondence: (B.P.); (A.C.); Tel.: +1-813-745-3050 or +1-813-449-8077 (B.P. & A.C.)
| | | | - J. Kevin Hicks
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Alberto Chiappori
- Department of Thoracic Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL 33620, USA
- Correspondence: (B.P.); (A.C.); Tel.: +1-813-745-3050 or +1-813-449-8077 (B.P. & A.C.)
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10
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Kuo WK, Weng CF, Lien YJ. Treatment beyond progression in non-small cell lung cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:1023894. [PMID: 36465371 PMCID: PMC9713814 DOI: 10.3389/fonc.2022.1023894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/26/2022] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Treatment beyond progression (TBP) is defined as treatment continuing in spite of disease progression, according to the Response Evaluation Criteria In Solid Tumors. We performed a systematic review and meta-analysis to provide evidence for the effects of TBP on lung cancer survival. MATERIALS AND METHODS This study has been conducted following the PRISMA guidelines. A systematic review of PubMed, MEDLINE, Embase, and Cochrane Collaboration Central Register of Controlled Clinical Trials from the inception of each database to December 2021 was conducted. Two authors independently reviewed articles for inclusion and extract data from all the retrieved articles. Random-effects meta-analysis was performed using Comprehensive Meta-Analysis software, version 3 (Biostat, Englewood, NJ, USA). Hazard ratios (HRs) with the corresponding 95% confidence intervals (CI) were used for survival outcomes. RESULTS We identified five (15.6%) prospective randomized trials and twenty-seven (84.4%) retrospective observational studies of a total of 9,631 patients for the meta-analysis. 3,941 patients (40.9%) were in a TBP group and 5,690 patients (59.1%) were in a non-TBP group. There is a statistically significant advantage for patients who received TBP compared with those who did not in post progression progression-free survival (ppPFS), post progression overall survival (ppOS), and overall survival (OS) from initiation of drugs (ppPFS: HR, 0.746; 95% CI, 0.644-0.865; P<0.001; ppOS: HR, 0.689; 95% CI, 0.596-0.797; P<0.001; OS from initiation of drugs: HR, 0.515; 95% CI, 0.387-0.685; P<0.001). CONCLUSION This study provides further evidence in support of TBP for NSCLC, however, these results require cautious interpretation. Large, randomized, controlled trials investigating the efficacy of TBP in lung cancer treatment are warranted. SYSTEMIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/ identifier CRD42021285147.
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Affiliation(s)
- Wei-Ke Kuo
- Division of Respiratory Therapy and Chest Medicine, Sijhih Cathay General Hospital, Taipei, Taiwan
| | - Ching-Fu Weng
- Division of Pulmonary Medicine, Department of Internal Medicine, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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Zahran SS, Ragab FA, El-Gazzar MG, Soliman AM, Mahmoud WR, Ghorab MM. Antiproliferative, antiangiogenic and apoptotic effect of new hybrids of quinazoline-4(3H)-ones and sulfachloropyridazine. Eur J Med Chem 2022; 245:114912. [DOI: 10.1016/j.ejmech.2022.114912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
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12
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Elganzory HH, Alminderej FM, El-Bayaa MN, Awad HM, Nossier ES, El-Sayed WA. Design, Synthesis, Anticancer Activity and Molecular Docking of New 1,2,3-Triazole-Based Glycosides Bearing 1,3,4-Thiadiazolyl, Indolyl and Arylacetamide Scaffolds. Molecules 2022; 27:molecules27206960. [PMID: 36296551 PMCID: PMC9611297 DOI: 10.3390/molecules27206960] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/12/2022] Open
Abstract
New 1,3,4-thiadiazole thioglycosides linked to a substituted arylidine system were synthesized via heterocyclization via click 1,3-dipolar cycloaddition. The click strategy was used for the synthesis of new 1,3,4-thiadiazole and 1,2,3-triazole hybrid glycoside-based indolyl systems as novel hybrid molecules by reacting azide derivatives with the corresponding acetylated glycosyl terminal acetylenes. The cytotoxic activities of the compounds were studied against HCT-116 (human colorectal carcinoma) and MCF-7 (human breast adenocarcinoma) cell lines using the MTT assay. The results showed that the key thiadiazolethione compounds, the triazole glycosides linked to p-methoxyarylidine derivatives and the free hydroxyl glycoside had potent activity comparable to the reference drug, doxorubicin, against MCF-7 human cancer cells. Docking simulation studies were performed to check the binding patterns of the synthesized compounds. Enzyme inhibition assay studies were also conducted for the epidermal growth factor receptor (EGFR), and the results explained the activity of a number of derivatives.
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Affiliation(s)
- Hussein H. Elganzory
- Department of Chemistry, College of Science, Qassim University, Buraidah 51452, Saudi Arabia
| | - Fahad M. Alminderej
- Department of Chemistry, College of Science, Qassim University, Buraidah 51452, Saudi Arabia
- Correspondence: (F.M.A.); (M.N.E.-B.)
| | - Mohamed N. El-Bayaa
- Photochemistry Department, National Research Centre, Cairo 12622, Egypt
- Correspondence: (F.M.A.); (M.N.E.-B.)
| | - Hanem M. Awad
- Tanning Materials and Leather Technology Department, National Research Centre, El-Behouth St, Dokki, Cairo 12622, Egypt
| | - Eman S. Nossier
- Department of Pharmaceutical Medicinal Chemistry and Drug Design, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo 11754, Egypt
| | - Wael A. El-Sayed
- Department of Chemistry, College of Science, Qassim University, Buraidah 51452, Saudi Arabia
- Tanning Materials and Leather Technology Department, National Research Centre, El-Behouth St, Dokki, Cairo 12622, Egypt
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13
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Li P, Yu J, Wang X, Pang X, Yu C, Xu Y. Study on the Evaluation of Lung Cancer Patients from the Three Aspects of Emotion. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8139680. [PMID: 36176932 PMCID: PMC9499786 DOI: 10.1155/2022/8139680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/07/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
In recent years, epidemiological survey data have shown that lung cancer is the tumor with the fastest increase in cancer incidence and mortality in China. The incidence and mortality of lung cancer in China rank first among tumors, and 80% of patients die within one year of diagnosis. This paper aims to study the evaluation of lung cancer patients from three aspects of emotion, coping style, and Quality of Life (QoL), expounding on the changes in emotion, coping style, and QoL in lung cancer patients after chemotherapy. We assess the negative emotions and survival of lung cancer patients after chemotherapy quality satisfaction survey research. We investigate the general data, QoL, and coping styles of 219 lung cancer patients undergoing chemotherapy before, during, and after chemotherapy based on the artificial intelligence processor. All survey data are input into SPSS 19 for descriptive and relevant statistical analysis. The experimental results show that under a survey of 219 lung cancer chemotherapy patients with negative emotions and QoL satisfaction after chemotherapy, at a significance level of = 0.05, there is a linear regression relationship between mental resilience and anxiety and depression.
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Affiliation(s)
- Panpan Li
- Department of Pulmonary and Critical Care Medicine, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China
| | - Jiangli Yu
- Department of Neurology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100048, China
| | - Xiaohui Wang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230088, China
| | - Xiaonan Pang
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230088, China
| | - Chengjing Yu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230088, China
| | - Yingqiong Xu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230088, China
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14
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The Therapeutic Potential of the Restoration of the p53 Protein Family Members in the EGFR-Mutated Lung Cancer. Int J Mol Sci 2022; 23:ijms23137213. [PMID: 35806218 PMCID: PMC9267050 DOI: 10.3390/ijms23137213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Despite the recent development of precision medicine and targeted therapies, lung cancer remains the top cause of cancer-related mortality worldwide. The patients diagnosed with metastatic disease have a five-year survival rate lower than 6%. In metastatic disease, EGFR is the most common driver of mutation, with the most common co-driver hitting TP53. EGFR-positive patients are offered the frontline treatment with tyrosine kinase inhibitors, yet the development of resistance and the lack of alternative therapies make this group of patients only fit for clinical trial participation. Since mutant p53 is the most common co-driver in the metastatic setting, therapies reactivating the p53 pathway might serve as a promising alternative therapeutic approach in patients who have developed a resistance to tyrosine kinase inhibitors. This review focuses on the molecular background of EGFR-mutated lung cancer and discusses novel therapeutic options converging on the reactivation of p53 tumor suppressor pathways.
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15
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Min HY, Lee HJ, Suh YA, Pei H, Kwon H, Jang HJ, Yun HJ, Moon HG, Lee HY. Targeting epidermal growth factor receptor in paclitaxel-resistant human breast and lung cancer cells with upregulated glucose-6-phosphate dehydrogenase. Br J Cancer 2022; 127:661-674. [PMID: 35597872 DOI: 10.1038/s41416-022-01843-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 04/17/2022] [Accepted: 05/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemoresistance is a major obstacle to the successful treatment of triple-negative breast cancer (TNBC) and non-small-cell lung cancer (NSCLC). Therapeutic strategies to overcome chemoresistance are necessary to improve the prognosis of patients with these cancers. METHODS Paclitaxel-resistant TNBC and NSCLC sublines were generated through continuous paclitaxel treatment over 6 months. The mechanistic investigation was conducted using MTT assay, LC/MS-based metabolite analysis, flow cytometry, western blot analysis, real-time PCR and tumour xenograft experiments. RESULTS Glucose-6-phosphate dehydrogenase (G6PD) expression along with an increase in 3-phosphoglycerates and ribulose-5-phosphate production was upregulated in paclitaxel-resistant cells. Blockade of G6PD decreased viability of paclitaxel-resistant cells in vitro and the growth of paclitaxel-resistant MDA/R xenograft tumours in vivo. Mechanistically, activation of the epidermal growth factor receptor (EGFR)/Akt pathway mediates G6PD expression and G6PD-induced cell survival. Blockade of the EGFR pathway inhibited G6PD expression and sensitised those paclitaxel-resistant cells to paclitaxel treatment in vitro and in vivo. Analysis of publicly available datasets revealed an association between G6PD and unfavourable clinical outcomes in patients with breast or lung cancer. CONCLUSIONS EGFR signaling-mediated G6PD expression plays a pivotal role in paclitaxel resistance, highlighting the potential of targeting EGFR to overcome paclitaxel resistance in TNBC and NSCLC cells overexpressing G6PD.
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Affiliation(s)
- Hye-Young Min
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Ho Jin Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Young-Ah Suh
- Institute for Innovative Cancer Research, Asan Institute for Life Science, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Honglan Pei
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hyukjin Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hyun-Ji Jang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hye Jeong Yun
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Ho-Young Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, 08826, Republic of Korea.
