1
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Westeel V, Schuette W, Urban T, Radonjic D, von Wangenheim U, Lorence RM, Reck M. Safety and tolerability of weekly docetaxel plus nintedanib: A phase I trial after first-line chemotherapy failure in NSCLC. PLoS One 2023; 18:e0292307. [PMID: 37847688 PMCID: PMC10581470 DOI: 10.1371/journal.pone.0292307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Studies have shown improved tolerability with once-weekly versus three-weekly docetaxel in the second-line treatment of advanced non-small cell lung cancer (NSCLC). This study aimed to evaluate the tolerability of nintedanib plus weekly docetaxel in patients with NSCLC. METHODS This phase I, open-label, dose-escalation study (NCT02668393) enrolled patients with locally advanced/metastatic adenocarcinoma NSCLC that had progressed on first-line platinum chemotherapy. The primary endpoint was to determine the maximum tolerated dose of nintedanib (up to 200 mg twice daily [BID]) combined with weekly docetaxel (35 mg/m2) on days 1, 8, and 15 based on the occurrence of dose-limiting toxicities (DLTs) over a 28-day treatment cycle. Adverse events (AEs) were also evaluated. RESULTS The trial terminated prematurely due to recruitment challenges. At termination, seven patients had received nintedanib 150 mg BID and seven nintedanib 200 mg BID, in combination with weekly docetaxel. In the first treatment cycle, DLTs were reported for 1/6 evaluable patients (16.7%) in each group. The disease control rates were 57.1% and 42.9%, respectively. Grade ≥3 treatment-related AEs affected three patients in each group (42.9%); neutropenia was reported in one patient (14.3%) in each group. Treatment-related serious AEs were reported in three patients (42.9%) receiving nintedanib 150 mg, and two patients (28.6%) receiving nintedanib 200 mg. CONCLUSIONS Overall, nintedanib plus weekly docetaxel was well-tolerated in patients with locally advanced or metastatic lung adenocarcinoma who progressed on first-line platinum-based chemotherapy, without loss of efficacy. DLTs were manageable.
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Affiliation(s)
- Virginie Westeel
- Service de Pneumologie, CHRU Besançon-Hôpital Minjoz, Besançon, France
- INSERM UMR1098, Université de Bourgogne Franche Comté, Besançon, France
| | - Wolfgang Schuette
- 2 Medical Department, Krankenhaus Martha-Maria Halle-Dölau, Halle/Salle, Germany
| | | | - Dejan Radonjic
- TA Oncology Medicine, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Ute von Wangenheim
- Department Global Biostatistics and Data Sciences, Boehringer Ingelheim, Biberach an der Riß, Germany
| | - Robert M. Lorence
- Department of Medical Oncology, Boehringer Ingelheim, Ridgefield, CT, United States of America
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungenClinic, Grosshansdorf, Germany
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2
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Reck M, Popat S, Grohé C, Corral J, Novello S, Gottfried M, Brueckl W, Radonjic D, Kaiser R, Heymach J. Anti-angiogenic agents for NSCLC following first-line immunotherapy: Rationale, recent updates, and future perspectives. Lung Cancer 2023; 179:107173. [PMID: 36940614 DOI: 10.1016/j.lungcan.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
The implementation of immune checkpoint inhibitors (ICIs), with or without chemotherapy, as first-line treatment for patients who do not have actionable mutations has proved to be a major paradigm shift in the management of advanced non-small cell lung cancer (NSCLC). However, the transition of ICIs, such as pembrolizumab and nivolumab, to a first-line setting has left an unmet need for effective second-line treatment options, which is an area of intense research. In 2020, we reviewed the biological and mechanistic rationale for anti-angiogenic agents in combination with, or following, immunotherapy with the aim of eliciting a so called 'angio-immunogenic' switch in the tumor microenvironment. Here, we review the latest clinical evidence of the benefits of incorporating anti-angiogenic agents into treatment regimens. While there is a paucity of prospective data, several recent observational studies indicate that the marketed anti-angiogenic drugs, nintedanib or ramucirumab, are effective in combination with docetaxel following immuno-chemotherapy. Addition of anti-angiogenics, like bevacizumab, have also demonstrated clinical benefit when combined with first-line immuno-chemotherapy regimens. Ongoing clinical trials are assessing these agents in combination with ICIs, with encouraging early results (e.g., ramucirumab plus pembrolizumab in LUNG-MAP S1800A). Also, several emerging anti-angiogenic agents combined with ICIs are currently being assessed in phase III trials following immunotherapy, including lenvatinib (LEAP-008), and sitravatinib (SAPPHIRE) It is hoped that these trials will help expand second-line treatment options in patients with NSCLC. Areas of focus in the future will include further molecular dissection of the mechanisms of resistance to immunotherapy and the various response-progression profiles to immunotherapy observed in the clinic and the monitoring of the dynamics of immunomodulation over the course of treatment. Improved understanding of these phenomena may help identify clinical biomarkers and inform the optimal use of anti-angiogenics in the treatment of individual patients.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN) Member of the German Center for Lung Research (DZL), LungenClinic, Großhansdorf, Germany.
