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Arva D, Cseh A, Mészáros Á, Major D, Jeney A, Dunai D, Zörgő S. A unified qualitative-quantitative method to evaluate the impact of being a near-peer health educator. Eur J Public Health 2022. [PMCID: PMC9594413 DOI: 10.1093/eurpub/ckac131.369] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Grasping the complexity of public health interventions is of increasing interest. Program evaluation may involve previously known and unknown variables; the former are best explored with quantitative, the latter with qualitative methods. As part of the impact evaluation of the Balassagyarmat Health Education Program (BEP), a near-peer education intervention targeting adolescents from a disadvantaged region of Hungary, we aimed to understand the complex effects of being an educator on medical students’ knowledge about the biopsychosocial model of health. Thus, we developed a unified method that enables us to conduct an exploratory study on the effects of our intervention, then quantify and model that qualitative data. We started the method design with literature review and consultations with methodological and public health experts. We then refined the research questions based on a focus-group discussion held with 6 peer educators. After a set of pilot-interviews, we chose simulation interviewing as our knowledge elicitation procedure, then finalized the protocol with the help of additional piloting. In this unified method, simulation interviews are administered to peer educators and aligned controls, and cognitive task analysis is performed with the help of visual stimuli. Codes are developed inductively and, along with segmentation procedures, applied deductively to the entire dataset via the Reproducible Open Coding Kit. Resulting quantified narratives are further processed with Epistemic Network Analysis. The relative frequency of code co-occurrence in each segment is modelled with networks enabling the qualitative and statistical comparison of data between subsamples. Building on the benefits of qualitative and quantitative approaches, this method offers a complex evaluation of the impact of health education interventions. By strengthening the methods of program evaluation we aim to facilitate the development of more effective interventions. Key messages • Qualitative and quantitative methods can be unified in program evaluation to promote a deeper understanding of the complexity in public health interventions. • Cognitive task analysis as a knowledge elicitation procedure can be used for the impact evaluation of health education programs.
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Affiliation(s)
- D Arva
- Department of Public Health, Semmelweis University, Faculty of Medicine , Budapest, Hungary
| | - A Cseh
- Department of Public Health, Semmelweis University, Faculty of Medicine , Budapest, Hungary
| | - Á Mészáros
- Department of Public Health, Semmelweis University, Faculty of Medicine , Budapest, Hungary
| | - D Major
- Department of Public Health, Semmelweis University, Faculty of Medicine , Budapest, Hungary
| | - A Jeney
- Baltic-Black Sea Regional Studies Programme, Ivan Franko National University of Lviv, Faculty of International Relations , Lviv, Ukraine
| | - D Dunai
- Interdisciplinary Social Research PhD Program, Eötvös Loránd University, Faculty of Social Sciences , Budapest, Hungary
| | - S Zörgő
- Care and Public Health Research Institute, Maastricht University, Faculty of Health, Medicine and Life Sciences , Maastricht, Netherlands
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Owen S, Alken S, Alshami J, Guiot MC, Kavan P, Reardon DA, Muanza T, Gibson N, Pemberton K, Solca F, Cseh A, Saran F. Genomic Analysis of Tumors from Patients with Glioblastoma with Long-Term Response to Afatinib. Onco Targets Ther 2022; 15:367-380. [PMID: 35422631 PMCID: PMC9005142 DOI: 10.2147/ott.s346725] [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: 11/02/2021] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Glioblastoma is an aggressive form of central nervous system tumor. Recurrence rates following primary therapy are high, and few second-line treatment options provide durable clinical benefit. Aberrations of the epidermal growth factor receptor (EGFR) gene are observed in up to 57% of glioblastoma cases and EGFR overexpression has been identified in approximately 60% of primary glioblastomas. In preclinical studies, afatinib, a second-generation ErbB blocker, inhibited cell proliferation in cells harboring mutations commonly found in glioblastoma. In two previous Phase I/II studies of afatinib plus temozolomide in patients with glioblastoma, limited efficacy was observed; however, there was notable benefit in patients with the EGFR variant III (EGFRvIII) mutation, EGFR amplification, and those with loss of phosphatase and tensin homolog (PTEN). This case series report details treatment histories of three long-term responders from these trials. Next-generation sequencing of tumor samples identified alterations in a number of cancer-related genes, including mutations in, and amplification of, EGFR. Tumor samples from all three patients shared favorable prognostic factors, eg O6-methylguanine-DNA methyl-transferase (MGMT) gene promoter methylation; however, negative prognostic factors were also observed, suggesting that these shared genetic features did not completely account for the favorable responses. The genetic profile of the tumor from Patient 1 showed clear differences from the other two tumors: lack of involvement of EGFR aberrations but with a mutation occurring in PTPN11. Preclinical studies showed that single-agent afatinib and temozolomide both separately inhibit the growth of tumors with a C-terminal EGFR truncation, thus providing further rationale for combining these two agents in the treatment of glioblastomas harboring EGFR aberrations. These findings suggest that afatinib may provide treatment benefit in patients with glioblastomas that harbor ErbB family aberrations and, potentially, other genetic aberrations. Further studies are needed to establish which patients with newly diagnosed/recurrent glioblastomas may potentially benefit from treatment with afatinib.
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Affiliation(s)
- Scott Owen
- Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
| | - Scheryll Alken
- Radiation Oncology Unit, Royal Marsden Hospital, London, UK
- St James’s Hospital, Dublin, Ireland
| | - Jad Alshami
- Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
| | - Marie-Christine Guiot
- Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
- Neuropathology Division, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
| | - Petr Kavan
- Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Thierry Muanza
- Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
- Neuropathology Division, Montreal Neurological Institute and Hospital, McGill University Health Center, Montreal, Canada
- Radiation Oncology, Jewish General Hospital, Montreal, Canada
| | - Neil Gibson
- Drug Metabolism & Pharmacokinetics, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Flavio Solca
- Department of Pharmacology, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | - Agnieszka Cseh
- Department of Medical Affairs, Boehringer Ingelheim International, Ingelheim am Rhein, Germany
| | - Frank Saran
- Radiation Oncology Unit, Royal Marsden Hospital, London, UK
- Department of Blood and Cancer, Auckland City Hospital, Auckland, New Zealand
- Correspondence: Frank Saran, Auckland City Hospital, Cancer and Blood Service, Building 8, 99 Park Road, Grafton, Private Bag 92024, Auckland, 1142, New Zealand, Tel +64 09 623 6046, Email
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Zhao J, Bai H, Wang X, Wang Y, Duan J, Chen H, Xue Z, Tian Y, Cseh A, Huang DCL, Wu YL, Wang J. Biomarker subset analysis of a phase IIIb, open-label study of afatinib in EGFR tyrosine kinase inhibitor-naive patients with EGFRm+ non-small-cell lung cancer. Future Oncol 2022; 18:1485-1497. [PMID: 35114807 DOI: 10.2217/fon-2021-0394] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: To explore the relationship between mutations in cfDNA and response to afatinib. Patients & methods: In total, 64 patients from one Chinese site with locally advanced/metastatic EGFRm+ non-small-cell lung cancer, who received afatinib 40 mg once daily, were included. Results: Overall, 33 (82.5%) patients became EGFRm- by visit 3; median progression-free survival was longer in these patients vs those who did not (11.0 vs 5.5 months). Progression-free survival was shorter in 42 (45.2%) patients with non-EGFR co-mutations at baseline vs those without (8.1 vs 12.5 months). Neither difference was significant. Conclusion: Afatinib provided clinical benefit for patients with EGFRm+ non-small-cell lung cancer across all subgroups. EGFRm status assessment in plasma cfDNA is a useful method of monitoring treatment.