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16
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Johnson M, Chiara Garassino M, Mok T, Mitsudomi T. Treatment Strategies and Outcomes for Patients with EGFR-mutant Non-Small Cell Lung Cancer Resistant to EGFR Tyrosine Kinase Inhibitors: Focus on Novel Therapies. Lung Cancer 2022; 170:41-51. [DOI: 10.1016/j.lungcan.2022.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/16/2022]
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17
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Yang LY, Cheng ZJ, Liu Z, Wang D, Zhang N, Fan ZL, Cai HQ, Zhang Y, Cai Y, Xu X, Wang JH, Du GH, Hao JJ, Wang MR. Remarkable inhibition effects of afatinib alone or combining with paclitaxel in esophageal squamous cell carcinoma. J Gastroenterol Hepatol 2021; 36:2513-2522. [PMID: 33721913 DOI: 10.1111/jgh.15490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 02/06/2021] [Accepted: 03/10/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND AIM Chemotherapy drugs do not work well in esophageal squamous cell carcinoma (ESCC), and none of the targeted drugs have been applied in clinic. This study aims to identify effective targeted drugs and related biomarkers for the treatment of ESCC. METHODS The effect of 40 Food and Drug Administration-approved small-molecule inhibitors was first tested in five ESCC cell lines. CCK8 assays and xenografts derived from ESCC cell lines were performed to evaluate the anti-ESCC effects of inhibitors or chemotherapeutic agents in vitro and in vivo, respectively. Immunohistochemistry was utilized to analyze the p-EGFR expression in tissues. Western blot combining with gray analysis was conducted to detect the expression of interest protein. Flow cytometry and immunofluorescence assay were used to analyze apoptosis, cell cycle, and mitotic changes after drug treatment. RESULTS Afatinib showed remarkable effects on inhibiting ESCC cells with higher expression of p-EGFR. Results from combinatorial screening in ESCC cells expressing lower phosphorylation level of EGFR showed that paclitaxel and afatinib presented a significant synergistic inhibitory effect (P < 0.001). Molecular analysis revealed that paclitaxel sensitized afatinib by activating EGFR, and afatinib in combination with paclitaxel effectively blocked MAPK pathway and induced G2/M cell arrest and apoptosis that is an indicator of mitotic catastrophe. CONCLUSIONS Our data demonstrate that afatinib is an effective drug for patients with ESCC expressing higher phosphorylation level of EGFR. And for patients with lower p-EGFR in tumors, paclitaxel in combination with afatinib might be a promising therapeutic strategy in ESCC.
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Affiliation(s)
- Li-Yan Yang
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Jian Cheng
- Department of Neurosurgery, The People's Hospital of Huangshan, Huangshan, China
| | - Zou Liu
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Wang
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na Zhang
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhi-Lu Fan
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Qing Cai
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Zhang
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Cai
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Xu
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Hua Wang
- Beijing Key Laboratory of Drug Target Identification, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guan-Hua Du
- Beijing Key Laboratory of Drug Target Identification, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Jie Hao
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming-Rong Wang
- State Key Laboratory of Molecular Oncology, Center for Cancer Precision Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Zheng Z, Ma Y, Wang L, Deng H, Wang Z, Li J, Xu Z. Chinese herbal medicine Feiyanning cooperates with cisplatin to enhance cytotoxicity to non-small-cell lung cancer by inhibiting protective autophagy. JOURNAL OF ETHNOPHARMACOLOGY 2021; 276:114196. [PMID: 33984457 DOI: 10.1016/j.jep.2021.114196] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Feiyanning (FYN), the Chinese herbal medicine (CHM), has been used to manage non-small cell lung cancer (NSCLC) for the past 23 years. Chemotherapeutic drugs can induce autophagy in cancer cells to protect themselves from death. However, FYN can inhibit the protective autophagy in cancer cells. We investigated the biological mechanisms on the synergistic effects of FYN combined with chemotherapy in lung cancer cells. MATERIALS AND METHODS We analyzed the effective chemical components for the quality control of FYN using the UPLC-Q-TOF-MS.The cell proliferation ability was detected by the cell counting kit-8 (CCK-8) and colony formation. The cell apoptosis was determined with Flow cytometry. Expression of important differential proteins were detected by western blot. Autophagy structure was observed by TEM (Tansmission electron microscopy). Tandem mCherry-EGFP-LC3B immunofluorescence was used to measure autophagic flux. RESULTS Both FYN and cisplatin significantly induced apoptosis and inhibited cell proliferation in A549 cells. FYN reduced cell viability and increased apoptotic cell populations less effectively than cisplatin. FYN cooperated with cisplatin suppressed the cell viability, colony formation, as well as increased the cell apoptosis rate, and the expression of cleaved caspase-3 and PARP. FYN inhibited autophagy in A549 cells, which characterized by the decrease of autophagosome formation, lysosomal fusion, LC3B-II accumulation and SQSTM1 degradation, down-regulation of ATG5 and ATG7. Protective autophagy in A549 cells was induced by cisplatin. Suppression of the autophagic response using chloroquine (CQ) which is autophagy inhibitor improved the ability of cisplatin to kill cancer cells, as did FYN combined with cisplatin. CONCLUSION In summary, we revealed that the synergistic mechanism of FYN and cisplatin is that FYN inhibited the protective autophagy induced by cisplatin in A549 cells.
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Affiliation(s)
- Zhan Zheng
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China.
| | - Yue Ma
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China.
| | - Lifang Wang
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China.
| | - Haibin Deng
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China.
| | - Zhongqi Wang
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China.
| | - Jianwen Li
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China.
| | - Zhenye Xu
- Department of Oncology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China.
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Tran HT, Lam VK, Elamin YY, Hong L, Colen R, Elshafeey NA, Hassan ISA, Altan M, Blumenschein GR, Rinsurongkawong W, Rivera MJ, Vasquez ME, Carter BW, Byers LE, Tsao AS, Gibbons DL, Fossella F, Glisson BS, Zhang J, Heymach JV. Clinical Outcomes in Non-Small-Cell Lung Cancer Patients Treated With EGFR-Tyrosine Kinase Inhibitors and Other Targeted Therapies Based on Tumor Versus Plasma Genomic Profiling. JCO Precis Oncol 2021; 5:PO.20.00532. [PMID: 34377884 PMCID: PMC8345916 DOI: 10.1200/po.20.00532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/13/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare clinical outcomes in a cohort of patients with advanced non-small-cell lung cancer (NSCLC) with targetable genomic alterations detected using plasma-based circulating tumor DNA (ctDNA) or tumor-based next-generation sequencing (NGS) assays treated with US Food and Drug Administration-approved therapies at a large academic research cancer center. METHODS A retrospective review from our MD Anderson GEMINI database identified 2,224 blood samples sent for ctDNA NGS testing from 1971 consecutive patients with a diagnosis of advanced NSCLC. Clinical, treatment, and outcome information were collected, reviewed, and analyzed. RESULTS Overall, 27% of the ctDNA tests identified at least one targetable mutation and 73% of targetable mutations were EGFR-sensitizing mutations. Among patients treated with first-line epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapies, there were no significant differences in progression-free survival of 379 days and 352 days (P value = .41) with treatment based on tissue (n = 40) or ctDNA (n = 40), respectively. Additionally, there were no differences in progression-free survival or objective response rate among those with low (n = 8, 0.01%-0.99%) versus high (n = 16, ≥ 1%) levels of ctDNA of the targetable mutation as measured by variant allele frequency (VAF). Overall, there was excellent testing concordance (n = 217 tests) of > 97%, sensitivity of 91.7%, and specificity of 99.7% between blood-based ctDNA NGS and tissue-based NGS assays. CONCLUSION There were no significant differences in clinical outcomes among patients treated with approved EGFR-TKIs whose mutations were identified using either tumor- or plasma-based comprehensive profiling and those with very low VAF as compared with high VAF, supporting the use of plasma-based profiling to guide initial TKI use in patients with metastatic EGFR-mutant NSCLC.
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Affiliation(s)
- Hai T. Tran
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vincent K. Lam
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lingzhi Hong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rivka Colen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Mehmet Altan
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | - Anne S. Tsao
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Don L. Gibbons
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frank Fossella
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Jianjun Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX
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High-Trough Plasma Concentration of Afatinib Is Associated with Dose Reduction. Cancers (Basel) 2021; 13:cancers13143425. [PMID: 34298637 PMCID: PMC8305619 DOI: 10.3390/cancers13143425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022] Open
Abstract
Afatinib is used to treat non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutation as a second-generation EGFR-tyrosine kinase inhibitor (TKI). Early prediction of adverse effects based on the pharmacokinetics of afatinib enables support for quality of life (QOL) in patients with no change in efficacy. We examined the pharmacokinetic relationship between trough plasma concentration and adverse effects and evaluated the utility of measuring the trough plasma concentration of afatinib as the first EGFR-TKI treatment for NSCLC in a prospective multicenter study. Twenty-four patients treated with afatinib were enrolled in this study. All blood samples were collected at the trough point, and plasma concentrations were measured using high-performance liquid chromatography-tandem mass spectrometry. Logistic regression analysis for the dose reduction of afatinib was performed, and the receiver operating characteristic (ROC) curve was plotted. Although all patients started afatinib at 40 mg/day, plasma concentrations were variable, and mean and median trough plasma concentrations were 32.9 ng/mL and 32.5 ng/mL in this study, respectively. Minimum and maximum trough plasma concentrations were 10.4 ng/mL and 72.7 ng/mL, respectively. This variability was speculated to involve personal parameters such as laboratory data. However, no patient characteristics or laboratory data examined correlated with the trough plasma concentration of afatinib, except albumin. Albumin showed a weak correlation with plasma concentration (r = 0.60, p = 0.009). The trough plasma concentration of afatinib was significantly associated with the dose reduction of afatinib (p = 0.047). The area under the ROC curve (AUC) for the trough plasma concentration of afatinib was 0.81. The cut-off value was 21.4 ng/mL. The sensitivity and specificity of the cut-off as a risk factor were 0.80 and 0.75. In summary, the trough plasma concentration of afatinib was associated with continued or reduced dosage because of the onset of several adverse effects, and a threshold was seen. Adverse effects not only lower QOL but also hinder continued treatment. Measuring plasma concentrations of afatinib appears valuable to predict adverse effects and continue effective therapy.
