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Martin T, Rioufol C, Favier B, Martelli N, Madelaine I, Chouaid C, Borget I. Impact of Early Access Reform on Oncology Innovation in France: Approvals, Patients, and Costs. BioDrugs 2024; 38:465-475. [PMID: 38643301 DOI: 10.1007/s40259-024-00658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND An ambitious reform of the early access (EA) process was set up in July 2021 in France, aiming to simplify procedures and accelerate access to innovative drugs. OBJECTIVE This study analyzes the characteristics of oncology drug approvals through the EA process and its impact on real-life data for oncology patients. METHODS The number and characteristics of EA demands concerning oncology drugs submitted to the National Health Authority (HAS, Haute Autorité de Santé) were reviewed until 31 December 2022. A longitudinal retrospective study on patients treated with an EA oncology drug between 1 January 2019 and 31 December 2022 was also performed using the French nationwide claims database (Systeme National des Données de Santé [SNDS]) to assess the impact of the reform on the number of indications and patients, and the costs. RESULTS Among 110 published decisions, the HAS granted 88 (80%) EA indications within 70 days of assessment on average, including 46 (52%) in oncology (67% in solid tumors and 33% in hematological malignancies). Approved indications were mostly supported by randomized phase III trials (67%), whereas refused EA relied more on non-randomized (57%) trials. Overall survival was the primary endpoint of 28% of EA approvals versus none of denied EAs. In the SNDS data, the annual number of patients with cancer treated with an EA drug increased from 3137 patients in 2019 to 18,341 in 2022 (+ 484%), whereas the number of indications rose from 12 to 62, mainly in oncohematology (n = 17), lung (n = 12), digestive (n = 9) and breast cancer (n = 9). Reimbursement costs for EA treatments surged from €42 to €526 million (+ 1159%). CONCLUSION The French EA reform contributed to enabling rapid access to innovations in a wide range of indications for oncology patients. However, the findings highlight ongoing challenges in financial sustainability, warranting continued evaluation and adjustments.
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Affiliation(s)
- Tess Martin
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015, Paris, France.
- GRADES, Faculty of Pharmacy, Paris-Saclay University, 17 Av. des Sciences, 91400, Orsay, France.
| | - Catherine Rioufol
- Pharmacy Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
- EA3738, CICLY, UCBL1, Lyon, France
| | - Bertrand Favier
- Pharmacy Department, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015, Paris, France
- GRADES, Faculty of Pharmacy, Paris-Saclay University, 17 Av. des Sciences, 91400, Orsay, France
| | - Isabelle Madelaine
- Société Française de Pharmacie Oncologique [SFPO], Pharmacy Department, Saint-Louis Hospital, AP-HP, 1 Avenue Vellefaux, 75010, Paris, France
| | - Christos Chouaid
- Service de Pneumologie, CHI Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, Créteil, France
| | - Isabelle Borget
- Biostatistics and Epidemiology Office, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- CESP U1018, Oncostat, Labeled Ligue Contre le Cancer, Inserm, Université Paris-Saclay, Villejuif, France
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Pluchart H, Chanoine S, Moro-Sibilot D, Chouaid C, Frey G, Villa J, Degano B, Giaj Levra M, Bedouch P, Toffart AC. Lung cancer, comorbidities, and medication: the infernal trio. Front Pharmacol 2024; 14:1016976. [PMID: 38450055 PMCID: PMC10916800 DOI: 10.3389/fphar.2023.1016976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/25/2023] [Indexed: 03/08/2024] Open
Abstract
Most patients with lung cancer are smokers and are of advanced age. They are therefore at high risk of having age- and lifestyle-related comorbidities. These comorbidities are subject to treatment or even polypharmacy. There is growing evidence of a link between lung cancer, comorbidities and medications. The relationships between these entities are complex. The presence of comorbidities and their treatments influence the time of cancer diagnosis, as well as the diagnostic and treatment strategy. On the other hand, cancer treatment may have an impact on the patient's comorbidities such as renal failure, pneumonitis or endocrinopathies. This review highlights how some comorbidities may have an impact on lung cancer presentation and may require treatment adjustments. Reciprocal influences between the treatment of comorbidities and anticancer therapy will also be discussed.
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Affiliation(s)
- Hélène Pluchart
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Sébastien Chanoine
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
| | - Denis Moro-Sibilot
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, équipe CEpiA, CréteilFrance
| | - Gil Frey
- Service de Chirurgie Thoracique, Vasculaire et Endocrinienne, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Julie Villa
- Service de Radiothérapie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Bruno Degano
- Université Grenoble Alpes, Grenoble, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- Laboratoire HP2, INSERM U1042, Université Grenoble Alpes, Grenoble, France
| | - Matteo Giaj Levra
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pierrick Bedouch
- Pôle Pharmacie, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
- Université Grenoble Alpes, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC UMR5525, Grenoble, France
| | - Anne-Claire Toffart
- Université Grenoble Alpes, Grenoble, France
- Institut pour l’Avancée des Biosciences, UGA/INSERM U1209/CNRS 5309, Université Grenoble Alpes, La Tronche, France
- Service Hospitalier Universitaire de Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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Doubre H, Monnet I, Azarian R, Girard P, Meyer G, Trichereau J, Devillier P, Van Dreden P, Couderc LJ, Chouaid C, Vasse M. Plasma tissue factor activity in lung cancer patients predicts venous thromboembolism and poor overall survival. Res Pract Thromb Haemost 2024; 8:102359. [PMID: 38666062 PMCID: PMC11043639 DOI: 10.1016/j.rpth.2024.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/18/2024] [Accepted: 02/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background Biomarkers to identify lung cancer (LC) patients with high risk of venous thromboembolism (VTE) are needed. Objectives To evaluate the usefulness of plasma tissue factor activity (TFA) and D-dimer levels for the prediction of VTE and overall survival in patients with LC. Methods In a prospective multicenter observational cohort of consecutive LC patients, TFA and D-dimer levels were measured at diagnosis before any cancer treatment (V1) and between 8 and 12 weeks after diagnosis (V2). Results Among 302 patients, 38 (12.6%) experienced VTE within the first year after diagnosis. V1-TFA and V1-D-dimer levels were significantly (P = .02) higher in patients who presented VTE within 3 months than in patients without VTE: V1-TFA was 2.02 (25th-75th percentiles, 0.20-4.01) vs 0.49 (0.20-3.09) ng/mL and V1-D-dimer was 1.42 (0.64-4.40) vs 0.69 (0.39-1.53) μg/mL, respectively. Cutoffs of 1.92 ng/mL for TFA and 1.26 μg/mL for D-dimer could discriminate both groups of patients. In multivariate analysis, V1-TFA > 1.92 ng/mL was the only significant predictor of VTE risk at 1 year (hazard ratio, 2.10; 95% CI, 1.06-4.16; P = .03). V2-TFA, quantified in 251 patients, decreased significantly compared with V1-TFA (0.20 vs 0.56 ng/mL, P < .05), but a V2-TFA level > 0.77 ng/mL could predict VTE in the following 3 months. Median overall survival was worse for patients with V1-TFA > 1.92 ng/mL (14.6 vs 23.8 months) and V1-D-dimer > 1.26 μg/mL (13.8 vs 24 months, P < .001). Conclusion High plasma TFA levels are associated with the occurrence of VTE within the next 3 months after each visit (V1 or V2) and poor survival.