| | - Sanjay Popat
- Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | | | - Jesus Corral
- Clínica Universidad de Navarra en Madrid, Madrid, Spain
| | - Silvia Novello
- Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Italy
| | | | - Wolfgang Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg Lung Cancer Center, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Dejan Radonjic
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Rolf Kaiser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany; Institute of Pharmacology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - John Heymach
- Department of Thoracic/Head and Neck Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
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3
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Moliner L, Spurgeon L, Califano R. Controversies in NSCLC: which second-line strategy after chemo-immunotherapy? ESMO Open 2023; 8:100879. [PMID: 36791668 PMCID: PMC9958277 DOI: 10.1016/j.esmoop.2023.100879] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/30/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- L Moliner
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester
| | - L Spurgeon
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester
| | - R Califano
- Department of Medical Oncology, The Christie Hospital NHS Foundation Trust, Manchester; Division of Cancer Sciences, The University of Manchester, Manchester, UK.
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4
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Pan L, Meng F, Wang W, Wang XH, Shen H, Bao P, Kang J, Kong D. Nintedanib in an elderly non-small-cell lung cancer patient with severe steroid-refractory checkpoint inhibitor-related pneumonitis: A case report and literature review. Front Immunol 2023; 13:1072612. [PMID: 36703957 PMCID: PMC9872202 DOI: 10.3389/fimmu.2022.1072612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Immune checkpoint inhibitors tremendously improve cancer prognosis; however, severe-grade immune-related adverse events may cause premature death. Current recommendations for checkpoint inhibitor-related pneumonitis (CIP) treatment are mainly about immunosuppressive therapy, and anti-fibrotic agents are also needed, especially for patients with poor response to corticosteroids and a longer pneumonitis course. This is because fibrotic changes play an important role in the pathological evolution of CIP. Here, we report a case demonstrating that nintedanib is a promising candidate drug for CIP management or prevention, as it has potent anti-fibrotic efficacy and a safety profile. Moreover, nintedanib could partially inhibit tumor growth in patients with non-small-cell lung cancer, and its efficacy can be improved in combination with other anti-tumor therapies.