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21
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Tao G, Chityala PK. Epidermal growth factor receptor inhibitor-induced diarrhea: clinical incidence, toxicological mechanism, and management. Toxicol Res (Camb) 2021; 10:476-486. [PMID: 34141161 PMCID: PMC8201561 DOI: 10.1093/toxres/tfab026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) family is a class of receptor tyrosine kinase playing a central role in carcinogenesis and cancer progression. The members of this family, particularly EGFR and human epidermal growth factor receptor 2 (HER2), are the most extensively studied drug targets for malignancy. Today, numerous tyrosine kinase inhibitors targeting EGFR family have been developed to combat non-small-cell lung cancer and breast cancer. However, severe gastrointestinal (GI) toxicity leading to dose reduction and treatment discontinuation hampers the therapeutic outcome of EGFR inhibitors. Diarrhea is one of the most frequent GI side effects, especially when it comes to second-generation EGFR inhibitors. Enterocytes apoptosis and increased inflammation accompany with many oral EGFR inhibitors. Loperamide and budesonide are the first-line treatment to manage such adverse effects. However, current prophylaxis and management are all empirical interventions to relieve the symptom. They do not specifically target the toxicological mechanism of EGFR inhibitors. Hereby, those anti-diarrhea agents do not work well when used in cancer patients experiencing EGFR inhibitor-induced diarrhea. On the other hand, the toxicological mechanism of EGFR inhibitor-induced diarrhea is poorly understood. Thus, determining the mechanism behind such diarrhea is urgently in need for developing genuinely effective anti-diarrhea agents. This review aims to call attention to EGFR inhibitor-induced diarrhea, a highly occurring and devastating cancer drug toxicity.
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Affiliation(s)
- Gabriel Tao
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204, USA
| | - Pavan Kumar Chityala
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204, USA
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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22
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Paludan-Müller AS, Créquit P, Boutron I. Reporting of harms in oncological clinical study reports submitted to the European Medicines Agency compared to trial registries and publications-a methodological review. BMC Med 2021; 19:88. [PMID: 33827569 PMCID: PMC8028762 DOI: 10.1186/s12916-021-01955-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/01/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND An accurate and comprehensive assessment of harms is a fundamental part of an accurate weighing of benefits and harms of an intervention when making treatment decisions; however, harms are known to be underreported in journal publications. Therefore, we sought to compare the completeness of reporting of harm data, discrepancies in harm data reported, and the delay to access results of oncological clinical trials between three sources: clinical study reports (CSRs), clinical trial registries and journal publications. METHODS We used the EMA clinical data website to identify all trials submitted to the EMA between 2015 and 2018. We retrieved all CSRs and included all phase II, II/III or III randomised controlled trials (RCTs) assessing targeted therapy and immunotherapy for cancer. We then identified related records in clinical trial registries and journals. We extracted harms data for eight pre-specified variables and determined the completeness of reporting of harm data in each of the three sources. RESULTS We identified 42 RCTs evaluating 13 different drugs. Results were available on the EMA website in CSRs for 37 (88%) RCTs, ClinicalTrials.gov for 36 (86%), the European Clinical Trials Register (EUCTR) for 20 (48%) and in journal publications for 32 (76%). Harms reporting was more complete in CSRs than other sources. We identified marked discrepancies in harms data between sources, e.g. the number of patients discontinuing due to adverse events differed in CSRs and clinical trial registers for 88% of trials with data in both sources. For CSRs and publications, the corresponding number was 90%. The median (interquartile range) delay between the primary trial completion date and access to results was 4.34 (3.09-7.22) years for CSRs, 2.94 (1.16-4.52) years for ClinicalTrials.gov, 5.39 (4.18-7.33) years for EUCTR and 2.15 (0.64-5.04) years for publications. CONCLUSIONS Harms of recently approved oncological drugs were reported more frequently and in more detail in CSRs than in trial registries and journal publications. Systematic reviews seeking to address harms of oncological treatments should ideally use CSRs as the primary source of data; however, due to problems with access, this is currently not feasible.
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Affiliation(s)
- Asger S Paludan-Müller
- Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark , Department of Clinical Research, University of Southern Denmark, JB Winsløwsvej 9b, 3rd Floor, 5000, Odence C, Denmark. .,Open Patient data Exploratory Network (OPEN) , Odense University Hospital , Odense, Denmark.
| | - Perrine Créquit
- Direction de la recherche Clinique, Hôpital Foch, Suresnes, France.,Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France.,Cochrane France, Paris, France
| | - Isabelle Boutron
- Université de Paris, CRESS, INSERM, INRA, F-75004, Paris, France.,Cochrane France, Paris, France.,Centre d'Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France
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Provencio M, Terrasa J, Garrido P, Campelo RG, Aparisi F, Diz P, Aguiar D, García-Giron C, Hidalgo J, Aguado C, González JG, Esteban E, Gómez-Aldavarí L, Moran T, Juan O, Chara LE, Marti JL, Castro RL, Ortega AL, Moreno EM, Coves J, Sánchez Peña AM, Bosch-Barrera J, Gastaldo AS, Núñez NF, Del Barco E, Cobo M, Isla D, Majem M, Navarro F, Calvo V. Osimertinib in advanced EGFR-T790M mutation-positive non-small cell lung cancer patients treated within the Special Use Medication Program in Spain: OSIREX-Spanish Lung Cancer Group. BMC Cancer 2021; 21:230. [PMID: 33676426 PMCID: PMC7937205 DOI: 10.1186/s12885-021-07922-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AURA study reported 61% objective response rate and progression-free survival of 9.6 months with osimertinib in patients with EGFR/T790M+ non-small cell lung cancer. Due to lack of real-world data, we proposed this study to describe the experience with osimertinib in Spain. METHODS Post-authorization, non-interventional Special Use Medication Program, multicenter, retrospective study in advanced EGFR/T790M+ non-small cell lung cancer. One hundred-fifty five patients were enrolled (August 2016-December 2018) from 30 sites. PRIMARY OBJECTIVE progression-free survival. Secondary objectives: toxicity profile, objective response rate, and use of health service resources. RESULTS 70% women, median age 66. 63.9% were non-smokers and 99% had adenocarcinoma. Most patients had received at least one prior treatment (97%), 91.7% had received previous EGFR-tyrosine kinase inhibitors and 2.8% osimertinib as first-line treatment. At data cutoff, median follow-up was 11.8 months. One hundred-fifty five patients were evaluable for response, 1.3% complete response, 40.6% partial response, 31% stable disease and 11.6% disease progression. Objective response rate was 42%. Median progression-free survival was 9.4 months. Of the 155 patients who received treatment, 76 (49%) did not reported any adverse event, 51% presented some adverse event, most of which were grade 1 or 2. The resource cost study indicates early use is warranted. CONCLUSION This study to assess the real-world clinical impact of osimertinib showed high drug activity in pretreated advanced EGFR/T790M+ non-small cell lung cancer, with manageable adverse events. TRIAL REGISTRATION Clinical trial registration number: NCT03790397 .
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Affiliation(s)
- Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Health Research Institute, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Universidad Autónoma de Madrid, Madrid, Spain.
| | - Josefa Terrasa
- Medical Oncology Department, Hospital Universitari Son Espases, Islas Balears, Palma de Mallorca, Spain
| | - Pilar Garrido
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rosario García Campelo
- Medical Oncology Department, Hospital Universitario A Coruña, A Coruña, Spain.,Instituto de Investigación Biomédica A Coruña INIBIC, A Coruña, Spain
| | - Francisco Aparisi
- Medical Oncology Department Valencia, Hospital General Universitario de Valencia, Madrid, Spain
| | - Pilar Diz
- Medical Oncology Department León, Complejo Asistencial Universitario de León, Madrid, Spain
| | - David Aguiar
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de GC, Spain
| | - Carlos García-Giron
- Medical Oncology Department, Hospital Universitario De Burgos, Burgos, Spain
| | - Julia Hidalgo
- Medical Oncology Department, Hospital Lluís Alcanyis, Xátiva, Valencia, Spain
| | - Carlos Aguado
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Jorge García González
- Medical Oncology Department Santiago de Compostela, Hospital Clínico Universitario de Santiago, Madrid, Spain
| | - Emilio Esteban
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lorenzo Gómez-Aldavarí
- Medical Oncology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Teresa Moran
- Institut Català d'Oncologia Badalona, Medical Oncology Department, Badalona, Barcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Barcelona, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Badalona Applied Research Group in Oncology, Barcelona, Spain.,Fundació Germans Trias i Pujol, Barcelona, Spain
| | - Oscar Juan
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luís Enrique Chara
- Medical Oncology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Juan L Marti
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Rafael López Castro
- Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ana Laura Ortega
- Medical Oncology Department, Complejo Hospitalario de Jaen, Jaen, Spain
| | | | - Juan Coves
- Medical Oncology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Ana M Sánchez Peña
- Medical Oncology Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Joaquim Bosch-Barrera
- Department of Oncology, Catalan Institute of Oncology. Dr. Josep Trueta University Hospital, Girona, Spain
| | | | | | - Edel Del Barco
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Manuel Cobo
- Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Unidad de Gestión Clínica Intercentros de Oncología Médica, Málaga, Spain
| | - Dolores Isla
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Aragón, Spain
| | - Margarita Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fátima Navarro
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Health Research Institute, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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König D, Savic Prince S, Rothschild SI. Targeted Therapy in Advanced and Metastatic Non-Small Cell Lung Cancer. An Update on Treatment of the Most Important Actionable Oncogenic Driver Alterations. Cancers (Basel) 2021; 13:804. [PMID: 33671873 PMCID: PMC7918961 DOI: 10.3390/cancers13040804] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/18/2022] Open
Abstract
Due to groundbreaking developments and continuous progress, the treatment of advanced and metastatic non-small cell lung cancer (NSCLC) has become an exciting, but increasingly challenging task. This applies, in particular, to the subgroup of NSCLC with oncogenic driver alterations. While the treatment of epidermal growth factor receptor (EGFR)-mutated and anaplastic lymphoma kinase (ALK)-rearranged NSCLC with various tyrosine kinase inhibitors (TKIs) is well-established, new targets have been identified in the last few years and new TKIs introduced in clinical practice. Even for KRAS mutations, considered for a long time as an "un-targetable" alteration, promising new drugs are emerging. The detection and in-depth molecular analysis of resistance mechanisms has further fueled the development of new therapeutic strategies. The objective of this review is to give a comprehensive overview on the current landscape of targetable oncogenic alterations in NSCLC.