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Affiliation(s)
- Helene Doubre
- Service de Pneumologie, Hôpital Foch, Suresnes, France
| | - Isabelle Monnet
- Service de Pneumologie, Centre Hospitalier Intercommunal, Creteil, France
| | - Reza Azarian
- Service de Pneumologie, Centre Hospitalier Versailles, Le Chesnay, France
| | - Philippe Girard
- Département de pneumologie, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France
| | - Guy Meyer
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julie Trichereau
- Direction Recherche Clinique et Innovation, Hôpital Foch, Suresnes, France
| | - Philippe Devillier
- Service de Pneumologie, Hôpital Foch, Suresnes, France
- VIM Suresnes, UMR 0892, Pôle des Maladies Respiratoires, Hopital Foch, Université Paris Saclay, Suresnes, France
| | | | | | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal, Creteil, France
| | - Marc Vasse
- Biology Department, Hôpital Foch, Suresnes, France
- UMRS-1176, Le Kremlin-Bicêtre, France
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Valette CA, Filleron T, Debieuvre D, Lena H, Pérol M, Chouaid C, Simon G, Quantin X, Girard N. Treatment patterns and clinical outcomes of extensive stage small cell lung cancer (SCLC) in the real-world evidence ESME cohort before the era of immunotherapy. Respir Med Res 2023; 84:101012. [PMID: 37307617 DOI: 10.1016/j.resmer.2023.101012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Small cell lung cancer (SCLC) is a highly aggressive entity of lung cancer with tendency toward early recurrence after first-line treatment. As per recently updated European Society for Medical Oncology recommendations, first-line treatment with up to 4 cycles of platinum-etoposide combined with immune checkpoint inhibitor (ICIs)-targeting PD-L1, is now the standard of care. The purpose of the current analysis is to identify current patient profiles and treatment strategies in real life clinical practice, and report outcomes in Extensive Stage (ES)-SCLC. METHODS Non-interventional, retrospective, multicentre, comparative study was carried out to describe the outcome of ES-SCLC patients included in the Epidémiologie Stratégie Médico-Economique (ESME) data platform for advanced and metastatic lung cancer. Patients were selected from 34 health care facilities between January 2015 and December 2017, before the era of immunotherapy. RESULTS 1315 patients were identified, including 64% male and 78% under 70 year-old; 24% had at least 3 metastatic sites, mainly liver metastases (43%), bone metastases (36%), brain metastases (32%). 49% received only one line of systemic treatment; 30% and 21% received 2 and 3 lines or more, respectively. Carboplatin was more frequently used than cisplatin (71% and 29%, respectively). Prophylactic cranial irradiation was infrequent (4% of patients), but 16% of patients received thoracic radiation therapy, mainly after the completion of first-line chemotherapy (72% of patients); such strategies were more frequently applied in cisplatin/etoposide than carboplatin/etoposide patients (p = 0.006 and p = 0.015, respectively). After a median follow-up time of 21.8 (95% CI: 20.9-23.3) months, median real-world Progression-Free Survival (rw-PFS) was 6.2 (95% CI: 5.7; 6.9) and 6.1 (95% CI: 5.8; 6.3) months for cisplatin/etoposide and carboplatin/etoposide doublet regimens, respectively; 24-month rwPFS and Overall Survival were 3.2% (95% CI: 2.3; 4;2) and 22.2% (95% CI: 19.4; 25.1) in the whole population, respectively. CONCLUSION Our data provide with landmark reference findings on ES-SCLC before the immunotherapy era, and cover many aspects of the treatment strategy, while highlighting on the role of radiotherapy, subsequent lines of therapy, and the outcomes of patients. Generation of real-world data focusing on patients who received platinum-based chemotherapy combined with immune checkpoint inhibitors is under way.
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Affiliation(s)
| | | | - Didier Debieuvre
- Groupe Hospitalier de la Région de Mulhouse Sud Alsace, Mulhouse, France
| | - Hervé Lena
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | | | - Xavier Quantin
- Institut régional du Cancer de Montpellier, Montpellier, France
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France et Université Versailles Saint Quentin, Paris Saclay Campus, Versailles, France.
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Doubre H, Greillier L, Justeau G, Ricordel C, Swalduz A, Curcio H, Bylicki O, Auliac JB, Guisier F, Bigay-Game L, Bernardi M, Pinsolle J, Amrane K, Decroisette C, Descourt R, Chouaid C, Geier M. Venous thrombotic events and impact on outcomes in patients treated with first-line single-agent pembrolizumab in PD-L1 ≥ 50% advanced non small cell lung cancer. J Cancer Res Clin Oncol 2023; 149:15095-15102. [PMID: 37626173 DOI: 10.1007/s00432-023-05321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Few data are available on the impact of venous thrombotic events (VTE) in patients with metastatic non-small cell lung cancer (mNSCLC) treated with immunotherapy. METHODS This is a secondary analysis of the ESKEYP study, a national, retrospective, multicenter study that consecutively included all PD-L1 ≥ 50% mNSCLC patients who initiated first-line treatment with pembrolizumab monotherapy. From May 2017 to November 2019, 845 patients were included (from availability of pembrolizumab in this indication in France to the authorization of the combination with chemotherapy). Impact of VTE and patient characteristics were analyzed. RESULTS Of the 748 patients (88.5%) with available data, the incidence of VTE was 14.8% (111/748). At pembrolizumab initiation, Khorana score was ≥ 2 for 55.0% (61/111) of them. Recurrence of VTE was reported for 4 of the 111 patients and 5 had bleeding complications. Patients with VTE were significantly younger, had more frequently long-term corticosteroids treatment and more often liver metastases. Progression-free survival (PFS) was significantly shorter in patients with VTE compared to patients without VTE: 6.1 (95% CI 4.1-9.0) months vs. 8.3 (6.9-10.3) months (p = 0.03). VTE did not significantly impact overall survival (OS): 15.2 (10.0-24.7) months with VTE and 22.6 (18.4-29.8) months without VTE (p = 0.07). In multivariate analysis for PFS and OS, HRs for VTE were 1.3 (0.99-1.71), p = 0.06 and 1.32 (0.99-1.76), p = 0.05. CONCLUSION The incidence of VTE appears to be as high with in first-line immunotherapy as with chemotherapy in patients with mNSCLC, with in patient with VTE, a no significant trend for lower PFS and OS in multivariate analysis. more marked impact on PFS than on OS.
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Affiliation(s)
- Hélène Doubre
- Suresnes, Pneumology Department, Hôpital Foch, Suresnes, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Marseille, France
| | | | - Charles Ricordel
- Pneumology Department, Rennes University Hospital, Rennes, France
| | - Aurélie Swalduz
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Hubert Curcio
- OncologyDepartment, Caen François-Baclesse Cancer Center, Caen, France
| | | | - Jean-Bernard Auliac
- Service de Pneumologie, CHI Créteil, 40 Avenue de Verdun, 94010, Créteil, France
| | - Florian Guisier
- PneumologyDepartment, Rouen University Hospital, Rouen, France
| | | | - Marie Bernardi
- PneumologyDepartment, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Julian Pinsolle
- Pneumology Department, ChambéryMétropoleSavoie Hospital, Chambéry, France
| | - Karim Amrane
- Oncology Department, Morlaix Hospital, Morlaix, France
| | | | | | - Christos Chouaid
- Service de Pneumologie, CHI Créteil, 40 Avenue de Verdun, 94010, Créteil, France.
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Plessala I, Cawston H, Cortes J, Ajjouri R, Le Lay K, Souquet PJ, Chouaid C. Cost-effectiveness analysis of atezolizumab as adjuvant treatment of patients with stage II-IIIA non-small cell lung cancer, PD-L1+≥50% of tumor cells in France: A modeling study. Lung Cancer 2023; 184:107316. [PMID: 37562344 DOI: 10.1016/j.lungcan.2023.107316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The objective of this study was to assess the cost-effectiveness of atezolizumab versus best supportive care (BSC) as adjuvant treatment following resection and platinum-based chemotherapy for patients with stage II-IIIA non-small cell lung cancer (NSCLC) whose tumours have a programmed death-ligand 1 (PD-L1) expression ≥ 50% of tumour cells and excluding those with ALK/EGFR mutations, from a French collective perspective. MATERIAL AND METHODS A five state Markov model over a 20-year time horizon was considered, including disease-free survival (DFS1) from IMpower010 trial, three progression states (locoregional recurrence, first and second-line metastatic recurrence) and death. Utilities, quality-adjusted life year (QALY) decrements associated to adverse events, costs, resource use, and transition probabilities were considered in the model. These inputs were sourced from IMpower010 trial, literature, and clinical experts' opinion. Model uncertainty was assessed through deterministic, probabilistic sensitivity analyses and scenario analyses. RESULTS Atezolizumab was associated with a QALY gain of 1.662, mainly driven by additional time spent in the DFS state, and a life-year gain of 2.112 years. The incremental cost-effectiveness ratio (ICER) for atezolizumab versus BSC was €21,348/QALY gained. The sensitivity analyses highlighted that uncertainty within the model had limited impact on results. Changing the DFS survival curves to other plausible distributions produced ICERs below €20,000/QALY. Introducing an increasing proportion of cured patients (91.5%) from year two to year five reduced the ICER to €13,083/QALY, while including a loss of efficacy at year two in the atezolizumab treatment arm increased the ICER to €33,755/QALY. DISCUSSION Atezolizumab as adjuvant treatment in stage II-IIIA NSCLC resected patients with PDL1 ≥ 50% and without ALK/EGFR mutations has a lower ICER than other oncology drugs in France and a similar ICER to other adjuvant treatment in oncology.