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Affiliation(s)
- Lei Pan
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Fanqi Meng
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,The First Clinical College, China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Xu-hao Wang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,The First Clinical College, China Medical University, Shenyang, China
| | - Hui Shen
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Pengchen Bao
- The First Clinical College, China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Delei Kong
- Department of Respiratory and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China,*Correspondence: Delei Kong,
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5
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Panjaitan NSD. A Response to Article Anlotinib Hydrochloride and PD-1 Blockade as a Salvage Second-Line Treatment in Patients with Progress of Local Advanced Non-Small Cell Lung Cancer in Half a Year after Standard Treatment [Letter]. Onco Targets Ther 2022; 15:1405-1406. [DOI: 10.2147/ott.s396245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
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6
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Grohé C, Wehler T, Dechow T, Henschke S, Schuette W, Dittrich I, Hammerschmidt S, Müller-Huesmann H, Schumann C, Krüger S, Atz J, Kaiser R. Nintedanib plus docetaxel after progression on first-line immunochemotherapy in patients with lung adenocarcinoma: Cohort C of the non-interventional study, VARGADO. Transl Lung Cancer Res 2022; 11:2010-2021. [PMID: 36386456 PMCID: PMC9641040 DOI: 10.21037/tlcr-21-1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 08/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) with or without chemotherapy represent first-line standard of care for patients with advanced non-small cell lung cancer (NSCLC) without targetable driver mutations. The most appropriate second-line therapy after failing immunochemotherapy remains an open question. Nintedanib, an oral triple angiokinase inhibitor that targets the vascular endothelial growth factor receptor, fibroblast growth factor receptor, and, platelet-derived growth factor receptor, in combination with docetaxel, is approved for treatment of advanced NSCLC (adenocarcinoma histology) following progression on first-line chemotherapy. METHODS VARGADO (NCT02392455) is an ongoing, prospective, non-interventional study investigating the efficacy and safety of nintedanib plus docetaxel following first-line chemotherapy with or without ICIs in patients with locally advanced, metastatic, or locally recurrent NSCLC of adenocarcinoma histology. This analysis focuses on Cohort C, which enrolled patients who had received prior first line chemotherapy with ICIs. Patients received second-line docetaxel (75 mg/m<sup>2</sup>) by intravenous infusion on Day 1, plus oral nintedanib (200 mg twice daily) on Days 2-21 of each 21-day cycle during routine clinical care. The primary endpoint is overall survival (OS) rate 1 year after the start of treatment with nintedanib plus docetaxel. Secondary endpoints include progression-free survival (PFS), OS, and disease control rate (DCR). Safety was also assessed. RESULTS Among 137 patients treated, the median age was 63 years (range, 37-84); 57 patients (41.6%) were female, most patients had Eastern Cooperative Oncology Group performance status of 0 (28.5%) or 1 (43.1%); 118 (86.1%) had stage IV NSCLC and 27 (19.7%) had brain metastases. Most (n=120, 87.6%) patients had received pembrolizumab/pemetrexed/platinum-based chemotherapy as first-line treatment. In 80 patients with available response data, the DCR was 72.5% (complete response: 1.3%; partial response: 36.3%; stable disease: 35.0%). Median progression-free survival was 4.8 months (95% confidence interval: 3.7-6.6). OS data were immature. Grade ≥3 treatment-emergent adverse events (TEAEs), serious TEAEs, and TEAEs leading to treatment discontinuation were reported in 62 (45.3%), 50 (36.5%), and 40 patients (29.2%), respectively. CONCLUSIONS This analysis indicates that nintedanib plus docetaxel represents an effective second-line treatment option in patients with advanced adenocarcinoma NSCLC following progression on first-line immunochemotherapy. The safety profile was manageable with no unexpected signals.
