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Brown LJ, da Silva IP, Moujaber T, Gao B, Hui R, Gurney H, Carlino M, Nagrial A. Five‐year survival and clinical correlates among patients with advanced non‐small cell lung cancer, melanoma and renal cell carcinoma treated with immune check‐point inhibitors in Australian tertiary oncology centres. Cancer Med 2022; 12:6788-6801. [PMID: 36404632 PMCID: PMC10067054 DOI: 10.1002/cam4.5468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/03/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Abstract
AIMS There is robust trial evidence for improved overall survival (OS) with immunotherapy in advanced solid organ malignancies. The real-world long-term survival data and the predictive variables are not yet known. Our aim was to evaluate factors associated with 3-year and 5-year OS for patients treated with immune checkpoint inhibitors (ICIs). METHODS We performed a retrospective study of patients who received ICIs as management of advanced solid organ malignancies in two tertiary Australian oncology centres from 2012-2017. Data pertaining to clinical characteristics, metastatic disease burden, immune-related adverse events (IRAEs) and tumour responses were collected and their relationship to survival examined. RESULTS In this analysis of 264 patients, 202 (76.5%) had melanoma, 46 (17.4%) had non-small cell lung cancer (NSCLC), 12 (4.5%) had renal cell carcinoma (RCC) and 4 (1.5%) had mesothelioma. The 5-year OS rates were 42.1% in patients with melanoma, 19.6% with NSCLC, 75% with RCC, and none of the mesothelioma patients were alive at 5 years. In multivariate analysis, an ECOG score of 0 (Hazard ratio [HR] 0.39; 95% confidence interval [CI] 0.23-0.66; p < 0.001) and the occurrence of IRAE's of any grade (HR 0.61; 95% CI 0.37-0.95; p = 0.05) were associated with better 5-year survival. The presence of bone metastases (HR 1.62; 95% CI 1.03-2.82; p = 0.05) and liver metastases (HR 1.76; 95% CI 1.07-2.89; p = 0.03) were associated with worse 5-year survival. CONCLUSIONS These results support the long-term benefits of immunotherapy that in some patients, extend to at least 5 years. ECOG performance status of 0 and the occurrence of irAEs are associated with better long-term survival. Survival is significantly influenced by metastatic site and cancer type. These predictive clinical correlates aid discussions and planning in the delivery of ICIs to patients.
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Affiliation(s)
- Lauren J Brown
- Crown Princess Mary Cancer Centre Westmead Hospital Westmead New South Wales Australia
- Blacktown Cancer and Haematology Centre Blacktown Hospital Blacktown New South Wales Australia
- University of Sydney Camperdown New South Wales Australia
- Westmead Institute for Medical Research Westmead New South Wales Australia
| | - Ines Pires da Silva
- Blacktown Cancer and Haematology Centre Blacktown Hospital Blacktown New South Wales Australia
- University of Sydney Camperdown New South Wales Australia
- Melanoma Institute Australia Wollstonecraft New South Wales Australia
| | - Tania Moujaber
- Crown Princess Mary Cancer Centre Westmead Hospital Westmead New South Wales Australia
- Blacktown Cancer and Haematology Centre Blacktown Hospital Blacktown New South Wales Australia
- University of Sydney Camperdown New South Wales Australia
| | - Bo Gao
- Crown Princess Mary Cancer Centre Westmead Hospital Westmead New South Wales Australia
- Blacktown Cancer and Haematology Centre Blacktown Hospital Blacktown New South Wales Australia
- Westmead Institute for Medical Research Westmead New South Wales Australia
| | - Rina Hui
- Crown Princess Mary Cancer Centre Westmead Hospital Westmead New South Wales Australia
- University of Sydney Camperdown New South Wales Australia
| | - Howard Gurney
- Crown Princess Mary Cancer Centre Westmead Hospital Westmead New South Wales Australia
- Macquarie University Health Cancer Services Macquarie University Sydney New South Wales Australia
| | - Matteo Carlino
- Crown Princess Mary Cancer Centre Westmead Hospital Westmead New South Wales Australia
- Blacktown Cancer and Haematology Centre Blacktown Hospital Blacktown New South Wales Australia
- University of Sydney Camperdown New South Wales Australia
- Melanoma Institute Australia Wollstonecraft New South Wales Australia
| | - Adnan Nagrial
- Crown Princess Mary Cancer Centre Westmead Hospital Westmead New South Wales Australia
- Blacktown Cancer and Haematology Centre Blacktown Hospital Blacktown New South Wales Australia
- University of Sydney Camperdown New South Wales Australia
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Chen B, Wang J, Pu X, Li J, Wang Q, Liu L, Xu Y, Xu L, Kong Y, Li K, Xu F, Liang S, Cardona AF, Wu L. The efficacy and safety of immune checkpoint inhibitors combined with chemotherapy or anti-angiogenic therapy as a second-line or later treatment option for advanced non-small cell lung cancer: a retrospective comparative cohort study. Transl Lung Cancer Res 2022; 11:2111-2124. [PMID: 36386462 PMCID: PMC9641046 DOI: 10.21037/tlcr-22-697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although immune checkpoint inhibitor (ICI) monotherapy remains the standard of second-line treatment for patients with advanced non-small cell lung cancer (NSCLC) , the objective response rate (ORR) is low. There is an urgent need to increase the response population of second-line immunotherapy, and ICI combination