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Affiliation(s)
- Jun Zhao
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Thoracic Medical Oncology-I, Peking University Cancer Hospital & Institute, 52 Fucheng Rd., Haidian District, Beijing, 100142, China
| | - Hua Bai
- Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuannanli Number 17, Chaoyang District, Beijing, 100121, China
| | - Xin Wang
- Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuannanli Number 17, Chaoyang District, Beijing, 100121, China
| | - Yuyan Wang
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Thoracic Medical Oncology-I, Peking University Cancer Hospital & Institute, 52 Fucheng Rd., Haidian District, Beijing, 100142, China
| | - Jianchun Duan
- Molecular Oncology, Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuannanli Number 17, Chaoyang District, Beijing, 100121, China
| | - Hanxiao Chen
- Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Department of Thoracic Medical Oncology-I, Peking University Cancer Hospital & Institute, 52 Fucheng Rd., Haidian District, Beijing, 100142, China
| | - Zhiyi Xue
- Boehringer Ingelheim (China) Investment Co., Ltd, 29/F Park Place, 1601 Nanjing Road (West), Jingan District, Shanghai, 200040, China
| | - Yahui Tian
- Boehringer Ingelheim (China) Investment Co., Ltd, 29/F Park Place, 1601 Nanjing Road (West), Jingan District, Shanghai, 200040, China
| | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, Binger Strasse 173, Ingelheim, 55216, Germany
| | - Dennis Chin-Lun Huang
- Boehringer Ingelheim Taiwan Limited, 12F, No. 2, Sec 3, Minsheng E Road, Taipei, 104, Taiwan
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, 106 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Jie Wang
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuannanli Number 17, Chaoyang District, Beijing, 10021, China
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Tu HY, Feng J, Shi M, Zhao J, Wang Y, Chang J, Wang J, Cheng Y, Zhu J, Tan EH, Li K, Zhang Y, Lee V, Yang CT, Su WC, Lam DCL, Srinivasa BJ, Rajappa S, Ho CL, Lam KC, Hu Y, Bondarde SA, Liu X, Tian Y, Xue Z, Cseh A, Huang DCL, Zhou C, Wu YL. A Phase IIIb Open-Label, Single-Arm Study of Afatinib in EGFR TKI-Naïve Patients with EGFRm+ NSCLC: Final Analysis, with a Focus on Patients Enrolled at Sites in China. Target Oncol 2022; 17:1-13. [PMID: 35020119 PMCID: PMC8783858 DOI: 10.1007/s11523-021-00859-6] [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] [Accepted: 11/22/2021] [Indexed: 11/05/2022]
Abstract
Background Afatinib has been shown as a suitable option for the treatment of epidermal growth factor receptor mutation-positive (EGFRm+) non-small-cell lung cancer (NSCLC) in randomized controlled trials. However, patients treated in real-world clinical practice, including elderly patients, and those with brain metastases or poor Eastern Cooperative Oncology Group (ECOG) performance statuses, are often excluded from these studies. Objective To report the final results, with a particular focus on patients enrolled in China, from a prospective phase IIIb, “near real-world” study of afatinib in tyrosine kinase inhibitor (TKI)-naïve Asian patients with EGFRm+ NSCLC. Patients and Methods NCT01953913 was conducted at 34 centers across Asia. Entry criteria were broad to reflect real-world settings. Patients received afatinib 40 mg/day until tumor progression, lack of clinical benefit, or poor tolerability. Assessments included safety, time to symptomatic progression (TTSP), and progression-free survival (PFS). Results 541 patients were treated, of whom 412 were enrolled in China. Dose reductions were implemented in 28.7% of patients overall, and 17.7% of patients from China. Safety findings were consistent with phase III studies of afatinib. Median TTSP in all patients was 14.0 months (95% CI 12.9–15.9), and median PFS was 12.1 months (95% CI 11.0–13.6). Median TTSP (13.8 months, 95% CI 12.7–16.1) and PFS (11.4 months, 95% CI 10.9–13.7) were similar in patients from China to the overall population. Among patients from China who had dose reductions, TTSP was numerically longer than in those who did not (16.4 vs. 13.8 months; P = 0.0703), while PFS was significantly longer (13.9 vs. 11.1 months; P = 0.0275). Among patients from China with brain metastases, TTSP was numerically shorter than in those without (11.0 vs. 14.4 months; P = 0.0869), whereas PFS was significantly shorter (9.2 vs. 12.9 months; P = 0.0075). Conclusions Safety data for afatinib when used in a “near real-world” setting in patients with EGFRm+ NSCLC was consistent with the known safety profile of afatinib. Supporting efficacy data of afatinib were provided in all patients, and in those enrolled in China. Tolerability-guided afatinib dose reduction allowed patients to remain on treatment and continue to experience clinical benefit. Trial Registration Number and Date of Registration NCT01953913 (1 October 2013). Supplementary Information The online version contains supplementary material available at 10.1007/s11523-021-00859-6.
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Affiliation(s)
- Hai-Yan Tu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Jifeng Feng
- Department of Medical Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Meiqi Shi
- Department of Medical Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department 1 of Thoracic Oncology Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yuyan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department 1 of Thoracic Oncology Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Jianhua Chang
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Jialei Wang
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Ying Cheng
- Division of Thoracic Oncology, Jilin Province Cancer Hospital, Changchun, 130012, China
| | - Jing Zhu
- Division of Thoracic Oncology, Jilin Province Cancer Hospital, Changchun, 130012, China
| | - Eng-Huat Tan
- Department of Medical Oncology, National Cancer Centre, Singapore, 169610, Singapore
| | - Kai Li
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Yiping Zhang
- Zhejiang Cancer Hospital, Hangzhou, 310022, China
| | - Victor Lee
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053, China
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
| | - Wu-Chou Su
- National Cheng Kung University Hospital, Tainan, 704, Taiwan
| | - David Chi-Leung Lam
- Departments of Clinical Oncology, and Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | | | - Senthil Rajappa
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, 500034, India
| | - Ching-Liang Ho
- Division of Hematology/Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, 114, Taiwan
| | - Kwok Chi Lam
- Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Yi Hu
- Department of Oncology, Chinese PLA General Hospital, Beijing, 100853, China
| | | | | | - Yahui Tian
- Boehringer Ingelheim (China) Investment Co., Ltd, Shanghai, China
| | - Zhiyi Xue
- Boehringer Ingelheim (China) Investment Co., Ltd, Shanghai, China
| | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, 55216, Ingelheim, Germany
| | | | - Caicun Zhou
- Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Saran F, Welsh L, James A, McBain C, Gattamaneni R, Jefferies S, Harris F, Pemberton K, Schaible J, Bender S, Cseh A, Brada M. Afatinib and radiotherapy, with or without temozolomide, in patients with newly diagnosed glioblastoma: results of a phase I trial. J Neurooncol 2021; 155:307-317. [PMID: 34787778 PMCID: PMC8651574 DOI: 10.1007/s11060-021-03877-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/03/2021] [Accepted: 10/13/2021] [Indexed: 12/13/2022]
Abstract
Background Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults. Amplification or overexpression of the epidermal growth factor receptor gene, part of the ErbB family, occur in approximately 40% and 60% of patients with GBM, respectively. We present data from a dose-finding study of the ErbB inhibitor afatinib in combination with radiotherapy (RT), with or without temozolomide (TMZ), in patients with GBM. Methods This was a phase I, open-label, 3 + 3 dose-escalation trial in patients with newly-diagnosed, histologically-confirmed grade 4 malignant glioma and proven O6-methylguanine-DNA methyltransferase gene promoter methylation status. The primary endpoint was the maximum tolerated dose (MTD) of continuous daily afatinib when given in combination with RT, with (regimen M) or without (regimen U) concomitant TMZ treatment. Results Fifty-five patients were enrolled; 36 received ≥ 1 dose of trial medication (regimen M, n = 20, regimen U, n = 16). Afatinib was discontinued by all patients during the study. Reasons for afatinib discontinuation (regimen M/U) included disease progression (45%/50%), dose-limiting toxicity (10%/0%), and other adverse events (AEs; 35%/38%). The most frequently reported AEs with either regimen were diarrhea and rash, with no new safety signals identified. The MTD was determined as afatinib 30 mg in combination with daily TMZ and RT, and afatinib 40 mg in combination with RT alone. Conclusions This study identified the MTD for afatinib in combination with RT, with and without TMZ, in patients with GBM. Further studies of afatinib in patients with GBM are warranted and should be based on appropriate biomarker-based preselection. Trial registration NCT00977431 (first posted September 15, 2009). Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03877-6.
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Affiliation(s)
- Frank Saran
- The Royal Marsden NHS Foundation Trust, London, UK. .,Cancer and Blood Service, Auckland City Hospital, Building 8, 99 Park Road, Grafton, Private Bag 92024, Auckland, 1142, New Zealand.
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Allan James
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fiona Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Michael Brada
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
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Passaro A, de Marinis F, Tu HY, Laktionov KK, Feng J, Poltoratskiy A, Zhao J, Tan EH, Gottfried M, Lee V, Kowalski D, Yang CT, Srinivasa BJ, Clementi L, Jalikop T, Huang DCL, Cseh A, Park K, Wu YL. Afatinib in EGFR TKI-Naïve Patients with Locally Advanced or Metastatic EGFR Mutation-Positive Non-Small Cell Lung Cancer: A Pooled Analysis of Three Phase IIIb Studies. Front Oncol 2021; 11:709877. [PMID: 34307179 PMCID: PMC8298067 DOI: 10.3389/fonc.2021.709877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 01/26/2023] Open
Abstract
Background Afatinib is approved for first-line treatment of patients with epidermal growth factor receptor mutation-positive (EGFRm+) non-small-cell lung cancer (NSCLC). Here, we report findings from a combined analysis of three phase IIIb studies of afatinib in EGFR tyrosine kinase inhibitor (TKI)-naïve patients. Methods EGFR-TKI-naïve patients with EGFRm+ NSCLC received afatinib 40 mg/day. Dose reductions were permitted for adverse events (AEs). Efficacy endpoints included progression-free survival (PFS), time to symptomatic progression (TTSP), and tumor response. Subgroup analyses were performed by Eastern Cooperative Oncology Group performance status (ECOG PS), presence of brain metastasis, age and common/uncommon EGFR mutations (plus other factors). Results 1108 patients were treated. Median age was 61 years (range, 25-89); 19.2% had baseline brain metastases, 4.4% had ECOG PS ≥2, and 17.9% had tumors harboring uncommon mutations. Treatment-related AEs (TRAEs) were reported in 97.2%, most commonly diarrhea and rash. 41.6% had AEs leading to dose reduction. Median PFS was 13.0 months [95% confidence interval (CI): 12.0-13.8]; median TTSP was 14.8 months (95% CI: 13.9-16.1). Objective response rate (ORR) was 55.0%. Age, presence of baseline brain metastases, major (G719X, L861Q, S768I) or compound uncommon mutations had little/no effect on PFS, TTSP, or ORR, while outcomes were poorer in patients with ECOG PS 2 or exon 20 insertion/T790M mutations. Conclusions Afatinib was tolerable with no new safety signals. Afatinib demonstrated encouraging efficacy in a broad patient population, including those with brain metastases or uncommon EGFR mutations.