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Affiliation(s)
- David König
- Department of Medical Oncology, University Hospital Basel, 4031 Basel, Switzerland;
- Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland;
| | - Spasenija Savic Prince
- Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland;
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, 4031 Basel, Switzerland
| | - Sacha I. Rothschild
- Department of Medical Oncology, University Hospital Basel, 4031 Basel, Switzerland;
- Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland;
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25
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Efficacy of Afatinib in the Treatment of Patients with Non-Small Cell Lung Cancer and Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13040688. [PMID: 33567737 PMCID: PMC7915355 DOI: 10.3390/cancers13040688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/19/2021] [Accepted: 01/25/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Evidence from randomized controlled trials about the efficacy of monotherapy of afatinib on survival of patients with advanced non-small cell lung cancer (NSCLC) and recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) has been not yet rigorously reviewed, which needs to be systemically reviewed and meta-analyzed in terms of overall survival and progression-free survival endpoints. The evidence from randomized controlled trials indicated that first- or second-line afatinib monotherapy has improved the survival of patients with NSCLC. Second-line monotherapy afatinib is well-tolerated and could be a promising monotherapy for recurrent/metastatic HNSCCs; however, further randomized controlled trials should be conducted to collect extra survival data regarding the efficacy of afatinib in R/M HNSCC. Abstract Several randomized controlled trials (RCTs) evaluated the afatinib efficacy in patients with advanced non-small cell lung cancer (NSCLC) and recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). This review systemically outlined and meta-analyzed the afatinib efficacy in NSCLC and R/M HNSCC in terms of overall survival (OS) and progression-free survival (PFS) endpoints. Records were retrieved from PubMed, Web of Science, and ScienceDirect from 2011 to 2020. Eight afatinib RCTs were included and assessed for the risk of bias. In meta-analysis, overall pooled effect size (ES) of OS in afatinib group (AG) significantly improved in all RCTs and NSCLC-RCTs [hazard ratios (HRs): 0.89 (95% CI: 0.81–0.98, p = 0.02); I2 = 0%, p = 0.71/ 0.86 (95% CI: 0.76–0.97; p = 0.02); I2 = 0%, p = 0.50, respectively]. ES of PFS in AG significantly improved in all RCTs, NSCLC-RCTs, and HNSCC-RCTs [HRs: 0.75 (95% CI: 0.68–0.83; p < 0.00001); I2 = 26%, p = 0.24; 0.75 (95% CI: 0.66–0.84; p < 0.00001); I2 = 47%, p = 0.15/0.76 (95% CI: 0.65–88; p = 0.0004); I2 = 34%, p = 0.0004, respectively]. From a clinical viewpoint of severity, interstitial lung disease, dyspnea, pneumonia, acute renal failure, and renal injury were rarely incident adverse events in the afatinib group. In conclusion, first- and second-line afatinib monotherapy improved the survival of patients with NSCLC, while second-line afatinib monotherapy could be promising for R/M HNSCC. The prospective protocol is in PROSPERO (ID = CRD42020204547).
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26
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Creelan BC, Yeh TC, Kim SW, Nogami N, Kim DW, Chow LQM, Kanda S, Taylor R, Tang W, Tang M, Angell HK, Roudier MP, Marotti M, Gibbons DL. A Phase 1 study of gefitinib combined with durvalumab in EGFR TKI-naive patients with EGFR mutation-positive locally advanced/metastatic non-small-cell lung cancer. Br J Cancer 2021; 124:383-390. [PMID: 33012782 PMCID: PMC7852511 DOI: 10.1038/s41416-020-01099-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/28/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND EGFR tyrosine kinase inhibitors (TKIs) induce cytolysis and release of tumour proteins, which can stimulate antigen-specific T cells. The safety and efficacy of durvalumab and gefitinib in combination for TKI-naive patients with advanced EGFRm NSCLC was evaluated. METHODS This Phase 1 open-label, multicentre trial (NCT02088112) was conducted in 56 patients with NSCLC. Dose expansion permitted TKI-naive patients, primarily with activating L858R or Ex19del EGFRm. Arms 1 + 1a received concurrent therapy; Arm 2 received 4 weeks of gefitinib induction followed by concurrent therapy. RESULTS From dose escalation, the recommended dose of durvalumab was 10 mg/kg Q2W with 250 mg QD gefitinib. Pharmacokinetics were as expected, consistent with inhibition of soluble PD-L1 and no treatment-emergent immunogenicity. In dose expansion, 35% of patients had elevated liver enzymes leading to drug discontinuation. In Arms 1 + 1a, objective response rate was 63.3% (95% CI: 43.9-80.1), median progression-free survival (PFS) was 10.1 months (95% CI: 5.5-15.2) and median response duration was 9.2 months (95% CI: 3.7-14.0). CONCLUSIONS Durvalumab and gefitinib in combination had higher toxicity than either agent alone. No significant increase in PFS was detected compared with historical controls. Therefore, concurrent PD-L1 inhibitors with gefitinib should be generally avoided in TKI-naive patients with EGFRm NSCLC.
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Affiliation(s)
- Benjamin C Creelan
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, FOB-1, Tampa, FL, 33612, USA.
| | - Tammie C Yeh
- Translational Medicine, Oncology R&D, AstraZeneca, 35 Gatehouse Drive, Waltham, MA, 02451, USA
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Naoyuki Nogami
- Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, 160 Minami-Umemoto-cho, Matsuyama City, 791-0280, Japan
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Laura Q M Chow
- Department of Medicine, Division of Oncology, University of Washington/Seattle Cancer Care Alliance, Seattle, WA, 98109, USA
| | - Shintaro Kanda
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Rosemary Taylor
- Oncology, AstraZeneca, Academy House, 132-136 Hills Road, Cambridge, CB2 8PA, UK
| | - Weifeng Tang
- Clinical Pharmacology and Safety Assessment, AstraZeneca, One Medimmune Way, 101 ORD, 2001D, Gaithersburg, MD, 20878, USA
| | - Mei Tang
- Clinical Pharmacology and Safety Assessment, AstraZeneca, One Medimmune Way, 101 ORD, 2001D, Gaithersburg, MD, 20878, USA
| | - Helen K Angell
- Translational Medicine, Oncology R&D, AstraZeneca, Darwin Building, Unit 310, Cambridge Science Park, Milton Road, Cambridge, CB4 0WG, UK
| | - Martine P Roudier
- Translational Medicine, Oncology R&D, AstraZeneca, Darwin Building, Unit 310, Cambridge Science Park, Milton Road, Cambridge, CB4 0WG, UK
| | - Marcelo Marotti
- Oncology, AstraZeneca, Academy House, 132-136 Hills Road, Cambridge, CB2 8PA, UK
| | - Don L Gibbons
- Departments of Thoracic/Head and Neck Medical Oncology and Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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27
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Song SY, Ha SJ, Park JH, Park SJ, Shin SH, Oak C, Choi JY, Yoon SW, Kim JA, Yoon SH, Son JW, Kim SJ, Yoo HS. A randomized, multi-center, open-label study to compare the safety and efficacy between afatinib monotherapy and combination therapy of afatinib and HAD-B1 for the locally advanced or metastatic NSCLC patients with EGFR mutations. Medicine (Baltimore) 2020; 99:e23455. [PMID: 33285743 PMCID: PMC7717758 DOI: 10.1097/md.0000000000023455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Afatinib is an epidermal growth factor receptor - tyrosine kinase inhibitor (EGFR-TKI) with proven efficacy for treating patients with advanced or metastatic non-small cell lung cancer (NSCLC). Unfortunately, responses are limited by acquired resistance. Because traditional Korean medicine may have synergistic effects when combined with chemotherapy or radiotherapy, the aim of our study is to elucidate the efficacy and safety of afatinib plus HangAmDan-B1 (HAD-B1) combination therapy in the treatment of patients with NSCLC, as well as EGFR mutations, who need afatinib therapy. METHODS/DESIGN This study is a randomized, multi-center, open clinical trial. A total of 178 eligible subjects, recruited at 8 centers, are randomly assigned to take Afatinib (20-40 mg) ± HAD-B1 (0.972 g/day) for 48 weeks. In the test group, HAD-B1 and afatinib will be used in combination. The primary outcome is a comparison of progression-free survival (PFS) between afatinib monotherapy and afatinib plus HAD-B1 combination therapy in patients with local advanced or metastatic (Stage IIIA, B, C/IV) NSCLC. Secondary outcomes are the overall survival rates, clinical responses, tumor size reductions, health-related qualities of life, and safety. DISCUSSION The result of this clinical trial will provide evidence for the efficacy and safety of using HAD-B1 in the treatment of EGFR-positive patients with locally advanced or metastatic NSCLC who require afatinib therapy. TRIAL REGISTRATION Clinical Research Information Service (CRIS), Republic of Korea (ID: KCT0005414), on September 23, 2020.
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Affiliation(s)
- Si-Yeon Song
- East West Cancer Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon
| | - Su-Jeong Ha
- East West Cancer Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon
| | - Ji-Hye Park
- East West Cancer Center, Seoul Korean Medicine Hospital of Daejeon University, Seoul
| | - So-Jung Park
- East West Cancer Center, Daejeon Korean Medicine Hospital of Daejeon University, Daejeon
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan
| | - Chulho Oak
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan
| | - Jun-Yong Choi
- Department of Internal Medicine, School of Korean Medicine & Korean Medicine Hospital of Pusan National University, Yangsan
| | - Seong Woo Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong
| | - Jung-A Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Kyung Hee University Gangdong Hospital, Seoul
| | - Seong Hoon Yoon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan
| | - Ji Woong Son
- Department of Internal Medicine, Konyang University Hospital, Daejeon
| | - Seung Joon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, Postech-Catholic Biomedical Engineering Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwa-Seung Yoo
- East West Cancer Center, Seoul Korean Medicine Hospital of Daejeon University, Seoul
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Liu D, Peng J, Chen L, Zhang Y, Han X, Yang P, He H. Solid phase extraction-based magnetic carbon nitride/metal organic framework composite with high performance liquid chromatography for the determination of tyrosine kinase inhibitors in urine samples. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2020; 12:4798-4805. [PMID: 32955051 DOI: 10.1039/d0ay01243b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this study, a novel solid phase extraction method was constructed to detect three tyrosine kinase inhibitors (TKIs) in urine with a high-performance liquid chromatography-diode array detector. The sorbent MCN/BIF-20 was constructed by magnetic g-C3N4 (MCN) and boron imidazole framework-20 (BIF-20) and was characterized by multiple techniques. The experimental results of the adsorption isotherm and adsorption kinetics indicated that the composites had good adsorption of TKIs (148.33 mg g-1, 283.25 mg g-1, 188.17 mg g-1). The reason for the good adsorption property of the complex material was revealed by comparison with each single material. The analytical method was built by a single factor experiment, and was evaluated as a suitable method to detect TKIs in urine by its good accuracy (90.35-98.69%), precision (<3.9%), appropriate detection limits (2.2-3.4 ng mL-1), and linear ranges (12.5-500 ng mL-1) with convenient determination coefficients (>0.9997). The performance of the MCN/BIF-20 composite did not decrease dramatically in 3 cycles. These analytical results demonstrated that g-C3N4 and BIFs had a bright prospect in sample pretreatment, and the proposed approach based on MCN/BIF-20 was applicable for analysis of TKIs in urine.
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Affiliation(s)
- Donghao Liu
- Department of Analytical Chemistry, China Pharmaceutical University, 639 Longmian Avenue, Nanjing 211198, Jiangsu Province, China.