therapy may be a possible option. However, the evidence is insufficient. METHODS We retrospectively collected the medical records of patients who received ICI monotherapy or ICI combination therapy as a second-line or later treatment option. We further analysed baseline clinical characteristics, evaluated treatment efficacy, assessed treatment-related adverse events (AEs) and followed up survival. The outcome variables assessed in the study were ORR, disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and AEs. RESULTS A total of 145 patients were ultimately enrolled in this study, including the ICI monotherapy group (n=63) and ICI combination therapy group (n=82). The ICI combination therapy group was further divided into the ICI/chemotherapy group (n=57) and ICI/anti-angiogenic therapy group (n=25). The baseline was comparable among the three subgroups. The ICI combination therapy groups showed a higher ORR (29.3% vs. 11.1%, P=0.008) and DCR (85.4% vs. 61.9%, P=0.001) and a longer PFS (6.77 vs. 3.47 months, P<0.001) and OS (18.60 vs. 8.47 months, P<0.001) than the ICI monotherapy group. The ICI/chemotherapy group showed a significantly higher ORR (31.6% vs. 11.1%, P=0.006) and DCR (84.2% vs. 61.9%, P=0.006) and a longer PFS (6.37 vs. 3.47 months, P<0.001) and OS (18.60 vs. 8.47 months, P<0.001) than the ICI monotherapy group. The ICI/anti-angiogenic therapy group showed a significantly higher DCR (88.0% vs. 61.9%, P=0.021) and a longer PFS (8.17 vs. 3.47 months, P<0.001) and OS (19.20 vs. 8.47 months, P=0.005) than the ICI monotherapy group. Neither of the combined ICI therapy groups showed a significant increase in the incidence of AEs compared to the ICI monotherapy group. CONCLUSIONS ICI combined with chemotherapy or anti-angiogenic therapy as second-line or later treatment demonstrated superiority over ICI monotherapy in advanced NSCLC patients without prior immunotherapy. These results provide a potentially superior treatment strategy and require verification in prospective clinical trials.
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Affiliation(s)
- Bolin Chen
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jingyi Wang
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xingxiang Pu
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jia Li
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qianzhi Wang
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Liyu Liu
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yan Xu
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Li Xu
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yi Kong
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Kang Li
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Fang Xu
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Shuzhi Liang
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Andrés F. Cardona
- Foundation for Clinical and Applied Cancer Research-FICMAC, Bogotá, Colombia;,Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia;,Direction of Research and Education, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Cencer-CTIC, Bogotá, Colombia
| | - Lin Wu
- The Second Department of Thoracic Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Chicas-Sett R, Zafra J, Rodriguez-Abreu D, Castilla-Martinez J, Benitez G, Salas B, Hernandez S, Lloret M, Onieva JL, Barragan I, Lara PC. Combination of Stereotactic Ablative Radiotherapy With Anti-PD-1 in Oligoprogressive Non-Small-Cell Lung Cancer And Melanoma: Results of a Prospective Multicenter Observational Study. Int J Radiat Oncol Biol Phys 2022; 114:655-665. [PMID: 35595158 DOI: 10.1016/j.ijrobp.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 10/31/2022]
Abstract
Introduction The percentage of patients with metastatic non-small-cell lung cancer (NSCLC) and melanoma who benefit from anti-programmed cell death protein 1 (anti-PD-1) is low due to resistance mechanisms. Stereotactic ablative radiotherapy (SABR) has a role in oligoprogressive disease and can improve responses to anti-PD-1. This multicenter prospective observational study aims to determine whether concomitant anti-PD-1 and SABR to oligoprogressive sites enhance tumor response in metastatic NSCLC and melanoma. Methods Patients with metastatic NSCLC or melanoma in progression to anti-PD-1 but continuing the same line due to clinical benefit were referred for palliative SABR. All patients received concomitant pembrolizumab or nivolumab and SABR to 1-5 lesions, maintaining anti-PD-1 until further progression, unacceptable toxicity, or medical/patient decision. Objective response rate (ORR)-complete responses (CR) and partial responses (PR) -was evaluated during all follow-up following RECIST1.1. The abscopal response (AR) was evaluated 8 weeks after SABR as a ≥30% reduction in 1-2 predefined non-irradiated lesions. Results Of the 61 patients enrolled, 50 could be analyzed. With a median follow-up of 32.8 months, ORR was 42% (30% CR and 12% PR). Median progression-free survival was 14.2 months (95% CI, 6.9-29 months). Median overall survival since SABR was 37.4 months (95% CI, 22.9 months-not reached). AR was 65%, evaluated in 40 patients who fulfilled the criteria. Conclusions Combined anti-PD-1 and SABR in oligoprogressive metastatic NSCLC or melanoma can achieve high rates of response and extend the clinical benefit of immunotherapy by delaying further progression and a new systemic therapy. This approach should be assessed in larger randomized trials.