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Affiliation(s)
- Christian Grohé
- Department of Respiratory Diseases, ELK Berlin, Berlin, Germany
| | - Thomas Wehler
- Department of Hematology, Oncology, Pneumology and Palliative Medicine, EVK, Evangelisches Krankenhaus Hamm, Hamm, Germany
| | - Tobias Dechow
- Private Oncology Practice Ravensburg, Ravensburg, Germany
| | - Sven Henschke
- Innere Medizin V, Medizinische Klinik, Universitätskliniken des Saarlandes, Homburg, Germany
| | | | | | | | | | - Christian Schumann
- Clinic for Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Allgaeu Hospitals, Kempten and Immenstadt, Germany
| | - Stefan Krüger
- Department of Pulmonology/Allergology/Sleep Medicine and Respiratory Care, Florence Nightingale Hospital, Düsseldorf, Germany
| | - Judith Atz
- Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Rolf Kaiser
- Medical Affairs, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany;,Institute of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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7
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Li J, Zhang Y, Wang L, Li M, Yang J, Chen P, Zhu J, Li X, Zeng Z, Li G, Xiong W, McCarthy JB, Xiang B, Yi M. FOXA1 prevents nutrients deprivation induced autophagic cell death through inducing loss of imprinting of IGF2 in lung adenocarcinoma. Cell Death Dis 2022; 13:711. [PMID: 35974000 PMCID: PMC9381574 DOI: 10.1038/s41419-022-05150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 01/21/2023]
Abstract
Lung cancer remains one of the most common malignancies and the leading cause of cancer-related death worldwide. Forkhead box protein A1 (FOXA1) is a pioneer factor amplified in lung adenocarcinoma (LUAD). However, its role in LUAD remains elusive. In this study, we found that expression of FOXA1 enhanced LUAD cell survival in nutrients deprived conditions through inhibiting autophagic cell death (ACD). FOXA1 bound to the imprinting control region of insulin-like growth factor 2 (IGF2) and interacted with DNA methyltransferase 1 (DNMT1), leading to initiation of DNMT1-mediated loss of imprinting (LOI) of IGF2 and autocrine of IGF2. Blockage of IGF2 and its downstream insulin-like growth factor 1 receptor (IGF1R) abolished the protective effect of FOXA1 on LUAD cells in nutrients deprived conditions. Furthermore, FOXA1 suppressed the expression of the lysosomal enzyme glucocerebrosidase 1 (GBA1), a positive mediator of ACD, through ubiquitination of GBA1 enhanced by IGF2. Notably, FOXA1 expression in A549 cells reduced the efficacy of the anti-angiogenic drug nintedanib to inhibit xenograft tumor growth, whereas a combination of nintedanib with IGF1R inhibitor linsitinib or mTORC1 inhibitor rapamycin enhanced tumor control. Clinically, high expression level of FOXA1 protein was associated with unfavorable prognosis in LUAD patients of advanced stage who received bevacizumab treatment. Our findings uncovered a previously unrecognized role of FOXA1 in mediating loss of imprinting of IGF2, which confer LUAD cells enhanced survival ability against nutrients deprivation through suppressing autophagic cell death.
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Affiliation(s)
- Junjun Li
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410008 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410078 Hunan China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Yongchang Zhang
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410008 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410078 Hunan China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Li Wang
- grid.216417.70000 0001 0379 7164Department of Thoracic Surgery, Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Min Li
- grid.216417.70000 0001 0379 7164Department of Respiratory Medicine, Xiangya Lung Cancer Center; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
| | - Jianbo Yang
- grid.17635.360000000419368657Department of Laboratory Medicine and Pathology, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455 USA
| | - Pan Chen
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China
| | - Jie Zhu
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410008 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410078 Hunan China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Xiayu Li
- grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Zhaoyang Zeng
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410008 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410078 Hunan China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Guiyuan Li