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29
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Long-term efficacy of afatinib in a patient with squamous cell carcinoma of the lung and multiple ERBB family aberrations: afatinib in ERBB+ lung squamous cell carcinoma. Anticancer Drugs 2020; 30:873-878. [PMID: 31283542 PMCID: PMC6727938 DOI: 10.1097/cad.0000000000000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the phase 3 LUX-Lung 8 study, the ERBB family blocker, afatinib, significantly prolonged progression-free survival and overall survival relative to erlotinib in patients with relapsed/refractory squamous cell carcinoma of the lung. We describe the case of a 53-year-old Asian male enrolled in LUX-Lung 8 who experienced long-term benefit from afatinib following failure of platinum-based chemotherapy. The patient received afatinib, and remained progression-free for 14.7 months according to investigator review. Overall survival was 17.7 months. Tolerability-guided dose adjustments helped facilitate long-term afatinib use by mitigating drug-related adverse effects. Next-generation sequencing revealed that multiple genetic aberrations were present, including epidermal growth factor receptor copy number amplification, and mutations in ERBB4, ALK, RET, and BRCA2. These findings may help to explain the enhanced response to afatinib and highlight the importance of biomarker analysis in guiding treatment decisions in patients with squamous cell carcinoma of the lung.
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30
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Fan Y, Chen J, Zhou C, Wang H, Shu Y, Zhang J, Hua H, Huang DCL, Zhou C. Afatinib in patients with advanced non-small cell lung cancer harboring HER2 mutations, previously treated with chemotherapy: A phase II trial. Lung Cancer 2020; 147:209-213. [PMID: 32738416 DOI: 10.1016/j.lungcan.2020.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite 1-4 % of NSCLC tumors harboring mutations in the HER2 gene, there are no approved HER2-pathway-targeted treatments available. We report an open-label, single-arm, multicenter phase II study investigating the efficacy and safety of afatinib in Asian patients with HER2-mutation positive (HER2m+) NSCLC. METHODS Eligible patients for Part A had confirmed stage IIIb/IV HER2m + NSCLC, had failed one or two prior lines of chemotherapy, and were EGFR/HER2-inhibitor naïve. Patients received oral afatinib 40 mg/day in continuous 28-day cycles, until disease progression or intolerable adverse events (AEs). Patients qualified for Part B if they had > 12 weeks' clinical benefit and Eastern Cooperative Oncology Group performance status ≤ 2. In Part B, patients were to receive afatinib at the last received dose, plus paclitaxel 80 mg/m2 weekly, until disease progression or intolerable AEs. The primary endpoint in Part A was objective response (OR); secondary endpoints included disease control (DC), progression-free survival (PFS), and overall survival (OS). Further exploratory endpoints were OR, DC, and PFS in Part B. RESULTS Eighteen patients received afatinib in Part A. No patient achieved an OR; 11 patients (61.1 %) achieved stable disease, and six patients (33.3 %) had progressive disease. DC rate was therefore 61.1 % (95 % confidence interval [CI]: 35.7, 82.7). A decrease in tumor size from baseline of > 0 to < 30 % was observed in eight patients. At the time of analysis, 16 patients (88.9 %) had progressed or died. Median PFS was 2.76 months (95 % CI: 1.87, 4.60) and median OS was 10.02 months (95 % CI: 8.47, 10.08). All patients experienced ≥ 1 AE, most commonly diarrhea (66.7 %) and rash (33.3 %). No patients met the inclusion criteria for Part B, and recruitment was slow; therefore, the study was terminated. CONCLUSIONS This study found no clinical benefit of afatinib for EGFR TKI-naïve patients with HER2m + NSCLC.
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Affiliation(s)
- Yun Fan
- Zhejiang Cancer Hospital, Hangzhou, China
| | | | - Chengzhi Zhou
- The First Affiliated Hospital of Guangzhou Medical University, Guangdong, China
| | - Huijuan Wang
- Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yongqian Shu
- The First Affiliated Hospital with Nanjing Medical University, Jiangsu, China
| | - Jacky Zhang
- Boehringer Ingelheim (China) Investment Co., Ltd, Shanghai, China
| | - Hairui Hua
- Boehringer Ingelheim (China) Investment Co., Ltd, Shanghai, China
| | | | - Caicun Zhou
- Medical Oncology, Shanghai Pulmonary Hospital, Shanghai, China.
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31
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Tripathi SK, Pandey K, Rengasamy KRR, Biswal BK. Recent updates on the resistance mechanisms to epidermal growth factor receptor tyrosine kinase inhibitors and resistance reversion strategies in lung cancer. Med Res Rev 2020; 40:2132-2176. [PMID: 32596830 DOI: 10.1002/med.21700] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/21/2020] [Accepted: 06/09/2020] [Indexed: 12/17/2022]
Abstract
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have led to a substantial improvement in the prognosis of lung cancer patients by explicitly targeting the activating mutations within the EGFR. Initially, patients harboring tumors with EGFR mutations show progression-free survival and improvement in the response rates toward all-generation EGFR-TKIs; however, these agents fail to deliver the intended results in the long-term due to drug resistance. Therefore, it is necessary to recognize specific cardinal mechanisms that regulate the resistance phenomenon. Understanding the intricate mechanisms underlying EGFR-TKIs resistance in lung cancer could provide cognizance for more advanced targeted therapeutics. The present review features insights into current updates on the discrete mechanisms, including secondary or tertiary mutations, parallel and downstream signaling pathways, acquiring an epithelial-to-mesenchymal transition (EMT) signature, microRNAs (miRNAs), and epigenetic alterations, which lead to intrinsic and acquired resistance against EGFR-TKIs in lung cancer. In addition, this paper also reviews current possible strategies to overcome this issue using combination treatment of recently developed MET inhibitors, allosteric inhibitors or immunotherapies, transformation of EMT, targeting miRNAs, and epigenetic alterations in intrinsic and acquired EGFR-TKIs resistant lung cancer. In conclusion, multiple factors are responsible for intrinsic and acquired resistance to EGFR-TKIs and understanding of the detailed molecular mechanisms, and recent advancements in pharmacological studies are needed to develop new strategies to overcome intrinsic and acquired EGFR-TKIs resistance in lung cancer.
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Affiliation(s)
- Surya K Tripathi
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
| | - Kamal Pandey
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
| | - Kannan R R Rengasamy
- Department of Bioresources and Food Science, Konkuk University, Seoul, South Korea
| | - Bijesh K Biswal
- Cancer Drug Resistance Laboratory, Department of Life Science, National Institute of Technology Rourkela, Rourkela, India
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Peng YM, Duan H, Zhang J, Sun C, Zhang X, Shen W, Zheng S, Tan K, Jiang X, Li J, Cui HJ. Application of Zizao Yangrong Granules for Treating Targeted Drugs-Related Skin Xerosis: A Randomized Double-Blinded Controlled Study. Integr Cancer Ther 2020; 19:1534735420924832. [PMID: 32567372 PMCID: PMC7309378 DOI: 10.1177/1534735420924832] [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] [Indexed: 11/17/2022] Open
Abstract
Background: Dermatologic toxicities are the most common side effects associated with the targeted drugs epidermal growth factor receptor inhibitors (EGFRIs), in which xerosis commonly complicated by pruritus severely disturbs the quality of life. The study has observed the curative effect of Zizao Yangrong granules (ZYG) from Chishui Xuanzhu in the treatment of EGFRIs-related xerosis and pruritus, as well as evaluating the safety of the prescription. Methods: Patients (n = 68) who had xerosis after using EGFRIs were enrolled and then randomly divided into the treatment group and control group, respectively, receiving ZYG and placebo granules combined with vitamin E ointment. The intervention lasted 4 weeks. Changes in xerosis and pruritus were observed, and blood routine examination as well as liver and kidney function are observed as safety indexes. The water content of skin and qualify of life were observed. Results: A total of 66 out of 68 patients finished the study with 34 patients in each group. The effective rates of xerosis among the treatment group and control group were 84.8% and 69.7% after 2 weeks’ treatment (P < .05), while they were 84.8% and 75.8% after 4 weeks’ treatment (P < .05). The patients in the experimental group had better quality of life than that in the control group (P = .045). Conclusion: ZYG can effectively improve the skin dryness associated with EGFRIs, and significantly improve the quality of life of patients with good safety; however, larger randomized controlled trials are needed to verify these findings.
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Affiliation(s)
- Yan Mei Peng
- Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hua Duan
- Beijing University of Chinese Medicine, Beijing, China
| | - Jingyi Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Chenyao Sun
- Beijing University of Chinese Medicine, Beijing, China
| | - Xu Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Wen Shen
- Beijing University of Chinese Medicine, Beijing, China
| | - Shuyue Zheng
- Beijing University of Chinese Medicine, Beijing, China
| | - Kexin Tan
- Beijing University of Chinese Medicine, Beijing, China
| | - Xuejiao Jiang
- Beijing University of Chinese Medicine, Beijing, China
| | - Jia Li
- Beijing University of Chinese Medicine, Beijing, China
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Sartori G, Belluomini L, Lombardo F, Avancini A, Trestini I, Vita E, Tregnago D, Menis J, Bria E, Milella M, Pilotto S. Efficacy and safety of afatinib for non-small-cell lung cancer: state-of-the-art and future perspectives. Expert Rev Anticancer Ther 2020; 20:531-542. [PMID: 32529917 DOI: 10.1080/14737140.2020.1776119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Afatinib is a second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, acting as an irreversible and multitarget blocker of ErbB family members. Afatinib is currently approved for advanced non-small-cell lung cancer (NSCLC) harboring common and uncommon sensitizing EGFR mutations and for squamous NSCLC patients progressing after first-line platinum-based chemotherapy. AREAS COVERED This review summarizes the efficacy and safety profile of afatinib compared with chemotherapy and other EGFR TKIs, in order to evaluate its characteristics and potential role in the increasingly complex treatment landscape of EGFR-mutant lung cancer. Future perspectives and innovative drug combinations are also discussed. EXPERT OPINION Afatinib has been demonstrated to improve efficacy and quality of life compared with chemotherapy with a managed toxicity profile. However, in recent years, the increasing availability of different treatment options for advanced EGFR-mutant NSCLC has made the current treatment scenario more complicated, with an increasing need of new and deeper scientific data. In this light, the identification and validation of potential clinicopathological and/or molecular predictors of benefit, as well as the clarification of resistance mechanisms, may help to clarify the most appropriate treatment strategies and sequences for EGFR-mutant patients.
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Affiliation(s)
- Giulia Sartori
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Fiorella Lombardo
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Alice Avancini
- Biomedical, Clinical and Experimental Sciences, Department of Medicine, University of Verona , Verona, Italy
| | - Ilaria Trestini
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Emanuele Vita
- Medical Oncology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' I.R.C.C.S ., Roma, Italy
| | - Daniela Tregnago
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova , Padova, Italy.,Medical Oncology Department, Istituto Oncologico Veneto IRCCS , Padova, Italy
| | - Emilio Bria
- Medical Oncology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' I.R.C.C.S ., Roma, Italy
| | - Michele Milella
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
| | - Sara Pilotto
- Medical Oncology, Department of Medicine, University of Verona, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona , Verona, Italy
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Muñoz Martín AJ, Ramírez SP, Morán LO, Zamorano MR, Benéitez MCV, Salcedo IA, Escobar IG, Fernández JMS. Pharmacological cancer treatment and venous thromboembolism risk. Eur Heart J Suppl 2020; 22:C2-C14. [PMID: 32368194 PMCID: PMC7189737 DOI: 10.1093/eurheartj/suaa004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Risk factors for cancer-associated thrombosis are commonly divided into three categories: patient-, cancer-, and treatment-related factors. Currently, different types of drugs are used in cancer treatment. Chemotherapy has been identified as an independent risk factor for venous thromboembolism (VTE). However, it should be noted, that the risk of VTE is not consistent among all cytotoxic agents. In addition, different supportive care drugs, such as erythropoiesis stimulating agents or granulocyte colony stimulating factors, and hormonotherapy have been associated to an increased risk of VTE. Immunotherapy and molecular-targeted therapies have significantly changed the treatment of cancer over the past decade. The main subtypes include tyrosine-kinase inhibitors, monoclonal antibodies, small molecules, and immunomodulatory agents. The relationship between VTE and targeted therapies remains largely unknown.