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Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Hai-Yan Tu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Jifeng Feng
- Jiangsu Provincial Tumor Hospital, Nanjing, China
| | | | - Jun Zhao
- Peking University Cancer Hospital & Institute, Beijing, China
| | | | | | - Victor Lee
- Department of Clinical Oncology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Dariusz Kowalski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Cheng Ta Yang
- Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | | | | | | | | | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Keunchil Park
- Division of Hematology Oncology, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
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Goss GD, Cobo M, Lu S, Syrigos K, Lee KH, Göker E, Georgoulias V, Isla D, Morabito A, Min YJ, Ardizzoni A, Bender S, Cseh A, Felip E. Afatinib versus erlotinib as second-line treatment of patients with advanced squamous cell carcinoma of the lung: Final analysis of the randomised phase 3 LUX-Lung 8 trial. EClinicalMedicine 2021; 37:100940. [PMID: 34195574 PMCID: PMC8225678 DOI: 10.1016/j.eclinm.2021.100940] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND LUX-Lung 8 was a randomised, controlled, phase 3 study comparing afatinib and erlotinib as second-line treatment of patients with advanced squamous cell carcinoma (SCC) of the lung. We report the final overall survival (OS) and safety analyses of LUX-Lung 8 and investigate the characteristics of patients who achieved long-term benefit (≥12 months' treatment). METHODS LUX-Lung 8 (NCT01523587) enroled patients between March 2012 and January 2014 in 183 cancer centres located in 23 countries worldwide and this final analysis had a data cut-off of March 2018. Eligible patients had stage IIIB or IV lung SCC and had progressed after at least four cycles of platinum-based chemotherapy. Patients were randomly assigned (1:1) to receive afatinib (40 mg per day) or erlotinib (150 mg per day) until disease progression. Endpoints included OS and safety; a post-hoc analysis of patients with long-term benefit (≥12 months on treatment) was also conducted. FINDINGS 795 eligible patients were randomly assigned (398 to afatinib, 397 to erlotinib). OS was significantly prolonged with afatinib compared with erlotinib (median 7·8 months vs 6·8 months; hazard ratio 0·84; 95% CI 0·73-0·97; p = 0·0193). These findings were consistent with those of the primary analysis and were consistent across subgroups. Adverse events (AEs) were manageable with dose interruption and reduction, with similar AEs being experienced between both groups. Twenty-one (5·3%) patients receiving afatinib and 13 (3·3%) patients receiving erlotinib achieved long-term benefit; median OS was 34·6 months and 20·1 months, respectively. Amongst 132 afatinib-treated patients who underwent tumour genetic analysis, ERBB family mutations were more common in patients with long-term benefit than in the overall population (50% vs 21%). INTERPRETATION Afatinib is a treatment option for patients with SCC of the lung progressing on chemotherapy who are ineligible for immunotherapy, particularly those with ERBB family genetic aberrations. Afatinib has a predictable and manageable tolerability profile, and long-term treatment may be well tolerated.
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Affiliation(s)
- Glenwood D Goss
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Corresponding author.
| | - Manuel Cobo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Shun Lu
- Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Ki Hyeong Lee
- Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Erdem Göker
- Ege University Faculty of Medicine, Izmir, Turkey
| | - Vassilis Georgoulias
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | - Young J Min
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | | | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, Ingelheim 55216, Germany
| | - Enriqueta Felip
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic-UCC, IOB-Quiron, Barcelona, Spain
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8
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Chang GC, Lam DCL, Tsai CM, Chen YM, Shih JY, Aggarwal S, Wang S, Kim SW, Kim YC, Wahid I, Li R, Lim DWT, Sriuranpong V, Chan RTT, Lorence RM, Carriere P, Raabe C, Cseh A, Park K. Experience from Asian centers in a named-patient-use program for afatinib in patients with advanced non-small-cell lung cancer who had progressed following prior therapies, including patients with uncommon EGFR mutations. Int J Clin Oncol 2021; 26:841-850. [PMID: 33783657 PMCID: PMC8055616 DOI: 10.1007/s10147-021-01869-0] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study evaluated outcomes among patients with advanced/metastatic non-small-cell lung cancer (NSCLC) treated at Asian centers participating in the global named-patient-use (NPU) program for afatinib. METHODS Patients had progressed after initial benefit with erlotinib or gefitinib, and/or had an EGFR or HER2 mutation, had no other treatment options, and were ineligible for afatinib trials. The recommended starting dose of afatinib was 50 mg/day. Dose modifications were allowed, and afatinib was continued as long as deemed beneficial. Response and survival information was provided voluntarily. Safety reporting was mandatory. RESULTS 2242 patients (26% aged ≥ 70 years, 96% with adenocarcinoma) received afatinib at centers in 10 Asian countries. Most were heavily pre-treated, including prior treatment with erlotinib or gefitinib. Of 1281 patients tested, 1240 had EGFR mutations (common: 1034/1101; uncommon: 117/1101). There were no new safety signals, the most common adverse events being rash and diarrhea. Objective response rate (ORR) was 24% overall (n = 431 with data available), 27% for patients with common EGFR mutations (n = 230) and 28% for those with uncommon mutations (n = 32); median time to treatment failure (TTF) in these groups was 7.6 months (n = 1550), 6.4 months (n = 692) and 8.4 months (n = 83), respectively. In patients with EGFR exon 20 insertions (n = 23) and HER2 mutations (n = 12), median TTF exceeded 12 months. CONCLUSIONS Patient outcomes in this study were similar to those reported in the analysis of the global NPU. Afatinib achieved clinical benefits in patients with refractory NSCLC. ORR and TTF were similar between patients with tumors harboring uncommon and common EGFR mutations.
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Affiliation(s)
- Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Boulevard, Xitun District, Taichung, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
- Institute of Medicine and School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | | | | | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming Medical University, Taipei, Taiwan
| | | | | | | | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Chul Kim
- Chonnam National University, Hwasun Hospital, Jeonnam, Republic of Korea
| | - Ibrahim Wahid
- Beacon International Specialist Centre, Selangor, Malaysia
| | - Rubi Li
- St Luke's Medical Center, Quezon City, Philippines
| | | | - Virote Sriuranpong
- Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Pathumwan, Bangkok, Thailand
| | | | | | | | - Christina Raabe
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | | | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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9
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Gajra A, Klink A, Kaufman J, Laney J, Cseh A, Fernamberg K, Moehring B, Jonna S. P86.11 A Real-World Feasibility Study of Patients with Solid Tumors Harboring NRG1 Gene Fusions: NSCLC Subset Analysis. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1240] [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] [Indexed: 10/21/2022]
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10
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Kim ES, Kish JK, Cseh A, Moehring B, Tang W, Terlizzi E, Subramanian J. Second-line Afatinib or Chemotherapy Following Immunochemotherapy for the Treatment of Metastatic, Squamous Cell Carcinoma of the Lung: Real-world Effectiveness and Safety From a Multisite Retrospective Chart Review in the USA. Clin Lung Cancer 2021; 22:292-300.e1. [PMID: 33745863 DOI: 10.1016/j.cllc.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/02/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The ErbB family blocker, afatinib, is approved for patients with squamous cell carcinoma (SqCC) of the lung following platinum-doublet chemotherapy but has not been explored following immunochemotherapy. Here, we assessed the characteristics and outcomes of patients with SqCC of the lung who received second-line afatinib or chemotherapy after first-line pembrolizumab plus chemotherapy in a "real-world" setting. METHODS In this retrospective, multisite cohort study, community oncologists identified eligible patients and extracted data from electronic health records. Primary outcome measures were patient demographics and clinical characteristics, time on treatment, and incidence of severe immune-related adverse events (irAEs). RESULTS Two hundred patients were included: 99 received second-line afatinib and 101 received second-line chemotherapy. Median age was 68 and 66 years, respectively; 35% and 3% of patients had mixed histology tumors, and 39% and 5% of tumors were epidermal growth factor receptor (EGFR) mutation-positive (EGFRm+). Median time on treatment was 7.3 months with afatinib (mixed histology/SqCC tumors: 8.1/5.8 months; EGFRm+/EGFRm- tumors: 7.4/5.9 months) and 4.2 months with chemotherapy. Grade 3/4 irAEs were observed in 6 patients in the afatinib cohort (all had a prior grade 3/4 irAE during first-line therapy) and no patients in the chemotherapy cohort. The most common adverse drug reactions with afatinib were diarrhea (26%), rash (6%), stomatitis, fatigue, and nausea (5% each). CONCLUSION Encouraging time on treatment, and absence of newly diagnosed irAEs, indicate that afatinib is a treatment option following immunochemotherapy in patients with SqCC of the lung, and is currently the only approved oral agent in this setting.
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Affiliation(s)
- Edward S Kim
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
| | | | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | | | - Wenbo Tang
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | | | - Janakiraman Subramanian
- Division of Oncology, Saint Luke's Cancer Institute, Kansas City, MO, USA; Center for Precision Oncology, Saint Luke's Cancer Institute, Kansas City, MO, USA
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11
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Zöchbauer-Müller S, Kaserer B, Prosch H, Cseh A, Solca F, Bauer MJ, Müllauer L. Case Report: Afatinib Treatment in a Patient With NSCLC Harboring a Rare EGFR Exon 20 Mutation. Front Oncol 2021; 10:593852. [PMID: 33575211 PMCID: PMC7871906 DOI: 10.3389/fonc.2020.593852] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 08/11/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
Unlike most other primary epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC), exon 20 insertions, comprising approximately 4% to 10% of all EGFR mutations, are generally considered to be resistant to EGFR tyrosine kinase inhibitors (TKIs). However, EGFR exon 20 insertions are structurally and pharmacologically heterogeneous, with variability in their position and size having implications for response to different EGFR TKIs. The second-generation ErbB family blocker, afatinib, is approved for the first-line treatment of EGFR mutation-positive NSCLC and has been shown to have a broad inhibitory profile against common and uncommon EGFR mutations. Here, we describe a patient with bilateral multifocal lung adenocarcinoma harboring a very rare EGFR exon 20 insertion (c.2317_2319dup3; p.H773dup), who has been receiving treatment with afatinib for 4.5 years. To our knowledge, this is the first report describing long-term benefit for a patient treated with afatinib with this rare exon 20 insertion. We are aware of two further cases with this rare EGFR mutation. One patient, also reported here, has early-stage lung adenocarcinoma and has not yet received systemic therapy for NSCLC. The other patient received afatinib in the context of a global compassionate use program and had progressive disease. Our findings may be of clinical relevance for patients carrying tumors with this rare mutation as epidemiological evidence suggests that p.H773dup may function as a driver mutation in NSCLC. Together with previous preclinical and clinical evidence for the activity of afatinib against certain EGFR exon 20 insertions, these findings warrant further investigation.