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Affiliation(s)
| | - Hélène Cawston
- Amaris, Health Economics and Market Access, Paris, France
| | - Justine Cortes
- Amaris, Health Economics and Market Access, Paris, France
| | | | | | | | - Christos Chouaid
- Service de Pneumologie, CHI Créteil, 5 Inserm U955, UPEC, IMRB, Créteil, France
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Feredj E, Wiedemann A, Krief C, Maitre B, Derumeaux G, Chouaid C, Le Corvoisier P, Lacabaratz C, Gallien S, Lelièvre JD, Boyer L. Immune response to pertussis vaccine in COPD patients. Sci Rep 2023; 13:11654. [PMID: 37468500 DOI: 10.1038/s41598-023-38355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
Exacerbation triggered by respiratory infection is an important cause of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients. Strategies aiming to preventing infection may have significant public health impact. Our previous study demonstrated decreased immunological response to seasonal flu vaccination in COPD patients, questioning the efficiency of other vaccines in this group of patients. We performed a prospective, monocenter, longitudinal study that evaluated the humoral and cellular responses upon pertussis vaccination. We included 13 patients with stable COPD and 8 healthy volunteers. No difference in circulating B and T cell subsets at baseline was noted. Both groups presented similar levels of TFH, plasmablasts and pertussis specific antibodies induction after vaccination. Moreover, monitoring T cell immunity after ex-vivo peptide stimulation revealed equivalent induction of functional and specific CD4+ T cells (IFNγ, TNFα and IL-2-expressing T cells) in both groups. Our results highlight the immunological efficiency of pertussis vaccination in this particularly vulnerable population and challenge the concept that COPD patients are less responsive to all immunization strategies. Healthcare providers should stress the necessity of decennial Tdap booster vaccination in COPD patients.
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Affiliation(s)
- E Feredj
- Infectious Disease Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Groupe Hospitalier Henri-Mondor/Albert Chenevier, 94010, Créteil, France.
- INSERM U955, Equipe 16, IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), 94010, Créteil, France.
| | - A Wiedemann
- INSERM U955, Equipe 16, IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), 94010, Créteil, France
- Vaccine Research Institute, 94010, Créteil, France
| | - C Krief
- INSERM U955, Equipe 16, IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), 94010, Créteil, France
- Vaccine Research Institute, 94010, Créteil, France
| | - B Maitre
- Department of Physiology, APHP, Hôpital Henri Mondor, 94010, Créteil, France
- Department of Pulmonology, Centre Hospitalier Intercommunal, 94010, Créteil, France
| | - G Derumeaux
- Department of Physiology, APHP, Hôpital Henri Mondor, 94010, Créteil, France
| | - C Chouaid
- Department of Pulmonology, Centre Hospitalier Intercommunal, 94010, Créteil, France
| | - P Le Corvoisier
- INSERM, Clinical Investigation Center 1430, Hôpital Henri Mondor, 94010, Créteil, France
| | - C Lacabaratz
- INSERM U955, Equipe 16, IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), 94010, Créteil, France
- Vaccine Research Institute, 94010, Créteil, France
| | - S Gallien
- Infectious Disease Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Groupe Hospitalier Henri-Mondor/Albert Chenevier, 94010, Créteil, France
- EA Dynamyc, Université Paris Est Créteil-École Vétérinaire de Maison Alfort, 94000, Créteil, France
| | - J D Lelièvre
- Infectious Disease Department, AP-HP (Assistance Publique-Hôpitaux de Paris), Groupe Hospitalier Henri-Mondor/Albert Chenevier, 94010, Créteil, France
- INSERM U955, Equipe 16, IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), 94010, Créteil, France
- Vaccine Research Institute, 94010, Créteil, France
| | - L Boyer
- INSERM U955, Equipe 16, IMRB (Institut Mondor de Recherche Biomédicale), Université Paris-Est-Créteil (UPEC), 94010, Créteil, France
- Department of Physiology, APHP, Hôpital Henri Mondor, 94010, Créteil, France
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Heudel PE, de Montfort A, Debieuvre D, Chouaid C, Carton M, Audigier-Valette C, Filleron T, Chabaud S, Stancu A, Quantin X, Hiret S, Bosquet L, Blay JY. Reduced risk of secondary primary extra pulmonary cancer in advanced/metastatic lung cancer patients treated with immune checkpoint inhibitors. Lung Cancer 2023; 182:107280. [PMID: 37339550 DOI: 10.1016/j.lungcan.2023.107280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Lung cancer survivors are at high risk of developing a second primary cancer (SPC). We explored the Unicancer Epidemiology Strategy Medical-Economics for advanced or metastatic lung cancer (AMLC) database to assess the impact of immune checkpoint inhibitors (ICI) on the risk of SPC in patients with advanced/metastatic lung cancer. PATIENTS AND METHODS This retrospective study used data from patients with AMLC, with treatment initiated between January 1st 2015 and December 31st 2018. Patients with lung cancer as the second primary cancer were excluded and a 6-months landmark threshold was applied to exclude patients with synchronous SPC, patients dead without SPC or with a follow-up inferior to 6 months. A propensity score (PS) was calculated on the following baseline covariates: Age at locally advanced or metastatic diagnosis, sex, smoking status, metastatic status, performance status and histological type. The inverse probability of treatment weighting approach was used on the analyses aiming to assess the impact of ICI administered for AMLC, on the risk of occurrence of SPC. RESULTS Among the 10 796 patients, 148 (1.4%) patients had a diagnosis of SPC in a median interval of 22 (min-max: 7-173) months. All the patients (100%) with locally advanced or metastatic LC received at least one systemic treatment including (chemotherapy regimen (n = 9 851, 91.2%); ICI (n = 4 648, 43.0%); targeted treatment (n = 3 500; 32.4%). 40 (0.9%) SPC were reported in the 4 648 patients with metastatic LC treated with ICI vs 108 (1.7%) out of the 6 148 who did not receive immunotherapy (p < 0.0001). The multivariate analysis identified that treatment with ICI in patients with AMLC is associated with a reduced risk of SPC (HR = 0.40, 95% CI 0.27-0.58). CONCLUSION Treatment with ICI in AMLC patients was associated with a significantly reduced risk of SPC. Prospective studies are required to confirm these results.
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Affiliation(s)
| | - A de Montfort
- Biostatistical Unit, Centre Léon Bérard, Lyon, France
| | - D Debieuvre
- Groupe hospitalier de la région de Mulhouse Sud Alsace, Mulhouse, France
| | - C Chouaid
- Centre hospitalier Intercommunal, Créteil, France
| | - M Carton
- Biostatistical Unit, Institut Curie, Paris, France
| | - C Audigier-Valette
- Centre hospitalier intercommunal de Toulon - La Seyne-sur-Mer, Toulon, France
| | - T Filleron
- Biostatistics & Health Data Science Unit, Institut Claudius Régaud IUCT-O, Toulouse, France
| | - S Chabaud
- Biostatistical Unit, Centre Léon Bérard, Lyon, France
| | - A Stancu
- Institut Sainte Catherine, Avignon, France
| | - X Quantin
- Institut régional du cancer, Montpellier, France
| | - S Hiret
- Institut de cancérologie de l'Ouest, Angers&Nantes, France
| | - L Bosquet
- Health Data and Partnership Department, Unicancer, Paris, France
| | - J Y Blay
- Centre Léon Bérard, Lyon, France
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9
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Macro M, Hulin C, Vincent L, Charvet-Rumpler A, Benboubker L, Calmettes C, Stoppa AM, Laribi K, Clement-Filliatre L, Zerazhi H, Honeyman F, Richez V, Maloisel F, Karlin L, Barrak J, Chouaid C, Leleu X. Real-world effectiveness of ixazomib combined with lenalidomide and dexamethasone in relapsed/refractory multiple myeloma: the REMIX study. Ann Hematol 2023:10.1007/s00277-023-05278-3. [PMID: 37301786 DOI: 10.1007/s00277-023-05278-3] [Citation(s) in RCA: 1] [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: 01/20/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Ixazomib (IXA) is an oral proteasome inhibitor (PI) used in combination with lenalidomide and dexamethasone (IXA-Rd) for patients with relapsed and/or refractory multiple myeloma (RRMM). The REMIX study is one of the largest prospective, real-world analysis of the effectiveness of IXA-Rd in the setting of RRMM. Conducted in France between August 2017 and October 2019, the REMIX study, a non-interventional prospective study, included 376 patients receiving IXA-Rd in second line or later and followed for at least 24 months. Primary endpoint was the median progression-free survival (mPFS). Median age was 71 years (Q1-Q3 65.0 - 77.5) with 18.4% of participants older than 80 years. IXA-Rd was initiated in L2, L3 and L4 + for 60.4%, 18.1% and 21.5%, respectively. mPFS was 19.1 months (95% CI [15.9, 21.5]) and overall response rate (ORR) was 73.1%. mPFS was 21.5, 21.9 and 5.8 months in patients receiving IXA-Rd as L2, L3, L4 + respectively. Among patients receiving IXA-Rd in L2 and L3, mPFS was similar for patients previously exposed to lenalidomide (19.5 months) than for those lenalidomide naive (not exposed, 22.6 months, p = 0.29). mPFS was 19.1 months in patients younger than 80 years and 17.4 months in those 80 years or older (p = 0.06) with similar ORR (72.4% and 76.8%) in both subgroups. Adverse events (AEs) were reported in 78.2% of patients including 40.7% of treatment-related AE. IXA discontinuation was due to toxicity in 21% of patients. To conclude, the results of the REMIX study are consistent with the results of Tourmaline-MM1 and confirm the benefit of IXA-Rd combination in real life. It shows the interest of IXA-Rd in an older and frailer population, with an acceptable effectiveness and tolerance.