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Affiliation(s)
- Andrés J Muñoz Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Sara Pérez Ramírez
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Laura Ortega Morán
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Magdalena Ruiz Zamorano
- Department of Medicine, Faculty of Medicine, Universidad Complutense, Av. Séneca 2, 28040 Madrid, Spain
| | | | - Inmaculada Aparicio Salcedo
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Ignacio García Escobar
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Calle Obispo Rafael Torija s/n, 13005 Ciudad Real, Spain
| | - José Manuel Soria Fernández
- Genomic of Complex Disease Unit, Institut d'investigació Sant Pau (IIB-SANT PAU), Joan Alcover, 7-2° 2ª, 08031 Barcelona, Spain
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Harrison PT, Vyse S, Huang PH. Rare epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer. Semin Cancer Biol 2020; 61:167-179. [PMID: 31562956 PMCID: PMC7083237 DOI: 10.1016/j.semcancer.2019.09.015] [Citation(s) in RCA: 277] [Impact Index Per Article: 69.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/18/2022]
Abstract
Epidermal growth factor receptor (EGFR) mutations are the second most common oncogenic driver event in non-small cell lung cancer (NSCLC). Classical activating mutations (exon 19 deletions and the L858R point mutation) comprise the vast majority of EGFR mutations and are well defined as strong predictors for good clinical response to EGFR tyrosine kinase inhibitors (EGFRi). However, low frequency mutations including point mutations, deletions, insertions and duplications occur within exons 18-25 of the EGFR gene in NSCLC and are associated with poorer responses to EGFRi. Despite an increased uptake of more sensitive detection methods to identify rare EGFR mutations in patients, our understanding of the biology of these rare EGFR mutations is poor compared to classical mutations. In particular, clinical data focused on these mutations is lacking due to their rarity and challenges in trial recruitment, resulting in an absence of effective treatment strategies for many low frequency EGFR mutations. In this review, we describe the structural and mechanistic features of rare EGFR mutations in NSCLC and discuss the preclinical and clinical evidence for EGFRi response for individual rare EGFR mutations. We also discuss EGFRi sensitivity for complex EGFR mutations, and conclude by offering a perspective on the outstanding questions and future steps required to make advances in the treatment of NSCLC patients that harbour rare EGFR mutations.
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Affiliation(s)
- Peter T Harrison
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Simon Vyse
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK
| | - Paul H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, SW3 6JB, UK.
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Zhu C, Zhuang W, Chen L, Yang W, Ou WB. Frontiers of ctDNA, targeted therapies, and immunotherapy in non-small-cell lung cancer. Transl Lung Cancer Res 2020; 9:111-138. [PMID: 32206559 PMCID: PMC7082279 DOI: 10.21037/tlcr.2020.01.09] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-small-cell lung cancer (NSCLC), a main subtype of lung cancer, is one of the most common causes of cancer death in men and women worldwide. Circulating tumor DNA (ctDNA), tyrosine kinase inhibitors (TKIs) and immunotherapy have revolutionized both our understanding of NSCLC, from its diagnosis to targeted NSCLC therapies, and its treatment. ctDNA quantification confers convenience and precision to clinical decision making. Furthermore, the implementation of TKI-based targeted therapy and immunotherapy has significantly improved NSCLC patient quality of life. This review provides an update on the methods of ctDNA detection and its impact on therapeutic strategies; therapies that target epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) using TKIs such as osimertinib and lorlatinib; the rise of various resistant mechanisms; and the control of programmed cell death-1 (PD-1), programmed cell death ligand-1 (PD-L1), and cytotoxic T-lymphocyte antigen-4 (CTLA-4) by immune checkpoint inhibitors (ICIs) in immunotherapy; blood tumor mutational burden (bTMB) calculated by ctDNA assay as a novel biomarker for immunotherapy. However, NSCLC patients still face many challenges. Further studies and trials are needed to develop more effective drugs or therapies to treat NSCLC.
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Affiliation(s)
- Chennianci Zhu
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Weihao Zhuang
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Limin Chen
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Wenyu Yang
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Wen-Bin Ou
- Zhejiang Provincial Key Laboratory of Silkworm Bioreactor and Biomedicine, College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou 310018, China
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Soliman AM, Alqahtani AS, Ghorab M. Novel sulphonamide benzoquinazolinones as dual EGFR/HER2 inhibitors, apoptosis inducers and radiosensitizers. J Enzyme Inhib Med Chem 2019; 34:1030-1040. [PMID: 31074303 PMCID: PMC6522976 DOI: 10.1080/14756366.2019.1609469] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A series of sulphonamide benzoquinazolinones 5-18 was synthesized and evaluated for cytotoxic activity against MDA-MB-231 cell line. The compounds showed IC50 ranging from 0.26 to 161.49 µM. The promising compounds were evaluated for their inhibitory profile against epidermal growth factor (EGFR) and HER2 enzymes. Compound 10 showed more potent activity on both EGFR and HER2 than erlotinib (IC50 3.90 and 5.40 µM versus 6.21 and 9.42 µM). The pro-apoptotic activity of 10 was evaluated against caspase-3, Bax, B-cell lymphoma protein 2 (Bcl-2) expression levels, and cell cycle analysis. Compound 10 increased the level of caspase-3 by 10 folds, Bax level by 9 folds, decreased the level of the Bcl-2 by 0.14 and arrested the cell cycle in the G2/M phase. The radio-sensitizing activity of 10 was measured using a single dose of 8 Gy gamma radiation (IC50 decreased from 0.31 to 0.22 µM). Molecular docking was performed on EGFR and HER2 receptors.
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Affiliation(s)
- Aiten M. Soliman
- Department of Drug Radiation Research, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Nasr City,Egypt;
| | - Ali S. Alqahtani
- Department of Medicinal, Aromatic and Poisonous Plants Research Center (MAPPRC), College of Pharmacy, King Saud University, Riyadh, Saudi Arabia;
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Ali S. Alqahtani Department of Medicinal, Aromatic and Poisonous Plants Research Center (MAPPRC), College of Pharmacy, King Saud University, Riyadh11451, P.O. Box 2457, Saudi Arabia
| | - Mostafa Ghorab
- Department of Drug Radiation Research, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Nasr City,Egypt;
- CONTACT Mostafa Ghorab Department of Drug Radiation Research, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Nasr City, Cairo, P.O. Box 29, Egypt;
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Yang Y, Huang Z, Li J, Mo Z, Huang Y, Ma C, Wang W, Pan X, Wu C. PLGA Porous Microspheres Dry Powders for Codelivery of Afatinib-Loaded Solid Lipid Nanoparticles and Paclitaxel: Novel Therapy for EGFR Tyrosine Kinase Inhibitors Resistant Nonsmall Cell Lung Cancer. Adv Healthc Mater 2019; 8:e1900965. [PMID: 31664795 DOI: 10.1002/adhm.201900965] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/21/2019] [Indexed: 12/21/2022]
Abstract
Combination therapy of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR TKIs) with other chemotherapeutic agents is a feasible strategy to overcome resistance that often occurs after 9-13 months of EGFR TKIs administration in nonsmall cell lung cancer (NSCLC). In this study, a pulmonary microspheres system that codelivers afatinib and paclitaxel (PTX) is developed for treatment of EGFR TKIs resistant NSCLC. In this system, afatinib is loaded in stearic acid-based solid lipid nanoparticles, then these nanoparticles and PTX are loaded in poly-lactide-co-glycolide-based porous microspheres. These inhaled microspheres systems are characterized including geometric particle size, drug encapsulation efficiency, morphology by scanning electron microscopy, specific surface area, in vitro drug release, and aerodynamic particle size. Cell experiments indicate that afatinib and PTX have a synergistic effect and the codelivery system shows a superior treatment effect in drug-resistant NSCLC cells. The biocompatibility, pharmacokinetic, and tissue distribution experiments in Sprague-Dawley rats show that afatinib and PTX in the system can maintain 96 h of high lung concentration but low concentration in other tissues, with acceptable safety. These results demonstrate that this system may be a prospective delivery strategy for drug combination treatment in cancers developing resistance, especially drug-resistant lung cancer.
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Affiliation(s)
- Yao Yang
- School of Pharmaceutical SciencesSun Yat‐Sen University Guangzhou 510006 P. R. China
| | - Zhengwei Huang
- School of Pharmaceutical SciencesSun Yat‐Sen University Guangzhou 510006 P. R. China
| | - Jinyuan Li
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐Sen University Cancer Center Guangzhou 510060 P. R. China
| | - Ziran Mo
- School of Pharmaceutical SciencesSun Yat‐Sen University Guangzhou 510006 P. R. China
| | - Ying Huang
- School of PharmacyJinan University Guangzhou 510632 P. R. China
| | - Cheng Ma
- School of Pharmaceutical SciencesSun Yat‐Sen University Guangzhou 510006 P. R. China
| | - Wenhao Wang
- School of Pharmaceutical SciencesSun Yat‐Sen University Guangzhou 510006 P. R. China
| | - Xin Pan
- School of Pharmaceutical SciencesSun Yat‐Sen University Guangzhou 510006 P. R. China
| | - Chuanbin Wu
- School of Pharmaceutical SciencesSun Yat‐Sen University Guangzhou 510006 P. R. China
- School of PharmacyJinan University Guangzhou 510632 P. R. China
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Mu Y, Xing P, Hao X, Wang Y, Li J. Real-World Data Of Osimertinib In Patients With Pretreated Non-Small Cell Lung Cancer: A Retrospective Study. Cancer Manag Res 2019; 11:9243-9251. [PMID: 31802944 PMCID: PMC6826191 DOI: 10.2147/cmar.s221434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022] Open
Abstract
Purpose Osimertinib is an oral, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) targeted for both EGFR sensitizing mutations and T790M resistance mutation in patients with non-small-cell lung cancer (NSCLC). We assessed efficacy and safety of osimertinib in patients with pretreated NSCLC in a real-world setting. Patients and methods Ninety-four patients with advanced NSCLC who received osimertinib after progression of prior EGFR-TKIs or chemotherapy treatments were retrospectively collected. Results In patients evaluable for response analysis (n = 91), overall objective response rate (ORR) was 47.3%, and disease control rate (DCR) was 90.1%. Median duration of response (DoR) in responding patients was 12.5 months (95% confidence interval [CI], 10.7 to 14.3). Median progression-free survival (PFS) was 8.5 months (95% CI, 7.4 to 9.6) in 2nd line group, 9.1 months (95% CI, 6.6 to 11.6) in ≥3rd line group, and 8.6 months (95% CI, 7.2 to 10.0) in overall population. For subgroup analysis, DCR and median PFS were 91.9% and 8.6 months (95% CI, 7.2 to 10.0) in patients with detectable T790M mutation, respectively, while 80.0% and 3.2 months (95% CI, 0.5 to 5.9) for those without. Median PFS was significantly longer for T790M-positive patients co-occurring with exon19del than with L858R (17.9 months vs 7.3 months; P<0.001). Among 45 patients with metastases to the central nervous system (CNS), median systemic PFS was 8.8 months (95% CI, 6.9 to 10.7), while intracranial time to progression (iTTP) was not reached. Safety profile was acceptable, no adverse events (AEs) related deaths was observed. Conclusion Osimertinib was highly active in patients with pretreated advanced NSCLC who harbored EGFR T790M mutation, with manageable side-effects.