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Affiliation(s)
- Rodolfo Chicas-Sett
- Department of Radiation Oncology, Dr Negrin University Hospital of Gran Canaria, 35010, Las Palmas de Gran Canaria, Spain; Department of Radiation Oncology, ASCIRES Grupo Biomedico, 46004, Valencia, Spain.; Faculty of Medicine, University of Malaga (UMA), 29071, Malaga, Spain.
| | - Juan Zafra
- Department of Radiation Oncology, Dr Negrin University Hospital of Gran Canaria, 35010, Las Palmas de Gran Canaria, Spain; Faculty of Medicine, University of Malaga (UMA), 29071, Malaga, Spain; Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Malaga, Spain; Department of Radiation Oncology, Virgen de la Victoria University Hospital, Malaga, Spain; Institute of Biomedical Research in Malaga (IBIMA), 29010, Malaga, Spain.
| | - Delvys Rodriguez-Abreu
- Department of Medical Oncology, Insular University Hospital of Gran Canaria, 35016, Las Palmas de Gran Canaria, Spain
| | - Juan Castilla-Martinez
- Department of Radiation Oncology, Dr Negrin University Hospital of Gran Canaria, 35010, Las Palmas de Gran Canaria, Spain; Department of Radiation Oncology, ASCIRES Grupo Biomedico, 03203, Elche, Spain
| | - Gretel Benitez
- Institute of Biomedical Research in Malaga (IBIMA), 29010, Malaga, Spain
| | - Barbara Salas
- Department of Radiation Oncology, Dr Negrin University Hospital of Gran Canaria, 35010, Las Palmas de Gran Canaria, Spain
| | - Samuel Hernandez
- Department of Medical Oncology, General Hospital of Fuerteventura, 35600, Puerto del Rosario, Spain
| | - Marta Lloret
- Department of Radiation Oncology, Dr Negrin University Hospital of Gran Canaria, 35010, Las Palmas de Gran Canaria, Spain
| | - Juan Luis Onieva
- Faculty of Medicine, University of Malaga (UMA), 29071, Malaga, Spain; Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Malaga, Spain; Institute of Biomedical Research in Malaga (IBIMA), 29010, Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, 29010, Malaga, Spain
| | - Isabel Barragan
- Faculty of Medicine, University of Malaga (UMA), 29071, Malaga, Spain; Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Malaga, Spain; Institute of Biomedical Research in Malaga (IBIMA), 29010, Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, 29010, Malaga, Spain; Group of Pharmacoepigenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Pedro C Lara
- Centro Oncologico Integral Canario. San Roque University Hospital, 35001, Las Palmas de Gran Canaria, Spain; Universidad Fernando Pessoa Canarias, 35450, Las Palmas, Spain
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Man J, Millican J, Mulvey A, Gebski V, Hui R. Response Rate and Survival at Key Timepoints With PD-1 Blockade vs Chemotherapy in PD-L1 Subgroups: Meta-Analysis of Metastatic NSCLC Trials. JNCI Cancer Spectr 2021; 5:pkab012. [PMID: 34084999 PMCID: PMC8160531 DOI: 10.1093/jncics/pkab012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/28/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Expression of programmed cell death ligand 1 (PD-L1) on tumor cells with or without immune cells is widely reported in clinical trials of programmed cell death receptor 1 (PD-1) blockade in metastatic non-small cell lung cancer. Various cutpoints have been studied. Methods We performed a systematic search of MEDLINE, EMBASE, and conference proceedings up to December 2019 for randomized and nonrandomized clinical trials of anti-PD-1 or anti-PD-L1 monotherapy in metastatic non-small cell lung cancer. We retrieved data on objective response rate (ORR), 1-year and 2-year progression-free survival (PFS), and 2-year and 3-year overall survival (OS) in various PD-L1 subgroups. Results