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Affiliation(s)
- M Macro
- IHBN - CHU de Caen, Caen, France.
| | - C Hulin
- CHU Bordeaux - Hôpital Haut Leveque, Pessac, France
| | - L Vincent
- CHU de Montpellier - Hôpital Saint-Eloi, Montpellier, France
| | | | - L Benboubker
- CHRU de Tours - Hôpital Bretonneau, Tours, France
| | | | - A-M Stoppa
- Institut Paoli Calmettes, Marseille, France
| | | | | | | | - F Honeyman
- CHU de Saint-Etienne, Saint-Etienne, France
| | - V Richez
- CHU de Nice - Hôpital de l'archet, Nice, France
| | - F Maloisel
- Clinique Sainte-Anne, Strasbourg, France
| | - L Karlin
- Hospices Civils de Lyon, Pierre Bénite, France
| | | | | | - X Leleu
- CHU de Poitiers, Poitiers, France
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10
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Bylicki O, Tomasini P, Radj G, Guisier F, Monnet I, Ricordel C, Bigay-Game L, Geier M, Chouaid C, Daniel C, Swalduz A, Toffart AC, Doubre H, Peloni JM, Moreau D, Subtil F, Grellard JM, Castera M, Clarisse B, Martins-Lavinas PH, Decroisette C, Greillier L. Atezolizumab with or without bevacizumab and platinum-pemetrexed in patients with stage IIIB/IV non-squamous non-small cell lung cancer with EGFR mutation, ALK rearrangement or ROS1 fusion progressing after targeted therapies: A multicentre phase II open-label non-randomised study GFPC 06-2018. Eur J Cancer 2023; 183:38-48. [PMID: 36801605 DOI: 10.1016/j.ejca.2023.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous reports showed limited efficacy of immune checkpoint inhibitors as single-agent treatment for non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutation or ALK/ROS1 fusion. We aimed at evaluating the efficacy and safety of immune checkpoint inhibitor combined with chemotherapy and bevacizumab (when eligible) in this patient subgroup. METHODS We conducted a French national open-label multicentre non-randomised non-comparative phase II study in patients with stage IIIB/IV NSCLC, oncogenic addiction (EGFR mutation or ALK/ROS1 fusion), with disease progression after tyrosine kinase inhibitor and no prior chemotherapy. Patients received platinum, pemetrexed, atezolizumab, bevacizumab (PPAB cohort) or, if not eligible to bevacizumab, platinum-pemetrexed-atezolizumab (PPA cohort). The primary end-point was the objective response rate (RECIST v1.1) after 12 weeks, evaluated by blind independent central review. RESULTS 71 patients were included in PPAB cohort and 78 in PPA cohort (mean age, 60.4/66.1 years; women 69.0%/51.3%; EGFR mutation, 87.3%/89.7%; ALK rearrangement, 12.7%/5.1%; ROS1 fusion, 0%/6.4%, respectively). After 12 weeks, objective response rate was 58.2% (90% confidence interval [CI], 47.4-68.4) in PPAB cohort and 46.5% (90% CI, 36.3-56.9) in PPA cohort. Median progression-free survival and overall survival were 7.3 (95% CI 6.9-9.0) months and 17.2 (95% CI 13.7-NA) months in PPAB cohort and 7.2 (95% CI 5.7-9.2) months and 16.8 (95% CI 13.5-NA) months in PPA cohort, respectively. Grade 3-4 adverse events occurred in 69.1% of patients in PPAB cohort and 51.4% in PPA cohort; Grade 3-4 atezolizumab-related adverse events occurred in 27.9% and 15.3%, respectively. CONCLUSION Combination approach with atezolizumab with or without bevacizumab and platinum-pemetrexed achieved promising activity in metastatic EGFR-mutated or ALK/ROS1-rearranged NSCLC after tyrosine kinase inhibitor failure, with acceptable safety profile.
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Affiliation(s)
- Olivier Bylicki
- Department of Pneumology, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France.
| | - Pascale Tomasini
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
| | - Gervais Radj
- Department of Medical Oncology, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Florian Guisier
- CHU Rouen, Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Normandie Univ, UNIROUEN, EA4108 LITIS Lab, QuantIF Team and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Isabelle Monnet
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Charles Ricordel
- Department of Pneumology, CHU Rennes, Univ Rennes 1, INSERM, OSS (Oncogenesis Stress Signaling), UMR_S 1242, CLCC Eugene Marquis, F-35000 Rennes, France
| | - Laurence Bigay-Game
- Department of Pneumology & Thoracic Oncology, CHU Toulouse-Hôpital Larrey, Toulouse, France
| | | | - Christos Chouaid
- CHU Rouen, Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, Normandie Univ, UNIROUEN, EA4108 LITIS Lab, QuantIF Team and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Catherine Daniel
- Thoracic Oncology Service, Thorax Institute Curie Montsouris, Institut Curie, Paris, France
| | - Aurelie Swalduz
- Department of Pneumology, Comprehensive Cancer Centre Léon Bérard, Lyon, France
| | | | | | - Jean-Michel Peloni
- Department of Pneumology, Maison de Santé Protestante de Bordeaux-Bagatelle, Talence, France
| | - Diane Moreau
- Department of Pneumology and Oncology, Medical University of Felix Guyon, Reunion Island, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Jean-Michel Grellard
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Marie Castera
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Benedicte Clarisse
- Clinical Research Department, Comprehensive Cancer Centre François Baclesse, Caen, France
| | - Pedro-Henrique Martins-Lavinas
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Chantal Decroisette
- Department of Pneumology & Thoracic Oncology, CH Annecy-Genevois, 74370 Metz-Tessy, France
| | - Laurent Greillier
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations, Marseille, France
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11
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Chouaid C, Grossi F, Minh CTT, Raymond R, Bosch-Barrera J. 56P Pooled analysis of 4 studies evaluating weekly oral vinorelbine in patients with locally advanced or metastatic non-small cell lung cancer. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00310-6] [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: 04/04/2023]
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12
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Chouaid C, Bosquet L, Girard N, Kron A, Scheffler M, Griesinger F, Sebastian M, Trigo J, Viteri S, Knott C, Rodrigues B, Rahhali N, Cabrieto J, Diels J, Perualila NJ, Schioppa CA, Sermon J, Toueg R, Erdmann N, Mielke J, Nematian-Samani M, Martin-Fernandez C, Pfaira I, Li T, Mahadevia P, Wolf J. An Adjusted Treatment Comparison Comparing Amivantamab Versus Real-World Clinical Practice in Europe and the United States for Patients with Advanced Non-Small Cell Lung Cancer with Activating Epidermal Growth Factor Receptor Exon 20 Insertion Mutations. Adv Ther 2023; 40:1187-1203. [PMID: 36652175 PMCID: PMC9988783 DOI: 10.1007/s12325-022-02408-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Patients with advanced, epidermal growth factor receptor (EGFR)-mutated, non-small cell lung cancer (NSCLC) with Exon 20 insertion mutations (Exon20ins) have poor prognoses, exacerbated by a previous lack of specific treatment guidelines and unmet need for targeted therapies. Amivantamab, an EGFR and MET bispecific antibody, demonstrated efficacy and tolerability in patients with advanced EGFR-mutated NSCLC with Exon20ins following platinum-based therapy in CHRYSALIS (NCT02609776; Cohort D+). Since CHRYSALIS was single-arm, individual patient data (IPD)-based adjusted analyses versus similar patients in real-world clinical practice (RWCP) were conducted to generate comparative evidence. METHODS RWCP cohorts were derived from seven European and US real-world sources, comprising patients fulfilling CHRYSALIS Cohort D+ eligibility criteria. Amivantamab was compared with a basket of RWCP treatments. Differences in prognostic characteristics were adjusted for using inverse probability weighting (IPW; average treatment effect among the treated [ATT]). Balance between cohorts was assessed using standardized mean differences (SMDs). Overall response rate (ORR; investigator- [INV] and independent review committee-assessed [IRC]), overall survival (OS), progression-free survival (PFS; INV and IRC) and time-to-next treatment (TTNT) were compared. Binary and time-to-event endpoints were analyzed using weighted logistic regression and proportional hazards regression, respectively. RESULTS Pre-adjustment, baseline characteristics were comparable between cohorts. IPW ATT-adjustment improved comparability, giving closely matched characteristics. ORR (INV) was 36.8% for amivantamab versus 17.0% for the adjusted EU + US cohort (response rate ratio [RR]: 2.16). Median OS, PFS (INV) and TTNT were 22.77 versus 12.52 months (hazard ratio [HR]: 0.47; p < 0.0001), 6.93 versus 4.17 months (HR: 0.55; p < 0.0001) and 12.42 versus 5.36 months (HR: 0.44; p < 0.0001) for amivantamab versus the adjusted EU + US cohort, respectively. Results were consistent versus EU- and US-only cohorts, and when using IRC assessment. CONCLUSION Adjusted comparisons demonstrated significantly improved outcomes for amivantamab versus RWCP, highlighting the value of amivantamab in addressing unmet need in patients with advanced EGFR Exon20ins NSCLC following platinum-based therapy. TRIAL REGISTRATION CHRYSALIS: NCT02609776.