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Affiliation(s)
- Yuxin Mu
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Puyuan Xing
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xuezhi Hao
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Wang
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Junling Li
- National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Moldaver D, Hurry M, Evans WK, Cheema PK, Sangha R, Burkes R, Melosky B, Tran D, Boehm D, Venkatesh J, Walisser S, Orava E, Grima D. Development, validation and results from the impact of treatment evolution in non-small cell lung cancer (iTEN) model. Lung Cancer 2019; 139:185-194. [PMID: 31812889 DOI: 10.1016/j.lungcan.2019.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Treatment of advanced NSCLC (aNSCLC) is rapidly evolving, as new targeted and immuno-oncology (I-O) treatments become available. The iTEN model was developed to predict the cost and survival benefits of changing aNSCLC treatment patterns from a Canadian healthcare system perspective. This report describes iTEN model development and validation. MATERIALS & METHODS A discrete event patient simulation of aNSCLC was developed. A modified Delphi process using Canadian clinical experts informed the development of treatment sequences that included commonly used, Health Canada approved treatments of aNSCLC. Treatment efficacy and the timing of progression and death were estimated from published Kaplan-Meier progression free and overall survival data. Costs (2018 CDN$) included were: drug acquisition and administration, imaging, monitoring, adverse events, physician visits, best supportive care, and end-of-life. RESULTS AND CONCLUSION Clinical validity of the iTEN model was assessed by comparing model survival predictions to published real-world evidence (RWE). Four RWE studies that reported the overall survival of patients treated with a broad sampling of common aNSCLC treatment patterns were used for validation. The validation coefficient of determination was R2 = 0.95, with the model generally producing estimates that were neither optimistic nor conservative. The model estimated that current Canadian practice patterns yield a median survival of almost 13 months, a five-year survival rate of 3% and a life-time per-treated-patient cost of $110,806. Cost and survival estimates are presented and were found to vary by aNSCLC subtype. In conclusion, the iTEN model is a reliable tool for forecasting the impact on cost and survival of new treatments for aNSCLC.
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Affiliation(s)
| | | | | | | | | | | | | | - Diana Tran
- Cornerstone Research Group, Burlington, Ontario, Canada
| | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Jaya Venkatesh
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Susan Walisser
- BC Cancer (Retired), Vancouver, British Columbia, Canada
| | - Erik Orava
- AstraZeneca Canada, Mississauga, Ontario, Canada
| | - Daniel Grima
- Cornerstone Research Group, Burlington, Ontario, Canada.
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Wang S, Li J. Second-generation EGFR and ErbB tyrosine kinase inhibitors as first-line treatments for non-small cell lung cancer. Onco Targets Ther 2019; 12:6535-6548. [PMID: 31496745 PMCID: PMC6700283 DOI: 10.2147/ott.s198945] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/13/2019] [Indexed: 12/12/2022] Open
Abstract
The discovery that mutations in the EGFR gene are present in up to 50% of patients with lung adenocarcinoma, and the development of highly efficacious EGFR tyrosine kinase inhibitors (TKIs), has revolutionized the way this common malignancy is treated. Three generations of EGFR TKIs are now approved for use in EGFR mutation-positive non-small cell lung cancer (NSCLC); the first-generation agents erlotinib, gefitinib, and icotinib; the second-generation ErbB family blockers afatinib and dacomitinib; and most recently, osimertinib, a third-generation EGFR TKI. The second-generation agents have demonstrated impressive efficacy relative to both standard platinum-based chemotherapy and first-generation EGFR TKIs, significantly improving response and progression-free and overall survival. Data from real-world studies suggest that afatinib is as effective and well tolerated in routine clinical practice as it is in clinical studies and is effective in patients with certain uncommon EGFR mutations, patients with brain metastases, and older patients. Few real-world data are available for dacomitinib in the first-line setting. Afatinib and dacomitinib have similar safety profiles, with acne/skin dryzness, diarrhea, stomatitis, and paronychia the most common adverse events (AEs) reported in clinical and real-world studies. Numerous studies have shown that tolerability-guided dose reductions can help manage afatinib-related AEs without reducing efficacy. As the number of therapeutic options for advanced NSCLC increases, the optimal choice for first-line treatment will be determined by considering patient factors such as the presence of brain metastases, the type of EGFR mutation, tolerability, and subsequent therapy options for long-term treatment.
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Affiliation(s)
- Shouzheng Wang
- 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, People's Republic of China
| | - Junling Li
- 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, People's Republic of China
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Ranade A, Patil D, Bhatt A, Dhasare R, Datta V, Datar R, Akolkar D. Adaptive, Iterative, Long-Term Personalized Therapy Management in a Case of Stage IV Refractory NSCLC. J Pers Med 2019; 9:E34. [PMID: 31284461 PMCID: PMC6789881 DOI: 10.3390/jpm9030034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/03/2019] [Indexed: 12/27/2022] Open
Abstract
In this paper we report long-term therapy management based on iterative de novo molecular and cellular analysis in a case of metastatic non-small cell lung cancer (NSCLC), with prior history of treated colorectal cancer. In the described case temporal tumor evolution, emergent therapy resistance and disease recurrences were addressed via the administration of personalized label- and organ-agnostic treatments based on de novo tumor profiling. This adaptive and iterative treatment strategy countered disease progression at each instance and led to the durable regression of primary as well as metastatic lesions. Concurrently, serial evaluation of mutations in cell-free circulating tumor DNA (ctDNA) via liquid biopsy (LBx) was performed to monitor disease status, ascertain treatment response, identify emergent drug resistance and detect recurrence at sub-radiological levels. The treatment management strategy described herein effectively addressed multiple, sequential clinical conundrums for which viable options were unavailable under the current Standard of Care (SoC).
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Affiliation(s)
- Anantbhushan Ranade
- Avinash Cancer Clinic, Tilak Road, Pantancha Gate, Sadashiv Peth, Pune 411030, Maharashtra, India
| | - Darshana Patil
- Datar Cancer Genetics Ltd., F-8 D-Road, Ambad, Nasik 422010, Maharashtra, India
| | - Amit Bhatt
- Avinash Cancer Clinic, Tilak Road, Pantancha Gate, Sadashiv Peth, Pune 411030, Maharashtra, India
| | - Rucha Dhasare
- Avinash Cancer Clinic, Tilak Road, Pantancha Gate, Sadashiv Peth, Pune 411030, Maharashtra, India
| | - Vineet Datta
- Datar Cancer Genetics Ltd., F-8 D-Road, Ambad, Nasik 422010, Maharashtra, India
| | - Rajan Datar
- Datar Cancer Genetics Ltd., F-8 D-Road, Ambad, Nasik 422010, Maharashtra, India
| | - Dadasaheb Akolkar
- Datar Cancer Genetics Ltd., F-8 D-Road, Ambad, Nasik 422010, Maharashtra, India.
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Hess LM, Brnabic A, Mason O, Lee P, Barker S. Relationship between Progression-free Survival and Overall Survival in Randomized Clinical Trials of Targeted and Biologic Agents in Oncology. J Cancer 2019; 10:3717-3727. [PMID: 31333789 PMCID: PMC6636299 DOI: 10.7150/jca.32205] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/15/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction: With a gap in a full understanding of the mechanisms by which survival is extended for patients with cancer who are treated with novel biologic and targeted agents, there is the risk that discordant progression-free and overall survival outcomes are observed due to poor clinical trial design or biases in the interpretation of data. This study was designed to examine the role of study quality and design on the outcomes observed with biologic and targeted agents. Methods: A review of studies in clinicaltrials.gov supplemented with a literature review in OVID Medline was conducted to identify all randomized trials of a biologic/targeted agent versus a non-biologic/targeted comparator in oncology that report both median overall and progression-free survival outcomes. Details of the study, design, population, drugs, and outcomes were extracted. Study quality was evaluated using the PEDro scale. Data were summarized using SPSS 22.0.0.0. Results: A total of 192 unique studies of 206 pairwise comparisons between a biologic/targeted and comparator were identified. The average absolute magnitude of post-progression survival (difference between OS and PFS) was 9.7 months for biologic/targeted therapy and 9.8 for the comparator. A total of 64 comparisons (31.1%) showed an increase in OS and decrease in PFS, or vice versa, and 25 (12.1%) showed a magnitude of more than 4 months difference between the delta of OS and delta of PFS between the biologic/targeted and comparator arms. Average study quality was high overall (7.7/10), and was comparable for studies with directional differences (7.2/10) as well as for those with the greatest magnitude in post-progression survival (7.4/10). Conclusion: This review and analysis specifically examined small PFS benefit with large OS benefit as well as small OS benefit with large PFS benefit, including differences in direction of PFS and OS outcomes. No evidence was identified that these are the result of poor study design, but may rather be due to the mechanism of action, specific disease, and population under study. Further work is needed to understand the mechanism of action of novel biologic/targeted agents to better understand their interaction with the tumor microenvironment.