were pooled and analyzed based on different cutpoints, with nonrandomized comparisons made with pooled chemotherapy outcomes. Results A total of 9810 patients in 27 studies were included. In treatment-naïve patients, benefits with PD-1 blockade over chemotherapy were seen in ORR in patients having PD-L1 50% or greater, in 2-year OS for PD-L1 1% or greater, and in 1-year PFS, 2-year PFS, and 3-year OS for unselected patients. First-line PD-1 blockade compared with chemotherapy demonstrated higher ORR, 2-year PFS, and 3-year OS if PD-L1 was 50% or greater; lower ORR, higher 2-year PFS, and similar 3-year OS if PD-L1 was 1%-49%; and lower ORR, similar 1-year PFS, and lower 2-year OS if PD-L1 was less than 1%. In previously treated patients, PD-1 blockade demonstrated similar or superior outcomes to chemotherapy in all PD-L1 subgroups. Conclusions PD-L1 should guide the choice of PD-1 blockade vs chemotherapy in treatment-naïve patients. In previously treated patients, PD-1 blockade provides a favorable outcome profile to chemotherapy in all PD-L1 subgroups.
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Affiliation(s)
- Johnathan Man
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
- Sydney West Translational Cancer Research Centre
| | - Jared Millican
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
- Sydney West Translational Cancer Research Centre
- University of Sydney, Australia
| | - Arthur Mulvey
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
| | - Val Gebski
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
- University of Sydney, Australia
| | - Rina Hui
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
- Sydney West Translational Cancer Research Centre
- University of Sydney, Australia
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Pollack M, Keating K, Wissinger E, Jackson L, Sarnes E, Cuffel B. Transforming approaches to treating TRK fusion cancer: historical comparison of larotrectinib and histology-specific therapies. Curr Med Res Opin 2021; 37:59-70. [PMID: 33148054 DOI: 10.1080/03007995.2020.1847057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The results from basket trials utilized to gain regulatory approval of tumor-agnostic therapies can be difficult to interpret without the context of a comparator arm. We describe the role and efficacy of histology-based treatments to provide a historical comparison with larotrectinib. METHODS A systematic literature review (SLR) was conducted on the clinical outcomes of current histology-based standard of care treatments used in non-small cell lung cancer, colorectal cancer, thyroid cancer, gliomas, soft tissue sarcoma, salivary gland cancer, and infantile fibrosarcoma (7 of the 21 tumor histologies in the larotrectinib trials). The review focused on advanced stage/metastatic disease to make a historical comparison with larotrectinib. RESULTS Larotrectinib provides positive outcomes in both adult and pediatric patients with advanced or metastatic solid tumors known to harbor NTRK gene fusions across a wide range of tumor types. Although the numbers of patients per tumor type are limited, the results of this historical comparison demonstrated that larotrectinib is an efficacious treatment option when naïvely indirectly compared with historical treatments across all 7 reviewed tumor types, especially in comparison to later lines of therapy. CONCLUSIONS Utilizing larotrectinib as a case example across these types of historical comparisons shows that larotrectinib provides positive efficacy outcomes in TRK fusion cancer across tumor histologies known to harbor NTRK gene fusions that may be preferable to historical treatments.