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Affiliation(s)
- Sabine Zöchbauer-Müller
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,Comprehensive Cancer Center, Vienna, Austria
| | - Bettina Kaserer
- Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Agnieszka Cseh
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Flavio Solca
- Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | | | - Leonhard Müllauer
- Comprehensive Cancer Center, Vienna, Austria.,Institute of Pathology, Medical University of Vienna, Vienna, Austria
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12
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Kim E, Subramanian J, Kish J, Cseh A, Tang W, Terlizzi E. MO01.14 Real-World Effectiveness and Safety of Afatinib Following Immunotherapy (IO) in the Treatment of Metastatic, Squamous Cell/Mixed Histology Carcinoma of the Lung: A Multi-Site Retrospective Chart Review Trial in the US. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Cadranel J, Liu SV, Duruisseaux M, Branden E, Goto Y, Weinberg BA, Heining C, Schlenk RF, Cheema P, Jones MR, Drilon A, Trombetta D, Muscarella LA, Tolba K, Gounant V, Cseh A, Solca F, Laskin JJ, Renouf DJ. Therapeutic Potential of Afatinib in NRG1 Fusion-Driven Solid Tumors: A Case Series. Oncologist 2021; 26:7-16. [PMID: 32852072 PMCID: PMC7794194 DOI: 10.1634/theoncologist.2020-0379] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Neuregulin 1 (NRG1) fusions, which activate ErbB signaling, are rare oncogenic drivers in multiple tumor types. Afatinib is a pan-ErbB family inhibitor that may be an effective treatment for NRG1 fusion-driven tumors. PATIENTS AND METHODS This report summarizes pertinent details, including best tumor response to treatment, for six patients with metastatic NRG1 fusion-positive tumors treated with afatinib. RESULTS The six cases include four female and two male patients who ranged in age from 34 to 69 years. Five of the cases are patients with lung cancer, including two patients with invasive mucinous adenocarcinoma and three patients with nonmucinous adenocarcinoma. The sixth case is a patient with colorectal cancer. NRG1 fusion partners for the patients with lung cancer were either CD74 or SDC4. The patient with colorectal cancer harbored a novel POMK-NRG1 fusion and a KRAS mutation. Two patients received afatinib as first- or second-line therapy, three patients received the drug as third- to fifth-line therapy, and one patient received afatinib as fifteenth-line therapy. Best response with afatinib was stable disease in two patients (duration up to 16 months when combined with local therapies) and partial response (PR) of >18 months in three patients, including one with ongoing PR after 27 months. The remaining patient had a PR of 5 months with afatinib 40 mg/day, then another 6 months after an increase to 50 mg/day. CONCLUSION This report reviews previously published metastatic NRG1 fusion-positive tumors treated with afatinib and summarizes six previously unpublished cases. The latter include several with a prolonged response to treatment (>18 months), as well as the first report of efficacy in NRG1 fusion-positive colorectal cancer. This adds to the growing body of evidence suggesting that afatinib can be effective in patients with NRG1 fusion-positive tumors. KEY POINTS NRG1 fusions activate ErbB signaling and have been identified as oncogenic drivers in multiple solid tumor types. Afatinib is a pan-ErbB family inhibitor authorized for the treatment of advanced non-small cell lung cancer that may be effective in NRG1 fusion-driven tumors. This report summarizes six previously unpublished cases of NRG1 fusion-driven cancers treated with afatinib, including five with metastatic lung cancer and one with metastatic colorectal cancer. Several patients showed a prolonged response of >18 months with afatinib treatment. This case series adds to the evidence suggesting a potential role for afatinib in this area of unmet medical need.
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Affiliation(s)
- Jacques Cadranel
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon and Groupes de recherche clinique Theranoscan and Curamus Sorbonne UniversitéParisFrance
| | - Stephen V. Liu
- Georgetown University Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Michaël Duruisseaux
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer InstituteLyonFrance
- Anticancer Antibodies Laboratory, Cancer Research Center of LyonLyonFrance
- Université Claude Bernard Lyon 1, Université de LyonLyonFrance
| | | | | | | | - Christoph Heining
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden and German Cancer Research Center (DKFZ)DresdenGermany
- Center for Personalized Oncology, NCT Dresden and University Hospital Carl Gustav Carus Dresden at Technical University DresdenDresdenGermany
- German Cancer Consortium (DKTK)DresdenGermany
| | - Richard F. Schlenk
- National Center of Tumor Diseases Heidelberg, Heidelberg University Hospital and German Cancer Research CenterHeidelbergGermany
| | - Parneet Cheema
- William Osler Health System, University of TorontoTorontoOntarioCanada
| | - Martin R. Jones
- QIAGEN Digital Insights, QIAGEN Inc.Redwood CityCaliforniaUSA
| | | | - Domenico Trombetta
- Fondazione IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni RotondoFoggiaItaly
| | - Lucia Anna Muscarella
- Fondazione IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni RotondoFoggiaItaly
| | - Khaled Tolba
- Oregon Health and Science UniversityPortlandOregonUSA
| | - Valerie Gounant
- Assistance Publique Hôpitaux de Paris, Hôpital Bichat – Claude‐Bernard and Université Paris DescartesParisFrance
| | | | - Flavio Solca
- Boehringer Ingelheim Regional Center Vienna GmbH & Co KGViennaAustria
| | - Janessa J. Laskin
- University of British Columbia, BC CancerVancouverBritish ColumbiaCanada
| | - Daniel J. Renouf
- University of British Columbia, BC CancerVancouverBritish ColumbiaCanada
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14
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Gajra A, Klink A, Kaufman J, Laney J, Cseh A, Fernamberg K, Moehring B, Jonna S. MO01.34 Patients with Solid Tumors Harboring NRG1 Gene Fusions: A Real-World Feasibility Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.139] [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] [Indexed: 11/25/2022]
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15
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de Marinis F, Laktionov KK, Poltoratskiy A, Egorova I, Hochmair M, Passaro A, Migliorino MR, Metro G, Gottfried M, Tsoi D, Ostoros G, Rizzato S, Mukhametshina GZ, Schumacher M, Novello S, Dziadziuszko R, Tang W, Clementi L, Cseh A, Kowalski D. Afatinib in EGFR TKI-naïve patients with locally advanced or metastatic EGFR mutation-positive non-small cell lung cancer: Interim analysis of a Phase 3b study. Lung Cancer 2020; 152:127-134. [PMID: 33387727 DOI: 10.1016/j.lungcan.2020.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Randomized controlled trials have demonstrated that afatinib is a suitable treatment option for patients with epidermal growth factor receptor mutation-positive (EGFRm +) non-small cell lung cancer (NSCLC). However, such studies often exclude patients treated in routine clinical practice. We report interim results from a Phase 3b, open-label, multicenter, single-arm, exploratory trial, in which afatinib was investigated in a real-world setting. MATERIALS AND METHODS Patients with EGFRm + tyrosine kinase inhibitor (TKI)-naïve NSCLC received afatinib 40 mg orally, once-daily, until disease progression, or voluntary withdrawal. Primary objective was safety. RESULTS Overall, 479 patients received afatinib: median age 65 years, 8 % of patients had an ECOG performance status ≥ 2, 17 % had brain metastases, and 13 % had tumors containing uncommon mutations only. All but one patient (99.8 %) had an adverse event (AE). Treatment-related AEs (TRAEs; any/grade ≥ 3) occurred in 97 %/44 % of patients; most common were diarrhea (87 %/16 %) and rash (51 %/11 %). AEs leading to afatinib dose-reduction were reported in 258 patients (54 %), and 37 patients (8 %) discontinued treatment due to a TRAE. Objective response rate was 45.5 %, median duration of response was 14.1 months (95 % CI: 12.2-16.4). Overall median time to symptomatic progression and progression-free survival were 14.9 months (95 % CI: 13.8-17.6) and 13.4 months (95 % CI: 11.8-14.5), respectively, in the overall population and 19.3 months (95 % CI: 15.6-21.8) and 15.9 months (95 % CI: 13.9-19.1) in patients with EGFR exon 19 deletions. CONCLUSIONS Afatinib administration in routine clinical practice was well tolerated with no new safety signals and demonstrated promising efficacy in patients with EGFRm + NSCLC. TRAEs were generally manageable with tolerability-guided dose reductions. Overall, these data independently support findings from randomized controlled trials of afatinib in EGFRm + NSCLC.