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Affiliation(s)
- Christos Chouaid
- Service de Pneumologie, Pneumology, Intercommunal Hospital, 40 avenue de Verdun, 94010, Créteil, France.
| | - Lise Bosquet
- Health Data and Partnerships Department, Unicancer, Paris, France
| | | | - Anna Kron
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Martin Sebastian
- Department of Medicine, Hematology and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Jose Trigo
- Hospital Universitario Virgen de la Victoria y Regional, IBIMA, Malaga, Spain
| | - Santiago Viteri
- UOMI Cancer Center, Clínica Mi Tres Torres, Barcelona, Spain.,Instituto Oncológico Dr Rosell, Hospital Universitari Dexeus, Grupo QuironSalud, Barcelona, Spain
| | - Craig Knott
- Health Data Insight CIC, Cambridge, UK.,National Disease Registration Service, NHS Digital, Leeds, UK
| | | | | | | | | | | | | | - Jan Sermon
- Janssen Pharmaceutica NV, Beerse, Belgium
| | | | | | | | | | | | | | | | | | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, Cologne, Germany
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13
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Girard N, Bar J, Garrido P, Garassino MC, McDonald F, Mornex F, Filippi AR, Smit HJM, Peters S, Field JK, Christoph DC, Sibille A, Fietkau R, Haakensen VD, Chouaid C, Markman B, Hiltermann TJN, Taus A, Sawyer W, Allen A, Chander P, Licour M, Solomon B. Treatment Characteristics and Real-World Progression-Free Survival in Patients With Unresectable Stage III NSCLC Who Received Durvalumab After Chemoradiotherapy: Findings From the PACIFIC-R Study. J Thorac Oncol 2023; 18:181-193. [PMID: 36307040 DOI: 10.1016/j.jtho.2022.10.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/16/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The phase 3 PACIFIC trial established consolidation therapy with durvalumab as standard of care for patients with unresectable, stage III NSCLC and no disease progression after definitive chemoradiotherapy (CRT). The observational PACIFIC-R study assesses the real-world effectiveness of durvalumab in patients from an early access program. Here, we report treatment characteristics and a preplanned analysis of real-world progression-free survival (rwPFS). METHODS PACIFIC-R (NCT03798535) is an ongoing, international, retrospective study of patients who started durvalumab (intravenously; 10 mg/kg every 2 wk) within an early access program between September 2017 and December 2018. The primary end points are investigator-assessed rwPFS and overall survival (analyzed by Kaplan-Meier method). RESULTS As of November 30, 2020, the full analysis set comprised 1399 patients from 11 countries (median follow-up duration, 23.5 mo). Patients received durvalumab for a median of 11.0 months. Median rwPFS was 21.7 months (95% confidence interval: 19.1-24.5). RwPFS was numerically longer among patients who received concurrent versus sequential CRT (median, 23.7 versus 19.3 mo) and among patients with programmed cell death-ligand 1 expression greater than or equal to 1% versus less than 1% (22.4 versus 15.6 mo). Overall, 16.5% of the patients had adverse events leading to treatment discontinuation; 9.5% of all patients discontinued because of pneumonitis or interstitial lung disease. CONCLUSIONS Consolidation durvalumab after definitive CRT was well tolerated and effective in this large, real-world cohort study of patients with unresectable, stage III NSCLC. As expected, rwPFS was longer among patients who received concurrent versus sequential CRT and patients with higher programmed cell death-ligand 1 expression. Nevertheless, favorable rwPFS outcomes were observed regardless of these factors.
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Affiliation(s)
- Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France and UVSQ, Paris Saclay, Versailles, France.
| | - Jair Bar
- Institute of Oncology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pilar Garrido
- Medical Oncology Department, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Marina C Garassino
- Department of Hematology/Oncology, The University of Chicago, Chicago, Illinois
| | - Fiona McDonald
- Lung Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Françoise Mornex
- Department of Radiation Oncology, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Andrea R Filippi
- Radiation Oncology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Hans J M Smit
- Department of Pulmonary Diseases, Rijnstate Hospital, Arnhem, The Netherlands
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Daniel C Christoph
- Department of Medical Oncology/Hematology, Evang. Kliniken Essen-Mitte, Evang. Huyssens-Stiftung Essen-Huttrop, Essen, Germany
| | - Anne Sibille
- Department of Pneumology and Allergology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikums Erlangen, Erlangen, Germany
| | - Vilde D Haakensen
- Department of Oncology and Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Ben Markman
- Cabrini Hospital and Monash University, Melbourne, Victoria, Australia
| | - T Jeroen N Hiltermann
- University of Groningen, Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, The Netherlands
| | - Alvaro Taus
- Department of Medical Oncology, Hospital del Mar-CIBERONC, Barcelona, Spain
| | | | | | | | | | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Victoria, Australia
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14
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Guisier F, Descourt R, Babey H, Huchot E, Falchero L, Veillon R, Cortot AB, Tissot C, Chouaid C, Decroisette C. Brief Report: First-line Pembrolizumab in Metastatic Non-Small Cell Lung Cancer Habouring MET Exon 14 Skipping Mutation and PD-L1 ≥50% (GFPC 01-20 Study). Clin Lung Cancer 2022; 23:e545-e549. [PMID: 36210290 DOI: 10.1016/j.cllc.2022.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Florian Guisier
- Department of Pneumology and Inserm CIC-CRB 1404, Normandie Univ, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU Rouen, Rouen, France.