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Affiliation(s)
| | - Karen Keating
- Bayer Healthcare Pharmaceuticals Inc, Whippany, NJ, USA
| | | | - Louis Jackson
- Bayer Healthcare Pharmaceuticals Inc, Whippany, NJ, USA
| | | | - Brian Cuffel
- Bayer Healthcare Pharmaceuticals Inc, Whippany, NJ, USA
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García-González J, Ruiz-Bañobre J, Afonso-Afonso FJ, Amenedo-Gancedo M, Areses-Manrique MDC, Campos-Balea B, Casal-Rubio J, Fernández-Núñez N, Fírvida Pérez JL, Lázaro-Quintela M, Pérez Parente D, Crama L, Ruiz-Gracia P, Santomé-Couto L, León-Mateos L. PD-(L)1 Inhibitors in Combination with Chemotherapy as First-Line Treatment for Non-Small-Cell Lung Cancer: A Pairwise Meta-Analysis. J Clin Med 2020; 9:E2093. [PMID: 32635291 PMCID: PMC7408884 DOI: 10.3390/jcm9072093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022] Open
Abstract
The combination of programmed cell death-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors with chemotherapy has emerged as a promising therapeutic option for advanced non-small-cell lung cancer (NSCLC). The aim of this meta-analysis was to evaluate the efficacy of the combined strategy in this setting. For this purpose, we performed a literature search of randomized controlled trials comparing PD-(L)1 inhibitors plus platinum-based chemotherapy versus chemotherapy alone in stage IV NSCLC patients. Seven clinical trials with 4562 patients were included. In the intention-to-treat wildtype population, PD-(L)1 inhibitor plus chemotherapy was significantly associated with improved progression-free survival (PFS) (Hazard ratio (HR) = 0.61, 95% confidence interval (CI): 0.57-0.65, p < 0.001) and overall survival (OS) (HR = 0.76, 95% CI: 0.67-0.86; p < 0.001) compared to chemotherapy. A significantly higher overall response rate (ORR) was also observed with the combined strategy (Odds ratio (OR) = 2.12, 95% CI: 1.70-2.63, p < 0.001). Furthermore, in all the analyzed subgroups, addition of PD-(L)1 inhibitors to chemotherapy significantly improved efficacy endpoints. Specifically, stratification according to PD-L1 expression revealed a benefit across all patients, regardless of their PFS status. In conclusion, PD-(L)1 blockade added to standard platinum-based chemotherapy significantly improved PFS, OS, and ORR in the up-front treatment of advanced NSCLC.
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Affiliation(s)
- Jorge García-González
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela and Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, 15706 Santiago de Compostela, Spain
| | - Juan Ruiz-Bañobre
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela and Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, 15706 Santiago de Compostela, Spain
| | | | | | | | - Begoña Campos-Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (B.C.-B.); (N.F.-N.)
| | - Joaquín Casal-Rubio
- Medical Oncology Department, Complexo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (J.C.-R.); (M.L.-Q.)
| | - Natalia Fernández-Núñez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (B.C.-B.); (N.F.-N.)
| | - José Luis Fírvida Pérez
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain; (M.d.C.A.-M.); (J.L.F.P.)
| | - Martín Lázaro-Quintela
- Medical Oncology Department, Complexo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (J.C.-R.); (M.L.-Q.)
| | - Diego Pérez Parente
- Lung Cancer Medical Department, Roche Farma S.A., 28042 Madrid, Spain; (D.P.P.); (L.C.); (P.R.-G.)
| | - Leonardo Crama
- Lung Cancer Medical Department, Roche Farma S.A., 28042 Madrid, Spain; (D.P.P.); (L.C.); (P.R.-G.)
| | - Pedro Ruiz-Gracia
- Lung Cancer Medical Department, Roche Farma S.A., 28042 Madrid, Spain; (D.P.P.); (L.C.); (P.R.-G.)
