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Gandara DR, Kawaguchi T, Crowley J, Moon J, Furuse K, Kawahara M, Teramukai S, Ohe Y, Kubota K, Williamson SK, Gautschi O, Lenz HJ, McLeod HL, Lara PN, Coltman CA, Fukuoka M, Saijo N, Fukushima M, Mack PC. Japanese-US common-arm analysis of paclitaxel plus carboplatin in advanced non-small-cell lung cancer: a model for assessing population-related pharmacogenomics. J Clin Oncol 2009; 27:3540-6. [PMID: 19470925 PMCID: PMC2717760 DOI: 10.1200/jco.2008.20.8793] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/29/2009] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To explore whether population-related pharmacogenomics contribute to differences in patient outcomes between clinical trials performed in Japan and the United States, given similar study designs, eligibility criteria, staging, and treatment regimens. METHODS We prospectively designed and conducted three phase III trials (Four-Arm Cooperative Study, LC00-03, and S0003) in advanced-stage, non-small-cell lung cancer, each with a common arm of paclitaxel plus carboplatin. Genomic DNA was collected from patients in LC00-03 and S0003 who received paclitaxel (225 mg/m(2)) and carboplatin (area under the concentration-time curve, 6). Genotypic variants of CYP3A4, CYP3A5, CYP2C8, NR1I2-206, ABCB1, ERCC1, and ERCC2 were analyzed by pyrosequencing or by PCR restriction fragment length polymorphism. Results were assessed by Cox model for survival and by logistic regression for response and toxicity. Results Clinical results were similar in the two Japanese trials, and were significantly different from the US trial, for survival, neutropenia, febrile neutropenia, and anemia. There was a significant difference between Japanese and US patients in genotypic distribution for CYP3A4*1B (P = .01), CYP3A5*3C (P = .03), ERCC1 118 (P < .0001), ERCC2 K751Q (P < .001), and CYP2C8 R139K (P = .01). Genotypic associations were observed between CYP3A4*1B for progression-free survival (hazard ratio [HR], 0.36; 95% CI, 0.14 to 0.94; P = .04) and ERCC2 K751Q for response (HR, 0.33; 95% CI, 0.13 to 0.83; P = .02). For grade 4 neutropenia, the HR for ABCB1 3425C-->T was 1.84 (95% CI, 0.77 to 4.48; P = .19). CONCLUSION Differences in allelic distribution for genes involved in paclitaxel disposition or DNA repair were observed between Japanese and US patients. In an exploratory analysis, genotype-related associations with patient outcomes were observed for CYP3A4*1B and ERCC2 K751Q. This common-arm approach facilitates the prospective study of population-related pharmacogenomics in which ethnic differences in antineoplastic drug disposition are anticipated.
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Affiliation(s)
- David R Gandara
- University of California Davis Cancer Center, 4501 X St, Suite 3017, Sacramento, CA 95817-2229, USA.
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Wu CC, Hsu HY, Liu HP, Chang JWC, Chen YT, Hsieh WY, Hsieh JJ, Hsieh MS, Chen YR, Huang SF. Reversed mutation rates of KRAS and EGFR genes in adenocarcinoma of the lung in Taiwan and their implications. Cancer 2009; 113:3199-208. [PMID: 18932251 DOI: 10.1002/cncr.23925] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In western countries, the Kirsten ras oncogene homolog gene (KRAS) mutation rate is high in patients with nonsmall cell lung cancer (NSCLC), especially in those with adenocarcinoma (30%-50%), but the epidermal growth factor receptor gene (EGFR) mutation rate is very low (3%-8%). In addition, KRAS mutations reportedly were associated with EGFR tyrosine kinase inhibitor (EGFR-TKI) resistance. In Taiwan, high EGFR mutation rates associated with high EGFR-TKI response rates in patients with NSCLC have been reported; however, KRAS mutation data are limited and have not been correlated with TKI response. METHODS KRAS mutation analysis was performed on 237 NSCLC specimens, and the results were correlated with clinicopathologic features. All but 2 tumors also underwent EGFR mutation analysis. RESULTS KRAS mutations were identified in only 9 of 237 patients (3.80%). Five patients were women who were nonsmokers, and 4 patients were men who were ever-smokers. The mutation rate was 5.03% in patients with adenocarcinoma (8 of 159 patients) and 1.56% in patients with squamous cell carcinoma (1 of 64 patients). Four mutations were G12V, 3 mutations were G12D, 1 mutation was L19F, and 1 was the duplication insertion mutation dupT50_M72. In contrast, EGFR mutations were detected in 96 of 235 patients (40.8%) and in 90 of 157 adenocarcinomas (57.3%). None of the KRAS mutations coexisted with EGFR mutations. KRAS mutations were not associated significantly with any clinicopathologic characteristics, including smoking status. Among the 53 patients who had received TKI monotreatment, only 1 patient had a KRAS mutation and had progressive disease. CONCLUSIONS The KRAS mutation rate was too low to play a significant role in TKI resistance or tumorigenesis among Taiwanese patients with NSCLC, which was the complete reverse of the results reported in western countries.