| | - Renaud Descourt
- Institut de cancérologie, Hopital Morvan, CHRU Brest, Brest, France
| | - Helene Babey
- Institut de cancérologie, Hopital Morvan, CHRU Brest, Brest, France
| | - Eric Huchot
- CHU sud Reunion, Service de Pneumologie, Saint-Pierre, France
| | - Lionel Falchero
- L'Hôpital Nord-Ouest, Service de Pneumologie et Cancérologie Thoracique, Villefranche Sur Saône, France
| | - Remi Veillon
- CHU Bordeaux, service des maladies respiratoire, Bordeaux, France
| | - Alexis B Cortot
- CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Univ. Lille, Plasticity and Resistance to Therapies, Lille, France
| | - Claire Tissot
- Department of Medical Oncology, Institut de Cancérologie Lucien-Neuwirth, Saint-Etienne, France
| | - Christos Chouaid
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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15
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Garassino MC, Mazieres J, Reck M, Chouaid C, Bischoff H, Reinmuth N, Cove-Smith L, Mansy T, Cortinovis D, Migliorino MR, Delmonte A, Sánchez JG, Chara Velarde LE, Bernabe R, Paz-Ares L, Perez ID, Trunova N, Foroutanpour K, Faivre-Finn C. Durvalumab After Sequential Chemoradiotherapy in Stage III, Unresectable NSCLC: The Phase 2 PACIFIC-6 Trial. J Thorac Oncol 2022; 17:1415-1427. [PMID: 35961520 DOI: 10.1016/j.jtho.2022.07.1148] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION On the basis of the findings of the phase 3 PACIFIC trial (NCT02125461), durvalumab is standard of care for patients with stage III, unresectable NSCLC and no disease progression after concurrent chemoradiotherapy (cCRT). Many patients are considered unsuitable for cCRT owing to concerns with tolerability. The phase 2 PACIFIC-6 trial (NCT03693300) evaluates the safety and tolerability of durvalumab after sequential CRT (sCRT). METHODS Patients with stage III, unresectable NSCLC and no progression after platinum-based sCRT were enrolled to receive durvalumab (1500 mg intravenously) every 4 weeks for up to 24 months. The primary end point was the incidence of grade 3 or 4 adverse events possibly related to treatment occurring within 6 months. Secondary end points included investigator-assessed progression-free survival (PFS; Response Evaluation Criteria in Solid Tumors version 1.1) and overall survival. RESULTS Overall, 117 patients were enrolled (59.8% with performance status >0, 65.8% aged ≥65 y, and 37.6% with stage IIIA disease). Median treatment duration was 32.0 weeks; 37.6% of patients remained on treatment at data cutoff (July 15, 2021). Grade 3 or 4 AEs occurred in 18.8% of patients. Five patients had grade 3 or 4 possibly related adverse events within 6 months (incidence: 4.3%; 95% confidence interval: 1.4-9.7), including two pneumonitis cases. Two patients (1.7%) had grade 5 AEs of any cause. Survival data maturity was limited. Median PFS was 10.9 months (95% confidence interval: 7.3-15.6), and 12-month PFS and overall survival rates were 49.6% and 84.1%, respectively. CONCLUSIONS Durvalumab after sCRT had a comparable safety profile with that observed with durvalumab after cCRT in PACIFIC and had encouraging preliminary efficacy in a frailer population.
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Affiliation(s)
- Marina C Garassino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Hematology/Oncology, The University of Chicago, Chicago, Illinois.
| | - Julien Mazieres
- Centre Hospitalier Universitaire, Université Paul Sabatier, Toulouse, France
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Niels Reinmuth
- Asklepios Fachkliniken München-Gauting, German Center for Lung Research, Gauting, Germany
| | - Laura Cove-Smith
- The Christie NHS Foundation Trust and Manchester University Hospitals Foundation Trust, Manchester, United Kingdom
| | - Talal Mansy
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | | | | | - Angelo Delmonte
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori," Meldola, Italy
| | - José Garcia Sánchez
- Medical Oncology Department, Hospital Arnau de Vilanova, Fundación para el Fomento de la Investigación Sanitaria i Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
| | | | - Reyes Bernabe
- Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Luis Paz-Ares
- Universidad Complutense, CiberOnc, CNIO and Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Corinne Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
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Justeau G, Huchot E, Simonneau Y, Roa M, Le Treut J, Le Garff G, Bylicki O, Schott R, Bravard AS, Tiercin M, Lamy R, De Chabot G, Marty A, Moreau D, Locher C, Bernier C, Chouaid C, Descourt R. Impact of KRAS G12C mutation in patients with advanced non-squamous non-small cell lung cancer treated with first-line pembrolizumab monotherapy. Lung Cancer 2022; 174:45-49. [PMID: 36323057 DOI: 10.1016/j.lungcan.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Few data are available on the impact of KRAS mutation in patients with advanced non-squamous non-small cell lung cancer (aNSCLC) treated with immunotherapy. This analysis assessed the impact of KRAS mutation on the efficiency of first-line pembrolizumab immunotherapy in aNSCLC patients with PD-L1 ≥ 50 %. METHODS This was a secondary analysis of the ESCKEYP study, a retrospective, national, multicenter study which included consecutively all metastatic NSCLC patients who initiated first-line treatment with pembrolizumab monotherapy from May 2017 (date of pembrolizumab availability in this indication in France) to November 22, 2019 (pembrolizumab-chemotherapy combination approval). Progression-free survival (PFS) and overall survival (OS) were calculated from the start of pembrolizumab treatment by the Kaplan-Meier method. Tumor response and PFS were assessed locally. RESULTS Among the 681 non-squamous aNSCLC PD-L1 ≥ 50 % patients treated with pembrolizumab in the first line, 227 (33.0 %) had a KRAS mutation (KRAS G12C, 12.5 %; KRAS non-G12C, 20.5 %). Except among non-smokers (KRAS G12C, 0 %; KRAS non-G12C, 2.9 %; no KRAS mutation, 9.2 %), patients presented no differences in terms of sex, age, number and sites of metastatic disease at diagnosis, use of corticosteroids, use of antibiotics, and for biological factors between wild-type KRAS, KRAS G12C and non-KRAS G12C groups. Median (95 % CI) PFS in months were 7.0 (3.7-14) for KRAS G12C, 4.8 (3.4-6.7) for KRAS non-G12C and 8.5 (7.3-10.6) for wild-type KRAS genotypes (p = 0.23). Median OS were 18.4 (12.6-NR), 20.6 (11.4-NR) and 27.1 (18.7-34.2) months, respectively (p = 0.57). CONCLUSION No difference in efficacy was observed in non-squamous aNSCLC patients treated with first-line pembrolizumab immunotherapy whether they presented a KRAS G12C, non KRAS G12C or wild-type KRAS genotype.
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Affiliation(s)
- Grégoire Justeau
- Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49000 Angers, France; INSERM U955, Créteil, France.