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410008 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410078 Hunan China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Wei Xiong
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410008 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410078 Hunan China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - James B. McCarthy
- grid.17635.360000000419368657Department of Laboratory Medicine and Pathology, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455 USA
| | - Bo Xiang
- grid.216417.70000 0001 0379 7164Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis of the Chinese Ministry of Health, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410008 Hunan China ,grid.216417.70000 0001 0379 7164The Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medical Sciences, Central South University, Changsha, 410078 Hunan China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, 410013 Hunan China
| | - Mei Yi
- grid.216417.70000 0001 0379 7164Department of Respiratory Medicine, Xiangya Lung Cancer Center; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
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8
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Bilger G, Toffart AC, Darrason M, Duruisseaux M, Ulmer L, Wang P, Leprieur EG, Girard N, Massiani MA, Bore P, Descourt R, Pinsolle J, Valery S, Monnet I, Swalduz A, Tissot C, Fournel P, Baranzelli A, Cortot AB, Decroisette C. Paclitaxel–bevacizumab combination in advanced non-squamous non-small-cell lung cancer (NSCLC): AVATAX, a retrospective multicentric study. Ther Adv Med Oncol 2022; 14:17588359221099399. [PMID: 35694190 PMCID: PMC9174558 DOI: 10.1177/17588359221099399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Compared with docetaxel, the phase-III trial, ULTIMATE, showed a significant
improvement of progression-free survival (PFS) with paclitaxel–bevacizumab
combination (PB) as second- or third-line treatment in advanced non-small
cell lung cancer (NSCLC). With the increase of immunotherapy treatment in
first-line settings, the optimal treatment after first-line failure must be
redefined. Methods: This multicentric retrospective study identified all advanced NSCLC patients
treated with PB as second-line therapy and beyond. The main efficacy
outcomes assessed were objective response rate (ORR), disease control rate
(DCR), PFS, and overall survival (OS). The adverse events were reported
according to Common Terminology Criteria for Adverse Events (CTCAE). Results: From January 2010 to February 2020, 314 patients in 16 centers received the
PB combination. Most patients were male (55%), with a median age of 60 years
(19–82), 95% had adenocarcinoma, 27% had a performance status ⩾2, 45% had
brain metastases at the time of inclusion. They mostly received the PB
combination either in second (20%) or in third-line (39%), and 28% were
treated just after ICI failure. ORR and DCR were 40% and 77%, respectively;
median PFS and OS were 5.7 [interquartile range (IQR): 3.2–9.6] and 10.8
[IQR: 5.3–19.6] months, respectively. All grade adverse events concerned 82%
of patients, including 53% asthenia and 39% neurotoxicity, and 25% of
patients continued monotherapy (mostly with bevacizumab) alone due to
toxicity. Median PFS for patients treated after ICI failure (ICI+) was
significantly superior compared with those not previously treated with ICI
(ICI−): 7.0 [IQR: 4.2–11.0] versus 5.2 [IQR: 2.9–8.8]
months, p = 0.01, without statistically significant
difference for OS between these two groups. In multivariate analysis,
factors associated with superior PFS were previous ICI treatment and
performance status of 0–1. Only a performance status of 0–1 was associated
with superior OS. Conclusion: PB combination as second-line treatment or beyond for advanced non-squamous
NSCLC had acceptable toxicity and a clinically relevant efficacy and is an
option as salvage treatment for these patients, more particularly after ICI
progression.
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Affiliation(s)
- Geoffroy Bilger
- Centre Hospitalier Universitaire de Grenoble, 38700 Grenoble, France. Oncology, Grenoble University Hospital, Grenoble, France
| | - Anne-Claire Toffart
- Centre Hospitalier Universitaire de Grenoble, Grenoble, FranceOncology, Grenoble University Hospital, Grenoble, France
| | - Marie Darrason
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Hôpital Lyon-Sud, CHU Lyon, Pierre-Bénite, France
- Department of Pneumology and Thoracic Oncology, University Hospital of Lyon, Pierre-Bénite, France
- Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France
- Lyon Institute of Philosophical Research, Lyon 3 University, Lyon, France