| | | | - Luis León-Mateos
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela and Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, 15706 Santiago de Compostela, Spain
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Melosky B, Juergens R, Hirsh V, McLeod D, Leighl N, Tsao M, Card PB, Chu Q. Amplifying Outcomes: Checkpoint Inhibitor Combinations in First-Line Non-Small Cell Lung Cancer. Oncologist 2020; 25:64-77. [PMID: 31138727 PMCID: PMC6964132 DOI: 10.1634/theoncologist.2019-0027] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/10/2019] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Lung cancer is one of the most common types of cancer, resulting in approximately 1.8 million deaths worldwide. Immunotherapy using checkpoint inhibitors has become standard of care in advanced non-small cell lung cancer (NSCLC), and there is increasing interest in further improving outcomes through combination with other therapeutics. This systematic review evaluates emerging phase III data on the efficacy and safety of checkpoint inhibitor combinations as first-line treatment for advanced NSCLC. MATERIALS AND METHODS Published and presented literature was searched using the key search terms "non-small cell lung cancer" AND "checkpoint-inhibitors" (OR respective aliases) AND phase III trials. Seven randomized phase III clinical trials reporting outcomes on checkpoint inhibitor combinations in first-line advanced NSCLC were identified. RESULTS Four first-line trials reported outcomes for checkpoint inhibitor combinations in nonsquamous NSCLC. Pembrolizumab-chemotherapy, atezolizumab-chemotherapy, and atezolizumab-bevacizumab-chemotherapy showed significantly improved overall survival compared with controls in patients with advanced nonsquamous epidermal growth factor receptor-negative (EGFR-)/ anaplastic lymphoma kinase gene (ALK)- NSCLC. Two trials reported outcomes for squamous NSCLC, with pembrolizumab-chemotherapy reporting significantly improved overall survival (OS) compared with chemotherapy. The combination of nivolumab-ipilimumab in all-comer histology failed to improve OS compared with histology appropriate chemotherapy in patients regardless of their tumor mutational burden status. Based on improved survival and safety, either pembrolizumab monotherapy or pembrolizumab-chemotherapy administered based on PD-L1 status and histology is a preferred treatment option. Outcomes for atezolizumab-bevacizumab-chemotherapy in EGFR+/ALK+ patients are promising and require further exploration. CONCLUSION First-line checkpoint inhibitors added to standard therapies improve overall survival for nonsquamous EGFR-/ALK- and squamous advanced NSCLC. IMPLICATIONS FOR PRACTICE Single-agent immune checkpoint inhibitors are now standard of care for advanced non-small cell lung cancer (NSCLC), and emerging data show that combining these agents with established chemotherapy further improves outcomes. The phase III KEYNOTE-189 and IMPower-130 trials showed significantly improved survival using this strategy for nonsquamous NSCLC, and the phase III KEYNOTE-407 trial showed similar results in squamous disease. Checkpoint inhibitor combinations are therefore an important new treatment option for first-line NSCLC. Programmed death ligand-1 expression may inform the use of checkpoint inhibitor combination therapy, and overall tumor mutation burden is also an emerging biomarker for this new treatment strategy.
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Affiliation(s)
- Barbara Melosky
- BC Cancer Agency Vancouver CentreVancouverBritish ColumbiaCanada
| | - Rosalyn Juergens
- Division of Medical Oncology, McMaster University, Juravinski Cancer CentreHamiltonOntarioCanada
| | - Vera Hirsh
- Montreal General Hospital, Royal Victoria Hospital and Department of Oncology, McGill UniversityMontrealQuebecCanada
| | | | - Natasha Leighl
- Princess Margaret Cancer Centre, University Health Network, University of TorontoTorontoOntarioCanada
| | - Ming‐Sound Tsao
- Princess Margaret Cancer Centre, University Health Network, University of TorontoTorontoOntarioCanada
| | - Paul B. Card
- Kaleidoscope Strategic Inc. TorontoOntarioCanada
| | - Quincy Chu
- Cross Cancer Institute and Department of Oncology, University of AlbertaEdmontonAlbertaCanada
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Abstract
Immune checkpoint blockers have revolutionized cancer treatment in recent years. These agents are now approved for the treatment of several malignancies, including melanoma, squamous and non-squamous non-small cell lung cancer, renal cell carcinoma, urothelial carcinoma, and head and neck squamous cell carcinoma. Studies have demonstrated the significant impact of immunotherapy versus standard of care on patient outcomes, including durable response and extended survival. The use of immunotherapy-based combination therapy has been shown to further extend duration of response and survival. Immunotherapies function through modulation of the immune system, which can lead to immune-mediated adverse events (imAEs). These include a range of dermatologic, gastrointestinal, endocrine, and hepatic toxicities, as well as other less common inflammatory events. ImAEs are typically low grade and manageable when identified early and treated with appropriate measures. Identifying the right patient for the right therapy will become more important as new immunotherapies and immunotherapy-based combinations are approved and costs of cancer care continue to rise.