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Affiliation(s)
| | - Konstantin K Laktionov
- Federal State Budgetary Institution "N.N.Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation (N.N. Blokhin NMRCO), Moscow, Russia
| | | | - Inna Egorova
- Clinical Oncology Dispensary, St Petersburg, Russia
| | - Maximilian Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | | | | | - Giulio Metro
- Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Daphne Tsoi
- St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Gyula Ostoros
- National Korányi Institute for Pulmonology, Budapest, Hungary
| | - Simona Rizzato
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | | | | | | | | | - Wenbo Tang
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | | | | | - Dariusz Kowalski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
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16
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Laskin J, Liu SV, Tolba K, Heining C, Schlenk RF, Cheema P, Cadranel J, Jones MR, Drilon A, Cseh A, Gyorffy S, Solca F, Duruisseaux M. NRG1 fusion-driven tumors: biology, detection, and the therapeutic role of afatinib and other ErbB-targeting agents. Ann Oncol 2020; 31:1693-1703. [PMID: 32916265 DOI: 10.1016/j.annonc.2020.08.2335] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/03/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022] Open
Abstract
Oncogenic gene fusions are hybrid genes that result from structural DNA rearrangements, leading to deregulated activity. Fusions involving the neuregulin-1 gene (NRG1) result in ErbB-mediated pathway activation and therefore present a rational candidate for targeted treatment. The most frequently reported NRG1 fusion is CD74-NRG1, which most commonly occurs in patients with invasive mucinous adenocarcinomas (IMAs) of the lung, although several other NRG1 fusion partners have been identified in patients with lung cancer, including ATP1B1, SDC4, and RBPMS. NRG1 fusions are also present in patients with other solid tumors, such as pancreatic ductal adenocarcinoma. In general, NRG1 fusions are rare across different types of cancer, with a reported incidence of <1%, with the notable exception of IMA, which represents ≈2%-10% of lung adenocarcinomas and has a reported incidence of ≈10%-30% for NRG1 fusions. A substantial proportion (≈20%) of NRG1 fusion-positive non-small-cell lung cancer cases are nonmucinous adenocarcinomas. ErbB-targeted treatments, such as afatinib, a pan-ErbB tyrosine kinase inhibitor, are potential therapeutic strategies to address unmet treatment needs in patients harboring NRG1 fusions.
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Affiliation(s)
- J Laskin
- Division of Medical Oncology, Department of Medicine, University of British Columbia, BC Cancer, Vancouver, BC, Canada.
| | - S V Liu
- Georgetown University Medical Center, Washington, USA
| | - K Tolba
- Oregon Health and Science University, Portland, OR, USA
| | - C Heining
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden and German Cancer Research Center (DKFZ), Dresden, Germany; Center for Personalized Oncology, NCT Dresden and University Hospital Carl Gustav Carus Dresden at Technical University Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, Germany
| | - R F Schlenk
- National Center of Tumor Diseases Heidelberg, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - P Cheema
- William Osler Health System, University of Toronto, Toronto, ON, Canada
| | - J Cadranel
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon and Sorbonne Université, Paris, France
| | - M R Jones
- QIAGEN Digital Insights, QIAGEN Inc., Redwood City, CA, USA
| | - A Drilon
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Cseh
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - S Gyorffy
- AstraZeneca Canada Ltd, Mississauga, ON, Canada
| | - F Solca
- Boehringer Ingelheim RCV GmbH & Co KG, Vienna, Austria
| | - M Duruisseaux
- Hospices Civils de Lyon Cancer Institute, Anticancer Antibodies Lab Cancer Research Center of Lyon INSERM 1052 CNRS 528, Université Claude Bernard Lyon 1, Lyon, France
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Gajra A, Klink A, Kaufman J, Laney J, Cseh A, Fernamberg K, Moehring B, Jonna S. 1956P A real-world feasibility study of patients with solid tumours harbouring NRG1 gene fusions. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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18
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Gottfried M, de Marinis F, Tu H, Laktionov K, Feng J, Poltoratskiy A, Zhao J, Tan EH, Lee V, Kowalski D, Yang CT, Srinivasa B, Passaro A, Clementi L, Tang W, Huang DL, Cseh A, Park K, Zhou C, Wu YL. Activity of afatinib in patients (pts) with EGFR mutation-positive (EGFRm+) NSCLC and baseline brain metastases: Pooled analysis of three large phase IIIb trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.010] [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] [Indexed: 11/12/2022] Open
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19
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Goto Y, Cadranel J, Weinberg B, Duruisseaux M, Liu S, Tolba K, Branden E, Doebele R, Heining C, Schlenk R, Laskin J, Cheema P, Jones M, Trombetta D, Muscarella L, Cseh A, Solca F, Renouf D. NRG1-fusion-driven solid tumours: A case series indicating the therapeutic potential of afatinib. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz420.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Passaro A, De Marinis F, Tu H, Laktionov K, Feng J, Poltoratskiy A, Zhao J, Tan EH, Gottfried M, Lee V, Kowalski D, Yang CT, Srinivasa B, Clementi L, Tang W, Huang DL, Cseh A, Park K, Zhou C, Wu YL. Activity of afatinib in patients (pts) with NSCLC harboring uncommon EGFR mutations: Pooled analysis of three large phase IIIB trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.029] [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] [Indexed: 11/13/2022] Open
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21
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Rosell R, Poltoratskiy A, Hochmair M, Laktionov K, Ramlau R, Garcìa MA, Skrickova J, Piovano P, Rizzato S, Bidoli P, Kowalski D, Clementi L, Cseh A, De Marinis F. A phase IIIb, open-label study of afatinib in EGFR TKI-naïve patients with EGFR mutation-positive NSCLC: A biomarker analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz437.009] [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] [Indexed: 11/14/2022] Open
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22
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Goss GD, Felip E, Cobo M, Lu S, Syrigos K, Lee KH, Göker E, Georgoulias V, Li W, Guclu S, Isla D, Min YJ, Morabito A, Ardizzoni A, Gadgeel SM, Fülöp A, Bühnemann C, Gibson N, Krämer N, Solca F, Cseh A, Ehrnrooth E, Soria JC. Association of ERBB Mutations With Clinical Outcomes of Afatinib- or Erlotinib-Treated Patients With Lung Squamous Cell Carcinoma: Secondary Analysis of the LUX-Lung 8 Randomized Clinical Trial. JAMA Oncol 2019; 4:1189-1197. [PMID: 29902295 DOI: 10.1001/jamaoncol.2018.0775] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Treatment choice for lung squamous cell carcinoma could be aided by identifying predictive biomarkers. Objective To assess whether patient outcomes in the LUX-Lung 8 trial were associated with ERBB gene family member aberrations in tumor specimens. Design, Setting, and Participants Ad hoc secondary analysis of the LUX-Lung 8 trial conducted at 183 centers in 23 countries from March 30, 2012, to January 30, 2014. Eligible patients had stage IIIB or IV lung squamous cell carcinoma with progressive disease after 4 or more cycles of platinum-based chemotherapy. Tumor genetic analysis (TGA) was performed using next-generation sequencing in a cohort enriched for patients with progression-free survival (PFS) of more than 2 months. Epidermal growth factor receptor (EGFR) expression levels were assessed by immunohistochemistry in a separate cohort of patients from the LUX-Lung 8 population. Associations of PFS and overall survival (OS) with ERBB gene alterations and EGFR expression levels were assessed. This analysis was conducted from February 26, 2015, to June 12, 2017. Interventions Patients were randomized 1:1 to treatment with afatinib dimaleate (40 mg/d; n = 398) or erlotinib hydrochloride (150 mg/d; n = 397). Main Outcomes and Measures Overall survival, PFS, pooled and individual ERBB gene mutations, ERBB copy number alterations, and EGFR expression. Results Tumor specimens from 245 patients were eligible for next-generation sequencing (TGA subset: 132 patients treated with afatinib; 113 patients treated with erlotinib). In this population, outcomes were improved with afatinib vs erlotinib treatment (PFS: median, 3.5 vs 2.5 months; hazard ratio [HR], 0.69; 95% CI, 0.51-0.92; P = .01; OS: median, 8.4 vs 6.6 months; HR, 0.81; 95% CI, 0.62-1.05; P = .12). Of 245 patients in the TGA subset, 53 (21.6%) had tumors with 1 or more ERBB mutations. Among afatinib-treated patients, PFS (median, 4.9 vs 3.0 months; HR, 0.62; 95% CI, 0.37-1.02; P = .06) and OS (median, 10.6 vs 8.1 months; HR, 0.75; 95% CI, 0.47-1.17; P = .21) were longer among those with ERBB mutation-positive disease than among those without. The presence of HER2 mutations was associated with favorable PFS and OS following afatinib vs erlotinib treatment. There was no apparent association between copy number alteration or EGFR expression level and outcome. Conclusions and Relevance Next-generation sequencing may help identify patients with lung squamous cell carcinoma who would derive additional benefit from treatment with afatinib. The role of ERBB mutations, particularly HER2 mutations, as predictive biomarkers for afatinib treatment in this setting warrants further evaluation. Trial Registration ClinicalTrials.gov Identifier: NCT01523587.