| | | | - Lucie Ulmer
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
| | | | | | | | | | - Paul Bore
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Julian Pinsolle
- Unité de pneumologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | | | | | - Aurélie Swalduz
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Claire Tissot
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Pierre Fournel
- Service d’Oncologie Médicale, Institut de Cancérologie, CHU de Saint-Etienne, Saint-Etienne Cedex 2, France
| | - Anne Baranzelli
- Unité de pneumologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Alexis B. Cortot
- Thoracic Oncology Department, Hospital Albert Calmette, Lille, France
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Remon J, Lacas B, Herbst R, Reck M, Garon EB, Scagliotti GV, Ramlau R, Hanna N, Vansteenkiste J, Yoh K, Groen HJ, Heymach JV, Mandrekar SJ, Okamoto I, Neal JW, Heist RS, Planchard D, Pignon JP, Besse B, Besse B, Lacas B, Pignon J, Remon J, Berghmans T, Dahlberg S, Felip E, Berghmans T, Besse B, Dahlberg S, Felip E, Garon E, Groen HJ, Hanna N, Heist RS, Herbst R, Heymach JV, Lacas B, Adjei AA, Heist R, Mandrekar SJ, Neal JW, Okamoto I, Pignon JP, Ramlau R, Remon J, Reck M, Scagliotti GV, Vansteenkiste J, Yoh K. ANtiangiogenic Second-line Lung cancer Meta-Analysis on individual patient data in non-small cell lung cancer: ANSELMA. Eur J Cancer 2022; 166:112-125. [DOI: 10.1016/j.ejca.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
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Greystoke A. Re-evaluating Subsequent Treatment Options in Non-small Cell Lung Cancer in the Era of Immune Checkpoint Inhibitors. Clin Oncol (R Coll Radiol) 2022; 34:469-471. [PMID: 35474003 DOI: 10.1016/j.clon.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/18/2022] [Accepted: 04/08/2022] [Indexed: 11/03/2022]
Affiliation(s)
- A Greystoke
- Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK; Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
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Grohé C, Blau W, Gleiber W, Haas S, Hammerschmidt S, Krüger S, Müller-Huesmann H, Schulze M, Wehler T, Atz J, Kaiser R. Real-World Efficacy of Nintedanib Plus Docetaxel After Progression on Immune Checkpoint Inhibitors: Results From the Ongoing, Non-interventional VARGADO Study. Clin Oncol (R Coll Radiol) 2022:S0936-6555(21)00491-X. [PMID: 35012901 DOI: 10.1016/j.clon.2021.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022]
Abstract
AIMS To evaluate the efficacy and safety of nintedanib plus docetaxel in patients with advanced adenocarcinoma non-small cell lung cancer (NSCLC) who progressed after chemotherapy and immune checkpoint inhibitor (ICI) therapy. MATERIALS AND METHODS VARGADO (NCT02392455) is an ongoing, prospective, non-interventional, real-world study of nintedanib plus docetaxel after first-line chemotherapy in the routine clinical treatment of patients with locally advanced, metastatic or locally recurrent adenocarcinoma NSCLC. Data were collected during routine visits. We report the results from cohort B (n = 80), who received third-line nintedanib plus docetaxel after first-line chemotherapy and second-line ICI therapy. RESULTS The median duration of follow-up was 12.4 months. Median progression-free survival from initiation of third-line nintedanib plus docetaxel was 6.4 months (95% confidence interval 4.8, 7.3); median overall survival was 12.1 months (95% confidence interval 9.4, 13.5). The 1-year overall survival rate after initiation of third-line nintedanib plus docetaxel treatment (primary end point) was 52% (95% confidence interval 38.0%, 64.4%). Among 64 patients with a documented response, the objective response rate was 50% (n = 32; one complete response and 31 partial responses) and the disease control rate was 86% (n = 55). There were no new safety signals or unexpected toxicities. Among all treated patients, 74% (n = 59) experienced drug-related adverse events, most commonly (nintedanib-related/docetaxel-related) diarrhoea (34%/24%), a decreased white blood cell count (11%/19%) and nausea (13%/16%). CONCLUSIONS Nintedanib plus docetaxel demonstrated a high response rate and disease stabilisation in the third-line setting after failure of prior chemotherapy and ICI treatment, with a manageable safety profile. These results suggest that nintedanib plus docetaxel represents an efficient treatment option after failure of prior ICIs. The ongoing VARGADO study provides valuable real-world data to inform clinical decision-making regarding treatment sequencing after chemotherapy and ICI failure in patients with adenocarcinoma NSCLC.