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Final results of the SENECA (SEcond line NintEdanib in non-small cell lung CAncer) trial. Lung Cancer 2019; 134:210-217. [DOI: 10.1016/j.lungcan.2019.06.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/23/2019] [Accepted: 06/26/2019] [Indexed: 01/10/2023]
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10
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Immune checkpoint inhibitors, alone or in combination with chemotherapy, as first-line treatment for advanced non-small cell lung cancer. A systematic review and network meta-analysis. Lung Cancer 2019; 134:127-140. [PMID: 31319971 DOI: 10.1016/j.lungcan.2019.05.029] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 12/22/2022]
Abstract
This network meta-analysis (NMA), based on 12 phase-III studies with 9,236 metastatic NSCLC patients, aims to compare the efficacy of treatments including at least one immune-checkpoint inhibitor (ICI) with or without chemotherapy, as frontline therapy for advanced NSCLC patients. The NMA includes direct randomized evidence on treatments of interest along with indirect evidence from randomized studies with chemotherapy as the common comparator. Studies were identified by searching PubMed, and the abstracts of most recent main oncology congresses. The primary endpoint, Hazard-Ratio (HR) of Progression-free Survival (PFS), was estimated by a frequentist-approach NMA. Results are presented in the overall cohort (all-comers or PD-L1-positive) irrespective of histology, and by histology, PD-L1 expression level and sex. According to the primary PFS-NMA in the overall cohort, the combination of chemotherapy, first with pembrolizumab, second with atezolizumab exhibit significantly higher benefit than any other treatment examined. This superior PFS benefit is found for both squamous and non-squamous patients. Similarly for OS, the combination of pembrolizumab/chemotherapy, and atezolizumab/bevacizumab/chemotherapy-(ABC), followed by pembrolizumab-monotherapy and atezolizumab/chemotherapy, are the best treatments in the overall cohort, driven by the non-squamous histology. In the PD-L1-high patients again the combination of chemotherapy with atezolizumab or pembrolizumab, exhibit significant PFS benefit, followed by pembrolizumab-monotherapy. PFS benefit of these ICI/chemotherapy combinations are also found in PD-L1-negative and PD-L1-intermediate patients(1%≤PD-L1 < 50%). Of note, ABC is evaluated only for OS in non-squamous patients while the pembrolizumab-monotherapy PFS benefit and the atezolizumab/chemotherapy OS benefit are probably under-estimated since most of the data stems from non-significant interim analyses of ongoing studies [KN042;IM131/132/150]. In conclusion, the addition of chemotherapy to ICIs enhanced their treatment efficacy as first-line treatment for advanced NSCLC patients. The combination of chemotherapy with either pembrolizumab or atezolizumab show consistently higher efficacy than chemotherapy-alone or any other ICI-combination or monotherapy, particularly in non-squamous patients.
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11
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Boeri M, Milione M, Proto C, Signorelli D, Lo Russo G, Galeone C, Verri C, Mensah M, Centonze G, Martinetti A, Sottotetti E, Pastorino U, Garassino MC, Sozzi G. Circulating miRNAs and PD-L1 Tumor Expression Are Associated with Survival in Advanced NSCLC Patients Treated with Immunotherapy: a Prospective Study. Clin Cancer Res 2019; 25:2166-2173. [PMID: 30617131 DOI: 10.1158/1078-0432.ccr-18-1981] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/18/2018] [Accepted: 01/03/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Immune-checkpoint inhibitors (ICI) have improved the survival of patients with non-small cell lung cancer (NSCLC). However, only a subset of patients benefit from ICIs, and the role of PD-L1 as predictive biomarker is still debated. A plasma immune-related miRNA-signature classifier (MSC) was established in lung cancer screening settings to identify the lethal form of the disease in early stages. In this exploratory study, we tested the efficacy of the MSC as prognostic marker in patients with advanced NSCLC treated with ICIs. EXPERIMENTAL DESIGN The MSC risk level was prospectively assessed in a consecutive series of 140 patients with NSCLC before starting treatment with ICIs. Overall response rate (ORR), progression-free survival (PFS), and overall survival (OS) in strata of PD-L1 and MSC alone or combined were considered as endpoints. Multiple plasma samples to monitor MSC risk level during treatment were also profiled. RESULTS Adequate tissue and plasma samples were available from 111 (79%) and 104 (75%) patients with NSCLC, respectively. MSC risk level was associated with ORR (P = 0.0009), PFS [multivariate HR = 0.31; 95% confidence interval (CI), 0.17-0.56; P = 0.0001], and OS (multivariate HR = 0.33; 95% CI, 0.18-0.59; P = 0.0002). The combination of MSC and PD-L1 stratified patients into three risk groups having 39%-18%-0% 1-year PFS (P < 0.0001) and 88%-44%-0% 1-year OS (P < 0.0001), according to the presence of 2-1-0 favorable markers. During treatment, MSC risk level decreased or remained low until tumor progression in patients with responsive or stable disease. CONCLUSIONS The plasma MSC test could supplement PD-L1 tumor expression to identify a subgroup of patients with advanced lung cancer with worse ORR, PFS, and OS in immunotherapy regimens.