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Affiliation(s)
- Glenwood D Goss
- Division of Medical Oncology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel Cobo
- Department of Medical Oncology, Hospital Universitario Málaga General, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - Shun Lu
- Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Erdem Göker
- Ege University Faculty of Medicine, Izmir, Turkey
| | - Vassilis Georgoulias
- Department of Medical Oncology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Wei Li
- Cancer Center, First Hospital Affiliated to Jilin University, Jilin, China
| | - Salih Guclu
- Chest Diseases Clinic, Izmir Chest Diseases Research Hospital, Izmir, Turkey
| | - Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Young Joo Min
- Department of Medicine, Ulsan University Hospital, Ulsan, South Korea
| | - Alessandro Morabito
- Medical Oncology Unit, Thoraco-Pulmonary Department, Istituto Nazionale Tumori-IRCCS-"Fondazione G. Pascale," Naples, Italy
| | - Andrea Ardizzoni
- Division of Medical Oncology, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Shirish M Gadgeel
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, Michigan
| | | | | | - Neil Gibson
- Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Nicole Krämer
- Staburo GmbH, Munich, Germany, on behalf of Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany
| | - Flavio Solca
- Boehringer Ingelheim RCV GmbH & Co KG, Vienna, Austria
| | | | | | - Jean-Charles Soria
- Department of Medical Oncology, Gustave Roussy Cancer Campus and University Paris-Sud, Paris, France
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Laskin JJ, Cadranel J, Renouf DJ, Weinberg BA, Goto Y, Duruisseaux M, Tolba K, Branden E, Doebele RC, Heining C, Schlenk RF, Cheema PK, Jones MR, Trombetta D, Muscarella LA, Cseh A, Solca F, Liu SV. Afatinib as a novel potential treatment option for NRG1 fusion-positive tumors. J Glob Oncol 2019. [DOI: 10.1200/jgo.2019.5.suppl.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
110 Background: Neuregulin 1 (NRG1) is a growth factor that binds HER3/4 and activates ErbB signalling pathways. NRG1 gene fusions function as oncogenic drivers and represent a potential therapeutic target across tumour types. Afatinib, an ErbB-family blocker, is a potential treatment option for some patients with NRG1 fusion-positive ( NRG1+) tumours, as supported by preclinical evidence and clinical case reports. Of 13 patients with NRG1+ lung adenocarcinoma (ADC; n = 9), pancreatic ADC (n = 2), cholangiocarcinoma (n = 1), and ovarian cancer (n = 1) treated with afatinib, eight patients achieved a best response of partial response (PR; median duration 7.3 months, range 3–12), three patients had stable disease (SD) and two patients had progressive disease. Methods: Here, we report the clinico-pathological and molecular characteristics and current status of four additional cases of afatinib-treated NRG1+ tumours. Results: Patient 1, 66 year-old female, never-smoker with metastatic non-mucinous lung ADC. CD74-NRG1 fusion was identified, and 5th-line afatinib initiated. PR is ongoing after 16 months. Patient 2, 43 year-old female, non-smoker with advanced invasive mucinous lung ADC. CD74-NRG1 fusion was identified and 3rd-line afatinib initiated (PR, 18 months); treatment is ongoing following local progression. Patient 3, 69 year-old male, with KRAS-mutated metastatic colorectal cancer. Following a right hemicolectomy and liver/lung metastasectomies, a novel POMK-NRG1 fusion was detected and afatinib initiated (SD, 4 months). Eight months after initiation, afatinib treatment is ongoing, in combination with radiotherapy, with SD. Patient 4, 54 year-old male, with KRAS-wild-type metastatic pancreatic cancer. Following progression on chemotherapy, APP-NRG1 fusion was detected as part of the Personalized Oncogenomics study (NCT02155621), and afatinib initiated; PR is ongoing after 7 months. Conclusions: These findings add to a growing body of evidence that afatinib is a potential treatment option for patients with NRG1+ tumours. Prospective study is ongoing/planned in the Drug Rediscovery Protocol trial (DRUP; NCT02925234) and Targeted Agent and Profiling Utilization Registry study (TAPUR; NCT02693535).
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Affiliation(s)
| | - Jacques Cadranel
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon and Sorbonne Université, Paris, France
| | | | | | | | | | - Khaled Tolba
- Oregon Health and Science University, Portland, OR
| | | | | | | | - Richard F. Schlenk
- National Center of Tumor Diseases Heidelberg, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | | | | | - Domenico Trombetta
- Fondazione IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Lucia A. Muscarella
- Fondazione IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | - Flavio Solca
- Boehringer Ingelheim RCV GmbH & Co KG, Vienna, Austria
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Liu S, Duruisseaux M, Tolba K, Branden E, Goto Y, Weinberg B, Renouf D, Doebele R, Heining C, Schlenk R, Cheema P, Cadranel J, Jones M, Drilon A, Trombetta D, Muscarella L, Cseh A, Solca F, Laskin J. Targeting NRG1-fusions in multiple tumour types: Afatinib as a novel potential treatment option. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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de Marinis F, Laktionov K, Poltoratskiy A, Egorova I, Hochmair M, Passaro A, Migliorino M, Metro G, Gottfried M, Tsoi D, Ostoros G, Rizzato S, Mukhametshina G, Schumacher M, Novello S, Tang W, Clementi L, Cseh A, Kowalski D. Afatinib in EGFR TKI-naïve patients with EGFR mutation-positive (EGFRm+) NSCLC: Interim analysis of a phase IIIb, multi-national, open-label study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259.015] [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] [Indexed: 11/13/2022] Open
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Duruisseaux M, Laskin J, Tolba K, Brandén E, Goto Y, Doebele R, Cheema P, Cadranel J, Jones M, Drilon A, Trombetta D, Muscarella L, Cseh A, Solca F, Liu S. P1.14-25 Targeting NRG1-Fusions in Lung Adenocarcinoma: Afatinib as a Novel Potential Treatment Strategy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Marinis F, Tu H, Laktionov K, Feng J, Poltoratskiy A, Zhao J, Egorova I, Tan EH, Gottfried M, Lee V, Kowalski D, Yang CT, Srinivasa B, Passaro A, Clementi L, Tang W, Huang DCL, Cseh A, Zhou C, Wu YL. A combined analysis of two phase IIIb studies of afatinib in EGFR TKI-naïve patients (pts) with EGFR mutation-positive (EGFRm+) NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz259.017] [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] [Indexed: 11/14/2022] Open
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28
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De Marinis F, Laktionov K, Poltoratskiy A, Egorova I, Hochmair M, Passaro A, Migliorino M, Metro G, Gottfried M, Tsoi D, Ostoros G, Rizzato S, Mukhametshina G, Schumacher M, Novello S, Dziadziuszko R, Tang W, Clementi L, Cseh A, Kowalski D. P2.14-58 A Phase IIIb, Open-Label Study of Afatinib in Caucasian EGFR TKI-Naïve Patients with EGFRm+ NSCLC: An Interim Analysis. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1843] [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] [Indexed: 10/25/2022]
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Wu Y, Tu H, Feng J, Shi M, Zhao J, Wang Y, Chang J, Wang J, Cheng Y, Zhu J, Tan E, Zhang Y, Lee V, Yang C, Su W, Lam D, Srinivasa B, Rajappa S, Ho C, Lam K, Hu Y, Bondarde S, Liu X, Pang K, Tian Y, Cseh A, Huang D, Zhou C. P2.01-99 A Phase IIIb Open-Label Study of Afatinib in EGFR TKI-Naïve Patients with EGFR Mutation-Positive NSCLC: Final Analysis. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Thongprasert S, Geater SL, Clement D, Abdelaziz A, Reyes-Igama J, Jovanovic D, Alexandru A, Schenker M, Sriuranpong V, Serwatowski P, Suresh S, Cseh A, Gaafar R. Afatinib in locally advanced/metastatic NSCLC harboring common EGFR mutations, after chemotherapy: a Phase IV study. Lung Cancer Manag 2019; 8:LMT15. [PMID: 31807143 PMCID: PMC6891940 DOI: 10.2217/lmt-2019-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 01/08/2023] Open
Abstract
Aim The current study evaluated the efficacy and tolerability of second-line afatinib in patients with EGFR mutation-positive (EGFRm+) non-small-cell lung cancer (NSCLC) following chemotherapy. Patients & methods In this open-label, single-arm Phase IV study, patients with EGFRm+ (Del19/L858R) NSCLC who had progressed following platinum-based chemotherapy received afatinib (starting dose 40 mg/day). The primary end point was confirmed objective response. Results 60 patients received afatinib for a median duration of 11.5 months. 50% of patients had a confirmed objective response, of median duration 13.8 months. Median progression-free survival was 10.9 months. The most common treatment-related adverse events were diarrhea (72%), rash (28%) and paronychia (23%). Conclusion Our data support the use of afatinib (40 mg/day) as an effective and well-tolerated second-line treatment in EGFRm+ NSCLC.