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Hochmair MJ, Kolb R, Wurm R, Zach H, Bittner N. Nintedanib plus Docetaxel after Immune Checkpoint Inhibitor Failure in Patients with Advanced Non-Small-Cell Lung Cancer: A Case Series. Case Rep Oncol 2022; 15:138-148. [PMID: 35350799 PMCID: PMC8921945 DOI: 10.1159/000520939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022] Open
Abstract
Advances in the treatment of non-small-cell lung cancers (NSCLCs) lacking an actionable driver mutation have included the approval of immunotherapies, such as monotherapy or in combination with chemotherapy. However, limited evidence exists to guide clinical decision-making after progression with immunotherapy. The vascular endothelial growth factor (VEGF) signaling pathway promotes tumor angiogenesis and the development of an immunosuppressive tumor microenvironment (TME). Anti-VEGF treatment is postulated to favor an immunosupportive TME through an “angio-immunogenic switch.” Nintedanib, an anti-VEGF receptor treatment, is approved in the EU and other countries, in combination with docetaxel for the treatment of locally advanced, metastatic, or locally recurrent adenocarcinoma NSCLC after failure of first-line chemotherapy. We present a case series from 5 patients treated with nintedanib plus docetaxel, after chemotherapy and immunotherapy, during routine clinical practice in Austria and Hungary. Four patients were treated with nintedanib plus docetaxel as a second- or third-line treatment after chemotherapy and immunotherapy, and a fifth patient received immunotherapy before and after nintedanib plus docetaxel. Although these patients would typically have a poor prognosis, each achieved a partial response with nintedanib plus docetaxel, with response duration from 8 months to over 30 months. Adverse events were manageable. The fifth patient case shows that nintedanib does not preclude later-line immunotherapy or chemotherapy, supporting the angio-immunogenic switch hypothesis. Overall, the case studies indicate that nintedanib plus docetaxel is an effective and well tolerated treatment, after sequential or combined chemo-immunotherapy for advanced NSCLC, and is compatible with a rechallenge with immunotherapy.
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Affiliation(s)
- Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Rainer Kolb
- Department of Pulmonology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Robert Wurm
- Department of Pulmonology, Medical University Graz, Graz, Austria
| | - Herwig Zach
- Boehringer Ingelheim RCV GmbH & Co KG, Vienna, Austria
| | - Nora Bittner
- Department of Pulmonology, University of Debrecen, Debrecen, Hungary
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Abstract
PURPOSE OF REVIEW In the current review, we will explore the molecular bases that have determined the design of clinical trials exploring the efficacy of antivascular agents in combination with chemotherapy, immune check point inhibitors and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in patients with advanced nonsmall cell lung cancer. RECENT FINDINGS Recent clinical trials have demonstrated the synergistic effect of antivascular agents with immune checkpoint inhibitors and EGFR-TKIs, despite no molecular marker has been identified yet to select patients. SUMMARY Lung cancer remains one of the first causes of cancer-related death. However, thanks to the development of stratified molecular medicine and the introduction of immune checkpoint inhibitors, patients' survival has significantly improved. Due to the critical role of pro-angiogenic factors in cancer progression, antivascular agents targeting the vascular endothelial growth factor (VEGF) and its receptor (VEGFR) have been developed. Their efficacy has been explored in combination with chemotherapy, and immune checkpoint inhibitors, with promising but not definitive conclusions about their impact on prolonging patients' survival.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Alessandra Bulotta
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Giuseppe Damiano
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Aurora Mirabile
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Mariagrazia Viganó
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
| | - Giulia Veronesi
- Faculty of Medicine and Surgery-Vita-Salute San Raffaele University
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Vanesa Gregorc
- Department of Oncology, IRCCS Ospedale San Raffaele Scientific Institute
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Auliac JB, Monnet I, Bizieux A, Greillier L, Geier M, Falchero L, Le Garff G, Lamy R, Guisier F, Ricordel C, Chouaid C, Vergnenegre A; REFRACT GFPC 02-15 investigators. Multicenter phase II trial of nintedanib plus docetaxel in second-line treatment in advanced non-squamous non-small cell lung cancer patients refractory to first-line platin-based chemotherapy (REFRACT GFPC 02-15 study). Lung Cancer 2021; 161:122-7. [PMID: 34583220 DOI: 10.1016/j.lungcan.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Advanced non-squamous non-small cell lung cancer (NsqNSCLC) progressing at the induction of a first-line of platin-based chemotherapy is a subgroup of patients with poor prognosis and few second-line treatment options. MATERIALS AND METHODS This single-stage phase II prospective multicenter open-label trial performed in platin-based refractory (i.e. progressing during induction phase of first-line platin-based chemotherapy) advanced NsqNSCLC assessed the efficacy of the nintedanib-docetaxel combination in second-line treatment. The primary endpoint was progression-free survival (PFS) rates at 12 weeks with a cut-off at 30% for ineffectiveness and 50% for minimal efficacy. RESULTS A total of 59 patients from 23 centers were included (mean age, 58.5 years; male gender, 73.6%; performance status 0-1, 100%; former/current smokers, 92.5%; adenocarcinoma, 92.5%, median platin-based first-line chemotherapy, 2). Nintedanib-docetaxel combination was administered for a median of 4 cycles. The rate of PFS at 12 weeks was 39.6% (95% CI, 28.2-56.8). Median PFS was 2.7 (95% CI, 1.4-4.1) months and one-year PFS was 11.8% (95% CI, 4.8-22.2). Median overall survival (OS) was 6.9 (95% CI, 4.3-8.2) months and 12-month OS was 32.1% (95% CI, 19.8-45.0); 18-month OS was 27.6% (95% CI, 16,1-40.4). Twenty-nine (53.7%) patients reported at least one serious treatment-related adverse events leading to permanent discontinuation of at least one study drug in 12 (22.2%) patients. CONCLUSION The predefined minimal efficacy was not demonstrated. However, a number of NsqNSCLC patients refractory to first-line platin-based chemotherapy appeared to benefit from this combination.