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Affiliation(s)
- Mattia Boeri
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Massimo Milione
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Diego Signorelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carla Verri
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mavis Mensah
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Centonze
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Clinical Research Lab (CRAB), Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antonia Martinetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisa Sottotetti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Unit of Thoracic Surgery, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Chiara Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriella Sozzi
- Unit of Tumor Genomics, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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12
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Kim J, Cho J, Lee MH, Lim JH. Relative Efficacy of Checkpoint Inhibitors for Advanced NSCLC According to Programmed Death-Ligand-1 Expression: A Systematic Review and Network Meta-Analysis. Sci Rep 2018; 8:11738. [PMID: 30082893 PMCID: PMC6078964 DOI: 10.1038/s41598-018-30277-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/26/2018] [Indexed: 12/26/2022] Open
Abstract
Although currently available immune checkpoint inhibitors with similar but slightly different indications are recommended for patients with advanced non-small cell lung cancer (NSCLC), their effects by programmed death-ligand-1 (PD-L1) expression level are not yet known. This meta-analysis aims to assess the survival benefit and comparative efficacy of checkpoint inhibitors according to PD-L1 expression level: <1%, 1-49%, and ≥50%. We searched the MEDLINE, EMBASE, and Cochrane database through December 2017. A fixed-effect Bayesian network meta-analysis (NMA) was performed to estimate hazard ratios (HRs) for overall survival (OS) with 95% credible intervals (CrIs). Seven trials including 3688 patients were selected from among the 673 screened studies. Checkpoint inhibitor remarkably improved OS over chemotherapy in the PD-L1 ≥ 50% subgroup compared with the PD-L1 < 1% and PD-L1 1-49% subgroups. Atezolizumab, nivolumab, and nivolumab were the most effective agents for second- or later-line settings in the PD-L1 < 1%, PD-L1 1-49%, and PD-L1 ≥ 50% subgroups, respectively. PD-L1 expression ≥50% on tumor cells could be a reliable indicator that helps patient selection in view of cost-efficiency, and each checkpoint inhibitor reported to be the best agent by PD-L1 expression level could be carefully recommended in each PD-L1 expression subgroup.
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Affiliation(s)
- Jinchul Kim
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Jinhyun Cho
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Moon Hee Lee
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea
| | - Joo Han Lim
- Department of Hematology-Oncology, Inha University College of Medicine and Hospital, Incheon, Republic of Korea.
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Melosky B, Chu Q, Juergens R, Leighl N, Ionescu D, Tsao MS, McLeod D, Hirsh V. Breaking the biomarker code: PD-L1 expression and checkpoint inhibition in advanced NSCLC. Cancer Treat Rev 2018; 65:65-77. [DOI: 10.1016/j.ctrv.2018.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 01/20/2023]
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14
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Remon J, Vilariño N, Reguart N. Immune checkpoint inhibitors in non-small cell lung cancer (NSCLC): Approaches on special subgroups and unresolved burning questions. Cancer Treat Rev 2018; 64:21-29. [PMID: 29454155 DOI: 10.1016/j.ctrv.2018.02.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/29/2018] [Accepted: 02/04/2018] [Indexed: 01/08/2023]
Abstract
Immune checkpoint inhibitors (ICIs) have been incorporated in the treatment strategy of advanced non-small cell lung cancer (NSCLC). Beyond the already approved indications in first- and second-line setting of advanced NSCLC, new data has recently emerged demonstrating its efficacy in locally advanced disease as maintenance after chemo-radiotherapy and currently several trials are also exploring its efficacy in earlier stages of the disease to evaluate whether these results could be extrapolated to the adjuvant setting. With the advent of all these new therapies, their potential in other thoracic malignancies such as mesothelioma and small-cell lung cancer are also being evaluated with encouraging preliminary data that endorses their short-term incorporation as new therapeutic options in these thoracic malignancies. However, despite all these new evidence, there are still several open questions that remain to be solved like the use of immune agents in special subpopulations such as elderly or fragile patients or the case of patients with brain metastases or autoimmune disorders. In addition some other open questions remain with regards ICIs activity in patients receiving corticosteroid or antibiotics, the potential use in oncogenic addicted tumours, as well as the safety of retreatment after the onset of immune-related adverse events (ir-AE) or the optimal dose schedule or time on treatment for ICIs administration. Herein, we propose to address all these questions, reviewing most recent evidence available in order to give readers some practical advises and guidance on how to deal with these challenges when treating NSCLC patients with immunotherapy.
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Affiliation(s)
- J Remon
- Hospital Vall d'Hebron, Medical Oncology Department, Barcelona, Spain.
| | - N Vilariño
- Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
| | - N Reguart
- Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
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