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Excoffier JB, Salaün-Penquer N, Ortala M, Raphaël-Rousseau M, Chouaid C, Jung C. Analyse des patients hospitalisés pour COVID-19 lors du premier confinement de 2020 à l'aide de méthodes d'explicabilité. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634428 DOI: 10.1016/j.respe.2022.09.007] [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] [Indexed: 11/06/2022] Open
Abstract
Introduction La pandémie de COVID-19 a rapidement mis une forte pression sur les centres hospitaliers et en particulier sur les services de réanimation [1]. Il y eut lors du premier confinement un besoin urgent d'outils permettant d'identifier les patients hospitalisés les plus à risque de subir une aggravation de leur état, ainsi qu'une meilleure compréhension de la typologie des patients COVID-19. Méthodes Les données contiennent des informations sur des patients hospitalisés au Centre Hospitalier Intercommunal de Créteil à cause de la COVID-19 lors de la première vague de l'épidémie (printemps 2020). Les variables explicatives disponibles sur les patients étaient l'âge, le sexe, plusieurs comorbidités et les résultats des examens radiologiques et biologiques. Un modèle d'ensemble d'arbres stimulé (« Boosted Tree Ensemble » [2, 3]) a été appliqué pour détecter si l'état du patient allait s'aggraver pendant l'hospitalisation. L'analyse des effets de chaque variable explicative ainsi que des effets d'interaction entre deux variables ont été effectuées en utilisant des méthodes d'explicabilité, domaine aussi appelée intelligence artificielle explicable [4]. Une stratification de la typologie des patients [5] a été réalisée en utilisant techniques de regroupement (clustering) et de sélection d'instances. Résultats Il y avait 409 patients, dont 176 (43 %) avaient subi une aggravation pendant leur séjour hospitalier. La précision globale (« accuracy ») du modèle prédictif était de 75 % pour le modèle de risque tandis que le score ROC AUC était de 81 %. Les variables explicatives les plus importantes étaient l'âge, la gravité du scanner thoracique et les variables biologiques telles que la CRP, la saturation en oxygène et les éosinophiles. Plusieurs variables ont montré de forts effets non linéaires, en particulier pour la sévérité du scanner, comme indiqué dans la Figure 1. Des effets d'interaction ont également été détectés entre l'âge et le sexe ainsi qu'entre l'âge et les éosinophiles. Trois principaux sous-groupes de patients ont été identifiés. Le patient le plus représentatif de chaque groupe est indiqué dans la Figure 2. Le premier groupe présentait un risque très faible d'aggravation de l'état de santé (pas de facteur de risque), le deuxième groupe présentait un risque plus élevé d'aggravation, mais toujours inférieur à 50 % (leur seul facteur de risque était un âge avancé), tandis que le troisième groupe avait le pronostic le plus défavorable (plusieurs facteurs de risque comprenant un âge avancé, plusieurs comorbidités, une sévérité CT élevée et des valeurs biologiques anormales). Discussion Les méthodes d'explicabilité ainsi que les techniques de regroupement et de sélection d'instances ont permis de mieux comprendre les effets des variables explicatives. Cela a aussi permis de déterminer les principales typologies des patients hospitalisés, facilitant ainsi la définition et l'amélioration des protocoles médicaux pour fournir les soins les plus appropriés à chaque profil [6]. Mots clés COVID19; Intelligence artificielle; Explicabilité; Clustering Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
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Affiliation(s)
| | | | | | - M. Raphaël-Rousseau
- Centre hospitalier intercommunal de Créteil (CHIC) - Site web, Créteil, France
| | - C. Chouaid
- Centre hospitalier intercommunal de Créteil (CHIC) - Site web, Créteil, France
| | - C. Jung
- Centre hospitalier intercommunal de Créteil (CHIC) - Site web, Créteil, France
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Jung C, Excoffier JB, Raphaël-Rousseau M, Salaun-Penquer N, Ortala M, Chouaid C. Evolution du profil des patients hospitalisés au cours des trois premières vagues de COVID-19 par des techniques d'apprentissage automatique. Rev Epidemiol Sante Publique 2022. [PMCID: PMC9634431 DOI: 10.1016/j.respe.2022.09.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction La COVID-19 a rapidement évolué d'une épidémie locale à une pandémie mondiale, obligeant la plupart des pays à prendre de fortes mesures pour contenir la propagation au cours des différentes vagues et soulager la pression sur les centres hospitaliers, en particulier sur les unités de soins intensifs. Une abondante littérature a détaillé les caractéristiques des patients et les facteurs de protection et de risque lors du l'éclatement de la pandémie [1]. Malheureusement, très peu d'études ont ensuite été menées pour décrire l'évolution de ces caractéristiques au cours des vagues ultérieures [2,3]. De plus, comme les premiers facteurs de risque identifiés étaient pluriels (de l'âge aux comorbidités, multiples interactions) les méthodes classiques d'analyse ne suffisent pas à obtenir une compréhension précise de la population à risque de développer des formes sévères de COVID-19. Méthodes Les données ont été recueillies prospectivement au Centre hospitalier intercommunal de Créteil sur plus d'un an, correspondant aux trois premières vagues de COVID-19 en France. Les caractéristiques disponibles étaient l'âge, le sexe et de nombreuses comorbidités. La variable cible indiquant si le patient avait développé une forme sévère (ventilation mécanique, réanimation, décès) de COVID-19 pendant son l'hospitalisation. L'évolution des caractéristiques entre les cas non sévères et sévères au fil des vagues a été analysée en couplant un modèle d'apprentissage automatique [4] à une méthode d'explicabilité produisant des influences locales [5]. Ainsi, chaque patient se voit associé un niveau de risque (une probabilité d'être un cas sévère) et un score de contribution de chacune de ses variables explicatives, permettant de repérer les facteurs de protection et de risque. Résultats Il y avait 1076 patients sur les trois vagues: 429 pour la première vague, 214 pour la deuxième et 433 pour la troisième. Les formes sévères concernaient respectivement 29 %, 31 % et 18 % de chaque vague. Les facteurs de risque de la première vague comprenaient l'âge avancé (≥70 ans), être un homme et des comorbidités telles que le diabète et l'obésité, tandis que les problèmes cardiovasculaires apparaissaient comme un léger facteur de protection. Il y avait de plus des effets d'interaction entre l'âge et les autres variables importantes. La deuxième vague présentait moins de facteurs de risque, puisque seuls l'âge avancé (≥70 ans) et le fait d'être un homme étaient des informations importantes. Lors de la troisième vague, l'âge avancé (≥70 ans) a également été identifié comme un facteur de risque mais de manière plus hétérogène que pour les vagues précédentes. Être un homme et les comorbidités telles que l'obésité, la grossesse ainsi que les problèmes cardiovasculaires et pulmonaires sont également apparus comme des facteurs de risque mais il n'y avait pas d'interaction avec l'âge. Discussion La typologie des patients hospitalisés atteints de formes sévères de COVID-19 a rapidement évolué au fil des vagues. L'analyse a notamment mis en évidence que les facteurs de risque étaient beaucoup plus hétérogènes pour la troisième vague. Cette évolution peut être due aux changements des pratiques hospitalières à mesure que la maladie était mieux comprise ainsi qu'à la campagne de vaccination [6] ciblant en premier lieu les personnes comme à haut risque telles les personnes âgées ou présentant des comorbidités. Mots clés COVID; 19; Intelligence artificielle; Explicabilité Déclaration de liens d'intérêts Les auteurs n'ont pas précisé leurs éventuels liens d'intérêts.
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Affiliation(s)
- C. Jung
- Centre de Recherche Clinique, CHI Créteil, France
| | | | | | | | | | - C. Chouaid
- Service de pneumologie, CHI Créteil, France,Inserm U955, UPEC, IMRB, Créteil, France
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Ho C, Wong S, Hatswell A, Slater R, Vioix H, Chouaid C. 1180P Treatment patterns and progression-free survival in MET exon 14 (METex14) skipping advanced non-small cell lung cancer (aNSCLC) in real-world clinical practice. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1303] [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: 11/01/2022] Open
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Borget I, Chouaid C, Cotté FE, Gaudin AF, Grumberg V. 1330P Organizational impact of immune-checkpoint inhibitors in advanced cancers in France: Final analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1463] [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: 11/28/2022] Open
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Ricordel C, Anota A, Bernardi M, Falchero L, Auliac J, Greillier L, Bylicki O, De Chabot G, Demaegdt A, Vergnenegre A, Decroisette C, Martel-Lafay I, Chouaid C, Guisier F. 962P Quality of life at diagnosis for unresectable stage III NSCLC: Initial results from the national prospective study OBSTINATE (GFPC 06-2019). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1088] [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: 11/29/2022] Open
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Auliac J, Simmoneau Y, Thomas P, Guisier F, Bylicki O, Curcio H, Swalduz A, Wislez M, Geier M, J. Le Treut, Decroisette C, Falchero L, Tricard J, Moreau D, Huchot E, De Chabot G, Leroy K, Mansuet AL, Chouaid C, Greillier L. 937P Incidence and outcomes of EGFR mutated non-small cell lung cancer treated with surgery: EXERPOS GFPC study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1063] [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: 11/01/2022] Open