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Metzenmacher M, Rizzo F, Kambartel K, Panse J, Schaufler D, Scheffler M, Azeh I, Hoiczyk M, Turki AT, Atz J, Buchner H, Hoffmann C, C Christoph D. Real-world efficacy of docetaxel plus nintedanib after chemo-immunotherapy failure in advanced pulmonary adenocarcinoma. Future Oncol 2021; 17:3965-3976. [PMID: 34287064 DOI: 10.2217/fon-2021-0424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: This real-world analysis evaluated docetaxel plus nintedanib in patients with advanced pulmonary adenocarcinoma after chemotherapy and immune checkpoint inhibitor failure, for whom treatment options are limited. Methods: Data were sourced retrospectively from seven German centers. Results: Of 93 patients, overall response rate was 41.4% (disease control rate: 75.9%). Of 57 patients given third-line docetaxel plus nintedanib, overall response rate was 50.0% (disease control rate: 82.7%). Median overall survival following third-line docetaxel plus nintedanib was 8.4 months. Adverse events were consistent with the known safety profile of docetaxel plus nintedanib. Conclusion: To date, this was the largest retrospective, real-world analysis of docetaxel plus nintedanib after chemotherapy-immunotherapy failure, indicating that docetaxel plus nintedanib offers meaningful clinical benefits in this setting.
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Affiliation(s)
- Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, Essen 45122, Germany
| | - Filippo Rizzo
- Department of Medical Oncology/Hematology, Evang, Kliniken Essen-Mitte, Essen, Germany
| | - Kato Kambartel
- Department of Pneumology & Allergy, Lung Cancer Center, Bethanien Hospital Moers, Germany
| | - Jens Panse
- Department of Oncology, Haematology, Haemostaseology & Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Diana Schaufler
- University of Cologne, Faculty of Medicine & University Hospital of Cologne; Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf; Network Genomic Medicine, Lung Cancer Group Cologne, Cologne, Germany
| | - Matthias Scheffler
- University of Cologne, Faculty of Medicine & University Hospital of Cologne; Department I of Internal Medicine, Center for Integrated Oncology, Aachen Bonn Cologne Dusseldorf; Network Genomic Medicine, Lung Cancer Group Cologne, Cologne, Germany
| | - Ivo Azeh
- Onkologische Gemeinschaftspraxis und Tagesklinik, Gelsenkirchen, Germany
| | - Mathias Hoiczyk
- Department of Gastroenterology, Hematology, Oncology, Diabetology & Rheumatology, Marien-Hospital Wesel, Pastor-Janßen-Straße 8-38, Wesel 46483, Germany
| | - Amin T Turki
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, Essen 45122, Germany.,Department of Hematology & Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, Essen 45122, Germany
| | - Judith Atz
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | | | | | - Daniel C Christoph
- Department of Medical Oncology/Hematology, Evang, Kliniken Essen-Mitte, Essen, Germany
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