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Affiliation(s)
| | | | | | - Pablo Lee
- Eli Lilly and Company, Indianapolis USA
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Tanaka H, Sakagami H, Kaneko N, Konagai S, Yamamoto H, Matsuya T, Yuri M, Yamanaka Y, Mori M, Takeuchi M, Koshio H, Hirano M, Kuromitsu S. Mutant-Selective Irreversible EGFR Inhibitor, Naquotinib, Inhibits Tumor Growth in NSCLC Models with EGFR-Activating Mutations, T790M Mutation, and AXL Overexpression. Mol Cancer Ther 2019; 18:1366-1373. [DOI: 10.1158/1535-7163.mct-18-0976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/19/2018] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
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45
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Tanaka H, Taima K, Itoga M, Ishioka Y, Baba K, Shiratori T, Sakamoto H, Tsuchiya J, Nakagawa H, Hasegawa Y, Yasugahira H, Okudera K, Takanashi S, Tasaka S. Real-world study of afatinib in first-line or re-challenge settings for patients with EGFR mutant non-small cell lung cancer. Med Oncol 2019; 36:57. [PMID: 31089973 DOI: 10.1007/s12032-019-1278-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/26/2019] [Indexed: 11/24/2022]
Abstract
Afatinib, a second-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) for mutant non-small cell lung cancer (NSCLC), was approved in Japan in 2014. This study evaluated clinical outcomes of afatinib in real-world practice. Medical records of patients who received afatinib for advanced EGFR-mutant NSCLC were retrospectively reviewed. In total, 128 patients were analyzed. Seventy-six patients received afatinib as the first-line setting and 52 as the re-challenge setting (i.e., after failure of prior first-generation TKI). There was no difference in patient characteristics, such as age, sex, and PS, between the first-line and the re-challenge settings. In the first-line setting, the median progression-free survival (PFS) was 17.8 months (95% confidence interval [CI] 13.7-21.5 months). The overall survival (OS) was 39.5 months (95% CI 34.4- not reached). The response rate (RR) was 64.4%. Subset analysis indicated that patients with dose reduction showed longer PFS than those without dose reduction (18.5 months versus 7.9 months) (P = 0.016). In the re-challenge setting, the median PFS was 8.0 months (95% CI 4.9-9.5 months). The RR was 25%. Most common adverse events leading to dose modification or treatment discontinuation included diarrhea, paronychia, and oral mucositis in both settings. Interstitial lung disease occurred in 5.4% (7/128). In the real-world practice in Japan, afatinib showed comparable or better efficacy compared with that shown in previous clinical trials in both the first-line and the re-challenge settings.
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Affiliation(s)
- Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Kageaki Taima
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Masamichi Itoga
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yoshiko Ishioka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Keisuke Baba
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Toshihiro Shiratori
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hiroaki Sakamoto
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Junichiro Tsuchiya
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hideyuki Nakagawa
- Department of Respiratory Medicine, Hirosaki National Hospital, Aomori, Japan
| | - Yukihiro Hasegawa
- Department of Respiratory Medicine, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Hideo Yasugahira
- Department of Respiratory Medicine, Hachinohe City Hospital, Aomori, Japan
| | - Koichi Okudera
- Department of Respiratory Medicine, Hirosaki Central Hospital, Aomori, Japan
| | - Shingo Takanashi
- Hirosaki University, Health Administration Center, Aomori, Japan
| | - Sadatomo Tasaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5, Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Lim J, Samuelsen C, Golembesky A, Shrestha S, Wang L, Griebsch I. Duration of treatment among patients prescribed afatinib or erlotinib as first-line therapy for EGFR mutation-positive non-small-cell lung cancer in the USA. Future Oncol 2019; 15:1493-1504. [DOI: 10.2217/fon-2019-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Aim: Evaluate duration of therapy among patients treated with afatinib or erlotinib as first-line therapy for non-small-cell lung cancer (NSCLC). Materials & methods: NSCLC patients initiating afatinib or erlotinib between 2014 and 2017 were identified in three large claims databases in the USA. Propensity score matching was conducted to compare the duration of treatment between patients by treatment. Results: Patients prescribed afatinib had a significantly longer median duration of treatment compared with those prescribed erlotinib (12.1 vs 9.9 months; p = 0.035) and experienced a 14% reduction in risk of discontinuing therapy (adjusted hazard ratio: 0.86; CI: 0.75–0.99). Conclusion: First-line treatment duration in a real-world setting was significantly longer for patients prescribed afatinib compared with erlotinib.
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Affiliation(s)
- Jonathan Lim
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT 06877, USA
| | - Carl Samuelsen
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | | | - Li Wang
- STATinMED Research, Plano, TX 75024, USA
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Lu S. Development of treatment options for Chinese patients with advanced squamous cell lung cancer: focus on afatinib. Onco Targets Ther 2019; 12:1521-1538. [PMID: 30863118 PMCID: PMC6390854 DOI: 10.2147/ott.s188296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Lung cancer is the leading cause of cancer death in China, and approximately one third of these cancers are squamous cell carcinoma (SqCC) of the lung. Ethnic diversity and country-specific environmental factors can account for interindividual variations in response to and tolerability of anticancer therapies. Although several targeted therapies have recently been approved for patients with relapsed/refractory SqCC of the lung, only afatinib, an irreversible ErbB family blocker, has data of Chinese patients. In the Phase III LUX-Lung 8 trial, afatinib demonstrated a significant clinical benefit vs the reversible first-generation EGFR tyrosine kinase inhibitor erlotinib in both the overall population and the Chinese subset, with a manageable safety profile. Emerging biomarker data from LUX-Lung 8 suggest that patients with ErbB mutations, especially ErbB2, and those classified as “good” in the VeriStrat® proteomic test, may benefit from afatinib treatment in particular, regardless of ethnicity, and may get a long-term response. In conclusion, afatinib is a valid second-line option for Chinese patients with SqCC of the lung, and specific biomarkers may help guide in treatment decision-making. Ongoing studies will provide further guidance on afatinib’s place in the treatment algorithm, alongside the other novel targeted therapies.
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Affiliation(s)
- Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China,
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48
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Li J. Diarrhea With HER2-Targeted Agents in Cancer Patients: A Systematic Review and Meta-Analysis. J Clin Pharmacol 2019; 59:935-946. [DOI: 10.1002/jcph.1382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/10/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Jing Li
- College of Pharmacy; Southwest Minzu University; Chengdu Sichuan P. R. China
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Fuggetta MP, Migliorino MR, Ricciardi S, Osman G, Iacono D, Leone A, Lombardi A, Ravagnan G, Greco S, Remotti D, Romano MCP. Prophylactic Dermatologic Treatment of Afatinib-Induced Skin Toxicities in Patients with Metastatic Lung Cancer: A Pilot Study. SCIENTIFICA 2019; 2019:9136249. [PMID: 30838155 PMCID: PMC6374781 DOI: 10.1155/2019/9136249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/02/2018] [Accepted: 12/16/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Severe skin rash is listed among important side effects of EGFR tyrosine kinase inhibitors. Polydatin (PD), a glycosylated polyphenol, is endowed with anti-inflammatory activity in human epidermal keratinocytes. OBJECTIVE This study evaluated the effect of topical application of a moisturizer containing PD to prevent skin rash in patients with mutated non-small cell lung cancer (NSCLC) treated with afatinib. MATERIALS AND METHODS Eligible NSCLC patients with metastatic disease were treated with first-line afatinib 40 mg/die. One day before starting systemic therapy, all patients received topical administration of a 1.5% PD-based cream b.i.d. every day until the end of afatinib treatment. RESULTS Out of 34 treated patients, the incidence of skin rash (all grades) was 41.2% and grade 2 rash was 20.6%, and grade 3 rash was not observed in any of the patients. None of the patients discontinued therapy for toxicity. The mean duration of treatment was 6.4 months, calculated from the time treatment was started to the date treatment was stopped. CONCLUSION The results showed that a PD-based cream can reduce the incidence of grade ≥2 skin toxicities in patients treated with afatinib. Clinical study registration number: Prot. No. 130/CE Lazio 1 Italy.
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Affiliation(s)
| | | | - Serena Ricciardi
- UOSD of Oncologic Pneumology, San Camillo Forlanini Hospital, Rome, Italy
| | - Giorgia Osman
- UOSD of Oncologic Pneumology, San Camillo Forlanini Hospital, Rome, Italy
| | - Daniela Iacono
- UOSD of Oncologic Pneumology, San Camillo Forlanini Hospital, Rome, Italy
| | - Alvaro Leone
- UOC of Anatomopathology, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Stefania Greco
- UOSD of Oncologic Pneumology, San Camillo Forlanini Hospital, Rome, Italy
| | - Daniele Remotti
- UOC of Anatomopathology, San Camillo Forlanini Hospital, Rome, Italy
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Wang C, Li Y, Ke L, Cao L, Fan P, Wu Z, Wu Q. The Impact of Afatinib on Survival in Advanced Non-Small Cell Lung Cancer: A Meta-Analysis of Randomized Controlled Trials. J Cancer 2019; 10:885-892. [PMID: 30854094 PMCID: PMC6400820 DOI: 10.7150/jca.27528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 12/21/2018] [Indexed: 02/06/2023] Open
Abstract
Background: Afatinib is a second-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) that has been approved by the Food and Drug Administration for the treatment of advanced non-small cell lung cancer (NSCLC) harboring EGFR mutations. We performed a meta-analysis to assess the efficacy and safety of afatinib in advanced NSCLC. Methods: We searched PubMed, PMC database, EMBASE, Cochrane Library and Web of Science to obtain the relevant literature. The efficacy and safety of afatinib was assessed based on progression-free survival (PFS), overall survival (OS), overall response rate (ORR), primary grade 3/4 adverse events and fatal adverse events (FAEs). A subgroup analysis was performed according to control type for all end-points. Results: Seven randomized controlled trials were included, with a total of 3093 patients. The meta-analysis showed that afatinib treatment significantly prolonged PFS in patients compared with control groups (HR = 0.57, 95% CI: 0.42-0.76; P = 0.00), increased OS (HR = 0.91, 95% CI: 0.83-0.99; P = 0.04) and ORR (RR = 1.82, 95% CI: 1.13-2.93; P = 0.01). In terms of safety, afatinib significantly increased the incidence of diarrhea (RR = 8.9, 95% CI: 5.33-14.93; P = 0.00), rash (RR = 7.31, 95% CI: 1.56-34.12; P = 0.01) and stomatitis (RR = 6.45, 95% CI: 1.27-32.78; P = 0.03), compared with the control group. However, there was no significant difference in FAEs (RR = 0.75, 95% CI: 0.38-1.49; P = 0.41). Conclusions: This meta-analysis confirmed that afatinib extended survival, improved response rates and did not increase the risk of treatment-related mortality in advanced NSCLC. As a novel EGFR-TKI, afitinib has significant potential for clinical application.
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Affiliation(s)
- Chi Wang
- Central Laboratory of Medical Research Centre, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
| | - Yun Li
- Central Laboratory of Medical Research Centre, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
| | - Li Ke
- Department of Thoracic Surgery, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
| | - Lejie Cao
- Department of Respiration, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
| | - Pingsheng Fan
- Department of Oncology, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
| | - Zhiwei Wu
- Central Laboratory of Medical Research Centre, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
| | - Quan Wu
- Central Laboratory of Medical Research Centre, Anhui Provincial Hospital, Anhui Medical University, Hefei, 230001, China
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