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Affiliation(s)
- Chun-Chieh Wu
- Department of Pathology, Chang Gung Memorial Hospital, Tao Yuan, Taiwan
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Maruyama R, Yoshino I, Tokunaga S, Ohta M, Kato M, Yoshimine H, Yamazaki K, Nakanishi Y, Ichinose Y. Feasibility trial of adjuvant chemotherapy with paclitaxel and carboplatin after surgical resection in Japanese patients with non-small cell lung cancer: report of the Lung Oncology Group in Kyushu (LOGIK) protocol 0501. Gen Thorac Cardiovasc Surg 2008; 56:68-73. [PMID: 18297461 DOI: 10.1007/s11748-007-0188-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 10/04/2007] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The present study was designed to determine whether adjuvant chemotherapy with paclitaxel (TXL) and carboplatin (CBDCA) after surgical resection is feasible in Japanese patients with non-small cell lung cancer (NSCLC) in a multiinstitutional trial. METHODS From August 2005 to March 2006, 34 patients received the following regimen: TXL (175 mg/m2) and CBDCA (AUC = 5) on day 1, every 3 weeks. The primary endpoint of this trial was the completion rate of four cycles. RESULTS The completion rate of four cycles was 79.4% [90% confidence interval (CI), 67.5%-91.3%]. Perfect completion rate of four cycles on schedule and full doses without delay was 50% (90% CI, 34.9%-65.1%). The reasons for incomplete cycles were hypersensitivity to TXL infusion during the first cycle in 3 patients, patients refusal in 2, and anemia and cerebral infarction in 1 patient each. As a consequence of delay and/or dose reductions, the relative dose intensity of TXL and CBDCA was 86.2% and 85.8%, respectively. CONCLUSION Doublet chemotherapy with TXL and CBDCA in the planned doses and schedule was found to be a feasible treatment for Japanese patients following surgical resection for NSCLC:
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Affiliation(s)
- Riichiroh Maruyama
- Department of Surgery, Nippon Steel Yawata Memorial Hospital, 1-1-1 Harunomachi, Yahatahigashi-ku, Kitakyushu 805-8508, Japan.
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Park JO, Kim SW, Ahn JS, Suh C, Lee JS, Jang JS, Cho EK, Yang SH, Choi JH, Heo DS, Park SY, Shin SW, Ahn MJ, Lee JS, Yun YH, Lee JW, Park K. Phase III Trial of Two Versus Four Additional Cycles in Patients Who Are Nonprogressive After Two Cycles of Platinum-Based Chemotherapy in Non–Small-Cell Lung Cancer. J Clin Oncol 2007; 25:5233-9. [PMID: 18024869 DOI: 10.1200/jco.2007.10.8134] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeThis trial was conducted to determine the optimal duration of chemotherapy in Korean patients with advanced non–small-cell lung cancer (NSCLC).Patients and MethodsPatients with stages IIIB to IV NSCLC who had not progressed after two cycles of chemotherapy were randomly assigned to receive either four (arm A) or two (arm B) more cycles of third-generation, platinum-doublet treatment.ResultsOf the 452 enrolled patients, 314 were randomly assigned to the groups. One-year survival rates were 59.0% in arm A and 62.4% in arm B, and the difference of 3.4% (95% CI, −8.0 to 4.8) met the predefined criteria for noninferiority. The median time to progression (TTP), however, was 6.2 months (95% CI, 5.7 to 6.7 months) in arm A and 4.6 months (95% CI, 4.4 to 4.8 months) in arm B, the difference of which is statistically significant (P = .001). The frequencies of hematologic and nonhematologic toxicities were similar in the two arms.ConclusionThis study confirms the noninferiority of overall survival with four cycles compared with six cycles of chemotherapy for the first-line treatment of advanced NSCLC and supports the current American Society of Clinical Oncology guidelines. Notably, patients receiving six cycles of chemotherapy compared with four cycles showed a favorable TTP, suggesting that further investigation of the new strategies of maintenance therapy with less toxic agents after three to four cycles of induction chemotherapy might be warranted to improve survival, with consideration of both ethnicity and pharmacogenomic signatures.
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Affiliation(s)
- Joon Oh Park
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Sang-We Kim
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jin Seok Ahn
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Cheolwon Suh
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jung Shin Lee
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Joung Soon Jang
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Eun Kyung Cho
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Sung Hyun Yang
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jin-Hyuk Choi
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Dae Seog Heo
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Suk Young Park
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Sang Won Shin
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Myung Ju Ahn
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jong Seok Lee
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Young Ho Yun
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Jae-Won Lee
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
| | - Keunchil Park
- From the Samsung Medical Center, Sungkyunkwan University School of Medicine; the Asan Medical Center, College of Medicine, University of Ulsan; the Korea Cancer Center Hospital; the Seoul National University Hospital; the Korea University Medical Center; the Hanyang University Hospital; the Chung-Ang University, College of Medicine; and the Korea University, Seoul; the Ajou University Hospital, Suwon; the Gyeongsang National University, Chinju; the Gachon University Gil Medical Center, Inchon; the
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