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Affiliation(s)
- Sumitra Thongprasert
- Medical Oncology Unit, Wattanosoth Hospital & Bangkok Hospital Chiang Mai (BDMS), Chiang Mai 50000, Thailand
| | - Sarayut L Geater
- Department of Internal Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla 90110, Thailand
| | - Dana Clement
- Medical Oncology Department, Regional Oncology Institute of Iasi, Iasi 700483, Romania
| | - Amr Abdelaziz
- Clinical Oncology Department, Alexandria Clinical Research Centre, Alexandria University, Alexandria 21131, Egypt
| | - Jasmin Reyes-Igama
- Department of Internal Medicine, Hematology & Oncology, Baguio General Hospital & Medical Center, Baguio City, 2600 Benguet, Philippines
| | - Dragana Jovanovic
- Clinic for Pulmonology, Clinical Center Serbia, Belgrade 11000, Serbia
| | - Aurelia Alexandru
- Medical Oncology II Department, Oncology Institute of Bucharest, Bucharest 022328, Romania
| | | | - Virote Sriuranpong
- Department of Medicine, Faculty of Medicine, Chulalongkorn University & The King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Piotr Serwatowski
- Department of Clinical Oncology & Chemotherapy, Specialist Hospital, Szczecin-Zdunowo 70-891, Poland
| | - Sheethal Suresh
- Oncology Department, Boehringer Ingelheim Pharmaceuticals, Inc., Singapore 199555, Republic of Singapore
| | - Agnieszka Cseh
- Medical Department, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna 1120, Austria
| | - Rabab Gaafar
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo 11796, Egypt
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Weinberg B, Renouf D, Lim H, Heining C, Schlenk R, Jones M, Liu S, Cseh A, Solca F, Laskin J. NRG1-fusion positive gastrointestinal tumours: afatinib as a novel potential treatment option. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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32
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Passaro A, Laktionov K, Poltoratskiy A, Egorova I, Hochmair M, Migliorino M, Metro G, Gottfried M, Tsoi D, Ostoros G, Rizzato S, Mukhametshina G, Schumacher M, Novello S, Dziadziuszko R, Tang W, Clementi L, Cseh A, Kowalski D, De Marinis F. Afatinib in EGFR TKI-naïve patients (pts) with locally advanced/metastatic NSCLC harbouring EGFR mutations: An interim analysis of a phase IIIB trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz063.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hochmair MJ, Buder A, Schwab S, Burghuber OC, Prosch H, Hilbe W, Cseh A, Fritz R, Filipits M. Liquid-Biopsy-Based Identification of EGFR T790M Mutation-Mediated Resistance to Afatinib Treatment in Patients with Advanced EGFR Mutation-Positive NSCLC, and Subsequent Response to Osimertinib. Target Oncol 2019; 14:75-83. [PMID: 30539501 PMCID: PMC6403194 DOI: 10.1007/s11523-018-0612-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Acquired epidermal growth factor receptor (EGFR) T790M mutation is the primary resistance mechanism to first-generation EGFR tyrosine kinase inhibitors (TKIs) used in advanced, EGFR mutation-positive non-small-cell lung cancer (NSCLC). Available data, predominantly in Asian patients, suggest that this mutation is also the major cause of resistance to the irreversible ErbB family blocker, afatinib. For EGFR T790M-positive patients who progress on EGFR TKI therapy, osimertinib is an effective treatment option. However, data on osimertinib use after afatinib are, to date, scarce. OBJECTIVE To identify the prevalence of EGFR T790M mutations in predominantly Caucasian patients with stage IV EGFR mutation-positive NSCLC who progressed on afatinib, and to investigate the subsequent response to osimertinib. PATIENTS AND METHODS In this single-center, retrospective analysis, EGFR T790M mutation status after afatinib failure was assessed using liquid biopsy and tissue rebiopsy. EGFR T790M-positive patients subsequently received osimertinib. RESULTS Sixty-seven patients received afatinib in the first-, second-, or third-line (80.6%, 14.9%, and 4.5%, respectively). After afatinib failure, the T790M mutation was identified in 49 patients (73.1%). Liquid biopsy and tissue rebiopsy were concordant in 79.4% of cases. All patients with T790M-positive tumors received osimertinib (73.5% after first-line afatinib); 37 (75.5%) of these had an objective response (complete response: 22.4%; partial response: 53.1%). Response rate was independent of T790M copy number. CONCLUSION EGFR T790M mutation is a major mechanism of acquired resistance to afatinib. Osimertinib confers high response rates after afatinib failure in EGFR T790M-positive patients and its use in sequence potentially allows extended chemotherapy-free treatment.
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Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria.
| | - Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Sophia Schwab
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, 1140, Vienna, Austria
- Cardiothoracic and Vascular Center, Sigmund Freud University, Kelsenstrasse 2, 1030, Vienna, Austria
| | - Helmut Prosch
- Department of Radiology, Comprehensive Cancer Center, Medical University of Vienna, Währingergürtel 18-22, 1090, Vienna, Austria
| | - Wolfgang Hilbe
- Department of Internal Medicine 1, Wilhelminen Hospital, Montleartstraße 37, 1160, Vienna, Austria
| | - Agnieszka Cseh
- Boehringer Ingelheim RCV GmbH & Co. KG, Doktor-Boehringer-Gasse 5-11, 1120, Vienna, Austria
| | - Richard Fritz
- Boehringer Ingelheim RCV GmbH & Co. KG, Doktor-Boehringer-Gasse 5-11, 1120, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
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Lu S, Li W, Zhou C, Hu CP, Qin S, Cheng G, Feng J, Wang J, Cseh A, Peil B, Gibson N, Ehrnrooth E, Zhang L. Afatinib vs erlotinib for second-line treatment of Chinese patients with advanced squamous cell carcinoma of the lung. Onco Targets Ther 2018; 11:8565-8573. [PMID: 30573970 PMCID: PMC6292388 DOI: 10.2147/ott.s161506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Indexed: 12/17/2022] Open
Abstract
Background The global Phase III LUX-Lung 8 trial (ClinicalTrials.gov: NCT01523587) identified significant improvements in progression-free survival (PFS), overall survival (OS), and patient-reported outcomes (PROs) with second-line afatinib vs erlotinib in patients with advanced squamous cell carcinoma (SCC) of the lung. Materials and methods We conducted a post hoc analysis of data for patients in LUX-Lung 8 from mainland China (n=67). Compared with erlotinib, afatinib reduced the risk of disease progression or death (PFS) in the Chinese subgroup by 30% (HR=0.70; 95% CI: 0.38–1.27). Results The risk of death was reduced by 31% (HR=0.69; 95% CI: 0.39–1.21). The proportion of Chinese patients with improvements in PROs also favored afatinib vs erlotinib (global health status/quality of life [QoL], 52.8% vs 29.6%, P=0.072; dyspnea, 47% vs 26%, P=0.091; “dyspnea walked”, 44% vs 15%, P=0.017; QoL rate, 53% vs 26%, P=0.037). Discussion While this analysis was not powered to demonstrate differences compared to the overall trial population (OTP), and there were some differences in baseline characteristics (eg, the proportion of patients aged ≥65 years old), the benefits of afatinib treatment in Chinese patients with SCC of the lung appeared to be at least comparable to that observed in LUX-Lung 8. As with the OTP, the most common adverse events (AEs) with afatinib in the Chinese subgroup were diarrhea and rash/acne, and the incidence and type of the most frequently occurring AEs were similar. Conclusion The results suggest that afatinib represents a feasible treatment option for Chinese patients with advanced SCC of the lung following progression on platinum-based chemotherapy.
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Affiliation(s)
- Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China,
| | - Wei Li
- Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Shanghai, China
| | - Cheng-Ping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shukui Qin
- People's Liberation Army Cancer Center, Nanjing Bayi Hospital, Nanjing, Jiangsu, China
| | - Gang Cheng
- Department of Medical Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jifeng Feng
- Department of Internal Medicine, Jiangsu Provincial Tumor Hospital, Nanjing, China
| | - Jie Wang
- Department of Internal Medicine, Capital Medical University, Beijing, China.,Peking University School of Oncology, Beijing Cancer Hospital, Beijing, China
| | - Agnieszka Cseh
- Department of Medical Affairs, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | - Barbara Peil
- Biostatistics, Boehringer Ingelheim Pharma GmbH & Co. KG. Ingelheim, Germany
| | - Neil Gibson
- Translational Medicine and Clinical Oncology, Boehringer Ingelheim Pharma GmbH & Co. KG. Biberach, Germany
| | - Eva Ehrnrooth
- Division of Oncology, Boehringer Ingelheim, Danmark A/S, Copenhagen, Denmark
| | - Li Zhang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Saran F, James A, McBain C, Jefferies S, Harris F, Cseh A, Pemberton K, Schaible J, Bender S, Brada M. ACTR-38. A PHASE I TRIAL OF AFATINIB AND RADIOTHERAPY (RT) WITH OR WITHOUT TEMOZOLOMIDE (TMZ) IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM). Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank Saran
- Royal Marsden NHS Foundation Trust, Sutton, England, United Kingdom
| | - Allan James
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, United Kingdom
| | - Catherine McBain
- The Christie NHS Foundation Trust, Manchester, England, United Kingdom
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Fiona Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Agnieszka Cseh
- Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Wien, Austria
| | | | - Jennifer Schaible
- Boehringer Ingelheim Pharma GmbH Co. KG, Biberach, Baden-Wurttemberg, Germany
| | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Michael Brada
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, England, United Kingdom
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Thongprasert S, Geater S, Clement D, Abdelaziz A, Reyes-Igama J, Jovanovic D, Alexandru A, Schenker M, Sriuranpong V, Serwatowski P, Suresh S, Cseh A, Gaafar R. Afatinib in chemotherapy pre-treated EGFR mutation-positive NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy446.008] [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] [Indexed: 11/14/2022] Open
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Goss G, Cobo M, Lu S, Syrigos K, Lee K, Göker E, Georgoulias V, Li W, Isla D, Morabito A, Min Y, Ardizzoni A, Cseh A, Bender S, Felip E. Afatinib versus erlotinib as second-line treatment of patients (pts) with advanced lung squamous cell carcinoma (SCC): Final analysis of the global phase III LUX-Lung 8 (LL8) trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.064] [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] [Indexed: 11/14/2022] Open
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Chang G, Lam C, Tsai C, Chen Y, Shih J, Aggarwal S, Wang S, Kim S, Kim Y, Wahid I, Li R, Lim W, Sriuranpong V, Chan T, Lorence R, Carriere P, Raabe C, Cseh A, Park K. P1.01-11 Named Patient Use Program for Afatinib in Advanced NSCLC with Progression on Prior Therapy: Experience from Asian Centers. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Peters S, Curioni-Fontecedro A, Nechushtan H, Shih JY, Liao WY, Gautschi O, Spataro V, Unk M, Yang JCH, Lorence RM, Carrière P, Cseh A, Chang GC. Activity of Afatinib in Heavily Pretreated Patients With ERBB2 Mutation-Positive Advanced NSCLC: Findings From a Global Named Patient Use Program. J Thorac Oncol 2018; 13:1897-1905. [PMID: 30096481 DOI: 10.1016/j.jtho.2018.07.093] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [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: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Approximately 1% to 4% of NSCLC tumors harbor erb-b2 receptor tyrosine kinase 2 (ERBB2) mutation; there is no approved targeted treatment for this subgroup. METHODS Patients with stage IV NSCLC that progressed after clinical benefit on erlotinib/gefitinib and/or had activating EGFR or ERBB2 mutations, had exhausted other treatments, and were ineligible for afatinib trials were enrolled in a named patient use program, receiving afatinib 30 to 50 mg/d on a compassionate basis within routine clinical practice. Efficacy and safety were retrospectively assessed in the subgroup with ERBB2 mutation-positive NSCLC. RESULTS Twenty-eight heavily pretreated patients in the named patient use program had a documented ERBB2 mutation by local testing. Median time-to-treatment failure (TTF; time from treatment initiation to discontinuation for any reason) was 2.9 months; eight patients (29%) had TTF greater than 1 year. Objective response rate was 19% (3 of 16 patients with response data achieved partial response) and disease control rate (DCR) was 69% (11 of 16). Among 12 patients for whom type of ERBB2 mutation was specified, 10 had a p.A775_G776insYVMA insertion in exon 20, four of whom (40%) remained on afatinib for more than 1 year. This subgroup had median TTF of 9.6 months, objective response rate of 33% (two of six), and disease control rate of 100% (six of six). CONCLUSIONS This analysis of patients treated in clinical practice provides further evidence of the activity of afatinib in ERBB2 mutation-positive NSCLC, and suggests that identification of specific subgroups with certain mutations, such as p.A775_G776ins/YVMA insertion in exon 20, could help optimize outcomes with ErbB2-targeted treatment.
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Affiliation(s)
- Solange Peters
- Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | | | - Hovav Nechushtan
- Sharett Institute of Oncology, Hadassah Hebrew University Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Yu Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Oliver Gautschi
- Medical Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Vito Spataro
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Mojca Unk
- Department for Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Robert M Lorence
- Oncology Research, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Philippe Carrière
- Risk Management Oncology, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut
| | - Agnieszka Cseh
- Medical Department, Boehringer Ingelheim RCV GmbH & Co. KG, Vienna, Austria
| | - Gee-Chen Chang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; and the Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
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Saran F, Welsh L, James A, McBain C, Gattamaneni R, Jefferies S, Harris F, Cseh A, Pemberton K, Schaible J, Bender S, Brada M. Phase I study of afatinib and radiotherapy (RT) with or without temozolomide (TMZ) in newly diagnosed glioblastoma (GB). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2036] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frank Saran
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Allan James
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Rao Gattamaneni
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Fiona Harris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | | | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | - Michael Brada
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
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Thongprasert S, Geater S, Clement D, Abdelaziz A, Reyer-Igama J, Jovanovic D, Suresh S, Cseh A, Gaafar R. 157P Second-line afatinib for patients with locally advanced or metastatic NSCLC harbouring common EGFR mutations: A phase IV study. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30431-3] [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] [Indexed: 10/17/2022]
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Cappuzzo F, Soo R, Hochmair M, Schuler M, Lam KC, Stehle G, Cseh A, Lorence RM, Linden S, Forman ND, Hilbe W, Jazieh AR, Tsai CM. Global named patient use program of afatinib in advanced non-small-cell lung carcinoma patients who progressed following prior therapies. Future Oncol 2018; 14:1477-1486. [PMID: 29376400 DOI: 10.2217/fon-2017-0666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/26/2023] Open
Abstract
AIM A global afatinib named patient use program in non-small-cell lung carcinoma (NSCLC) commenced in 2010. MATERIALS & METHODS Eligible NSCLC patients had progressed after clinical benefit on prior erlotinib/gefitinib and/or had activating EGFR/HER2 mutations, exhausted all other treatments, and were ineligible for afatinib trials. RESULTS Data, as of January 2016, were reported on 3966 heavily pretreated NSCLC patients (41 countries; six continents). Among 2595/3966 (65.4%) patients with tumor EGFR status, 2407 (92.8%) were EGFR mutation positive. Median time to treatment failure (2862/3966 [72.2%] patients with available data) was 4.4 months. Among 1141/2862 (39.9%) patients with response reported, objective response rate was 23.4% (267/1141). Safety findings were as expected. CONCLUSION Time to treatment failure durations and objective response rates were encouraging.
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Affiliation(s)
- Federico Cappuzzo
- AUSL della Romagna, Ospedale Santa Maria delle Croci, viale Randi 5, 48100 Ravenna, Italy
| | - Ross Soo
- National University Health System & Cancer Science Institute of Singapore, Levels 8-10 NUH Medical Centre (NUHMC), 1 Kent Ridge Road, Singapore
| | - Maximilian Hochmair
- Department of Respiratory & Critical Care Medicine, & Ludwig Boltzmann Institute of COPD & Respiratory Epidemiology, Otto Wagner Spital, Baumgartner Höhe 1, Vienna, Austria
| | - Martin Schuler
- West German Cancer Center, University Hospital Essen, University Duisburg-Essen, & German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Hufelandstr. 55, Essen, Germany
| | - Kwok Chi Lam
- The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, NT, Hong Kong, PR China
| | - Gerd Stehle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Str 173, Biberach, Germany
| | - Agnieszka Cseh
- Boehringer Ingelheim RCV GmbH & Co. KG, Boehringer-Gasse 5-11, Vienna, Austria
| | - Robert M Lorence
- Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, Ridgefield, CT 06877, USA
| | - Stephan Linden
- Boehringer Ingelheim GmbH, Binger Straße 173, Ingelheim, Germany
| | - Nicole D Forman
- Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, Ridgefield, CT 06877, USA
| | - Wolfgang Hilbe
- Department of Internal Medicine 1, Wilhelminenspital, Montleartstraße 37, Vienna, Austria
| | - Abdul Rahman Jazieh
- King Saud bin Abdulaziz University for Health Sciences & King Abdullah International Medical Research Center, PO Box 22490, Riyadh, Saudi Arabia
| | - Chun-Ming Tsai
- Taipei Veterans General Hospital & National Yang-Ming University, No. 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan
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Hochmair M, Schwab S, Burghuber O, Koger R, Setinek U, Cseh A, Fritz R, Buder A, Filipits M. P2.03-025 Prevalence of EGFR T790M Mutation in NSCLC Patients after Afatinib Failure, and Subsequent Response to Osimertinib. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goss G, Felip E, Cobo M, Lu S, Syrigos K, Lee K, Göker E, Georgoulias V, Li W, Guclu S, Isla D, Min YJ, Morabito A, Ardizzoni A, Gadgeel S, Gibson N, Krämer N, Solca F, Cseh A, Ehrnrooth E, Soria J. P3.01-043 Impact of ErbB Mutations on Clinical Outcomes in Afatinib- or Erlotinib-Treated Patients with SCC of the Lung. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Peters S, Curioni-Fontecedro A, Nechushtan H, Shih JY, Liao WY, Gautschi O, Spataro V, Unk M, Yang JH, Lorence R, Carrière P, Cseh A, Chang GC. Activity of afatinib in heavily pretreated patients (pts) with HER2 mutation-positive (HER2m+) advanced non-small cell lung cancer (NSCLC): findings from a global named patient use (NPU) program. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Zhou C, Fan Y, Wang H, Liam CK, Hu C, Cseh A. P2.06-013 Afatinib in Patients with Advanced HER2 Mutation-Positive (M+) NSCLC Previously Treated with Chemotherapy. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1506] [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] [Indexed: 10/20/2022]
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Cappuzzo F, Soo R, Hochmair M, Schuler M, Mok T, Stehle G, Cseh A, Lorence R, Linden S, Forman N, Tsai CM. Global named patient use (NPU) program of afatinib, an oral ErbB family blocker, in heavily pretreated advanced non-small cell lung carcinoma (NSCLC) patients who progressed following prior therapies, including erlotinib or gefitinib (E/G). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw383.36] [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] [Indexed: 11/13/2022] Open
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Thongprasert S, Alexandru A, Schenker M, Abdelaziz A, Clement D, Boldeanu C, Jovanovic D, Reyes-Igama J, Petrović M, Geater S, Radosavljevic D, Perin B, Krzakowski M, Serwatowski P, Parra J, Sriuranpong V, Jones H, Cseh A, Gaafar R. 477TiP Phase IV study of afatinib as second-line therapy for patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) harboring common epidermal growth factor receptor (EGFR) mutations (Del19 and/or L858R). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv532.61] [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] [Indexed: 11/14/2022] Open
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Thongprasert S, Jones H, Cseh A, Gaafar R. Open-Label Single-Arm Phase Iv Study to Assess the Efficacy and Safety of Afatinib as Second-Line Therapy for Patients with Locally Advanced or Metastatic Non-Small Cell Lung Cancer (NSCLC) Harbouring Common Epidermal Growth Factor Receptor (EGFR) Mutations (DEL19 AND/OR L858R) Who Have Failed First-Line Treatment with Platinum-Based Chemotherapy. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv050.48] [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] [Indexed: 11/13/2022] Open
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Kim E, Halmos B, Kohut I, Patel T, Rostorfer R, Spira A, Cseh A, McKay J, Wallenstein G, Mileham K. Results of the Afatinib Expanded Access Program (EAP): Efficacy and Safety. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.221] [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] [Indexed: 11/24/2022]
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