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Benderra MA, Gonzalez-Serrano A, Paillaud E, Martinez-Tapia C, Cudennec T, Chouaid C, Lorisson E, De la Taille A, Laurent M, Brain E, Bringuier M, Gligorov J, Caillet P, Canouï-Poitrine F. 1605P Comparison of the prognostic value of comorbidities in older patients with colorectal, breast, prostate or lung cancer: The ELCAPA cohort study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1698] [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: 11/01/2022] Open
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Decroisette C, Monnet I, Ricordel C, Demaegdt A, Falchero L, Bylicki O, Geier M, Justeaux G, Bernardi M, Andre M, Guisier F, Fournel P, Vieillot S, Hauss P, Schott R, Crequit J, Auliac J, Chouaid C, Greillier L. 1035P A phase II trial of nivolumab and denosumab association as second-line treatment for stage IV non-small-cell lung cancer (NSCLC) with bone metastases: DENIVOS study (GFPC 06-2017). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1161] [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: 11/28/2022] Open
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Lena H, Monnet I, Bylicki O, Audigier-Valette C, Falchero L, Vergnenegre A, Demontrond P, Greillier L, Geier M, Guisier F, Decroisette C, Locher C, Corre R, Cropet C, Chouaid C, Ricordel C. Randomized phase III study of nivolumab and ipilimumab versus carboplatin-based doublet in first-line treatment of PS 2 or elderly (≥ 70 years) patients with advanced non–small cell lung cancer (Energy-GFPC 06-2015 study). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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
9011 Background: Combination of anti-PD1 and CTLA4 have showed superiority to chemotherapy (CT) in advanced non–small cell lung cancer (NSCLC), but data for fit elderly or PS2 patients are scarce. Methods: eNErgy compared the combination of nivolumab ipilimumab (N-I) to a platinum doublet in elderly or PS2 patients with advanced NSCLC. Primary endpoint was overall survival (OS), secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. Main inclusion criteria were: stage IV histologically proven NSCLC, age ≥ 70 y, and PS 0/1/2 or age < 70 and PS2, EGFR ALK/ROS1 negative, judged fit enough to receive a platinum doublet. The main exclusion criteria were active cerebral metastasis or contraindication to N-I. Patients were randomly selected 1/1, stratified by age (≥ 70 vs. < 70 y), PS (0/1 vs. 2), and histology (squamous vs. no-squamous). Nivolumab (240 mg, 2w), ipilimumab, 1 mg/kg, 6w, was administrated until progression or unacceptable toxicity. CT was planned for 4 cycles, with carboplatin (AUC5) and pemetrexed (500 mg/m2, 3w) or paclitaxel (90 mg/m2, d1,d8, d15); 242 patients had to be randomized to detect a treatment effect hazard ratio (HR) on OS of 0.65, with a 85% power at a 2-sided alpha level of 5%. Results: A preplanned interim analysis carried out after observation of 33% of deaths, out of 174 randomized patients, showed a risk of futility especially for PS 2 patients, HR: 1.8 (95% CI, 0.99-3.3). This led to a halt in randomization but continued follow-up of the 204 patients randomized at the time of the decision. The current final analysis is carried out 18 months after the inclusion of the last patient: men, 71%, median age 74 (51-89, PS 0/1/2 in 30%, 37.5%, and 36.6% respectively), smokers or former smokers in 25.5 and 64.4%, with 62% adenocarcinoma. The median OS of N-I and chemo arms were 14.7 (95% CI, 8.0-19.7) and 9.9 (95% CI, 7.7-12.3) months, HR 0.85, 95% CI, 0.62-1.16. The subgroup analyses showed a significant benefit of the association N-I compared to CT for elderly PS 0/1 patients, with median OS of 22.6 (95% CI, 18.1-36) vs. 11.8 (95% CI, 8.9-20.5) months, p = 0.02. In PS2 patients, median OS of N-I and CT arms was 2.9 (1.4-4.8) vs. 6.1 (3.5-10.4) months (p = 0.22). Median PFS was significantly in favor of N-I arm in the entire population: 5.5 (2.8-8.7) vs. 4.6 (3.5-5.6); p = 0.015. Safety was similar with 31.4% of patients with grade ≥ 3 related SAES in N-I arm vs. 49.5% for CT. Treatment was discontinued for toxicity in 28.6% in N-I arm vs. 22.3% of patients in CT arm. Conclusions: Despite no statistically significant benefit in OS observed in the entire population, there was a clinical signal of efficacy of N-I combination over platinum doublet in elderly NSCLC patients PS 0-1 with a significant benefit of OS of 22.6 months vs. 11.8 for CT arm. Clinical trial information: NCT03351361.
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Affiliation(s)
- Herve Lena
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | | | - Lionel Falchero
- Pneumology Department, Hopital Nord Ouest Villefranche Sur Saone, Villefranche Sur Saone, France
| | | | | | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Marseille, France
| | | | | | | | | | - Romain Corre
- Centre Hospitalier Intercommunal de Cornouaille, Service de Pneumologie, Quimper, France
| | - Claire Cropet
- Unite de Biostatistique et d'Evaluation des Therapeutiques-Direction de la Recherche et d l'Innovation, Centre Leon Berard, Lyon, France
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Sebbag E, Cloarec N, Barthelemy P, Sedmak N, Hamamouche N, Servy H, Desjeux G, Monnet I, Najem A, Porneuf M, Rajpar LS, Meunier J, San T, Chauvenet L, Darut Jouve A, Falkowski S, Rizzo C, Litrowski N, Canellas A, Paitel JF, Pracht M, Cadranel J, Weiss L, Chouaid C, Aparicio T, Nancey S, Arnold C, Sauleau E, Gottenberg JE. POS1412 FIRSTS RESULTS OF THE PRAISE STUDY (PATIENT-REPORTED AUTOIMMUNITY SECONDARY TO CANCER IMMUNOTHERAPY): MULTICENTRIC PROSPECTIVE COHORT STUDY ON AUTOIMMUNE DISEASES SECONDARY TO CANCER IMMUNOTHÉRAPY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIn cancer immunotherapy, T-lymphocyte activation can lead to secondary autoimmune diseases named OASI for Opportunistic Autoimmunity Secondary to cancer Immunotherapy [1]. The epidemiology of OASI deserves to be further studied due to the unadapted reporting of clinical trials and the lack of prospective studies. Moreover, literature focuses on the most severe OASI and/or on specific OASI (myocarditis, colitis, arthritis).ObjectivesOur goal was to determine incidence, severity of all grade OASI using a multicentric prospective patient cohort starting treatment with cancer immunotherapy.MethodsWe present a multicentric, prospective, observational, longitudinal, real life, French e-cohort. 900 patients treated with ipilimumumab and/or nivolumab will be included. Data is collected from the patient and the oncologist at inclusion, then patients report directly any symptom that could be suggestive of OASI with the help of monthly digital questionaries. In case an OASI is suspected, further confirmation is made with the practician in charge and by a paired analysis with the Système National De Santé (SNDS), the French health insurance registry.ResultsOn the 19/01/2022, 439 patients were included, 310 males (70.6%) and 129 females (29.4%). Mean age is 66 years old with a median follow up of 192 days. 354 patients (80.6%) are treated with Nivolumab alone, 7 (1.6%) with Ipilimumab alone and 76 (17.8 %) with combined Nivolumab + Ipilimumab. 136 patients (31.6%) are treated for a non-small cell lung carcinoma, 107 patients (24.9%) for a clear cell renal carcinoma, 91 patients (21.2%) for a skin melanoma, 49 patients (11.4%) for a head or neck epidermoid carcinoma, 24 patients (5.6%) for another lung cancer sub-type, and 32 patients (5.3%) for another histological cancer type. The mean follow-up is 294 days (+/- 192). 83 patients (18.9%) died since the beginning of the follow up.47 patients (10.7%) developed 63 OASI. The mean delay between the beginning of cancer immunotherapy and the OASI is 134.7 days (+/- 103.4).Approximately, one third of the OASI were musculoskeletal diseases. The OASI included polymyalgia rheumatica (3 patients), psoriatic arthritis (1 patient), polyarthritis (1 patient) systemic lupus (1 patient), arthralgias and myalgias (8 patients), colitis (11 patients), dysthyroïditis (6 patients), hepatitis (4 patients), nephritis (3 patients), pneumonitis (2 patients), hypophysitis (2 patients), adrenal insufficiency (4 patients), myocarditis (1 patient), hemophagocytic lympho-histiocytosis (1 patient), and other types of OASI (15 patients).26 patients (55% of patients with OASI, 5,9% of all patients) had to stop cancer immunotherapy due to an OASI, one because of a rheumatic disease (systemic lupus). 52 patients were treated with corticosteroids, 1 patient with methotrexate (psoriatic arthritis), 3 patients with infliximab (colitis) and 1 patient with abatacept (myocarditis). 1 patient died after an OASI (colitis).ConclusionThe first results of this prospective study, using an original patient-centered methodology, confirm the expected incidence of autoimmune events secondary to cancer immunotherapy and the role of rheumatologists in their therapeutic management.References[1]Kostine M, Chiche L, Lazaro E, et al. Opportunistic autoimmunity secondary to cancer immunotherapy (OASI): An emerging challenge. Rev Med Interne. 2017;38(8):513-525. doi:10.1016/j.revmed.2017.01.004AcknowledgementsBMS funded the study (unrestricted grant) but had no role in study design, data collection, analysis or decision to publish.Disclosure of InterestsEden Sebbag: None declared, Nicolas Cloarec: None declared, Philippe Barthelemy: None declared, Nathanaël Sedmak: None declared, Naima Hamamouche Consultant of: Work for Sanoia Digital CRO, Hervé Servy Consultant of: Work for Sanoia Digital CRO, Guillaume Desjeux Consultant of: Work for Sanoia Digital CRO, Isabelle Monnet: None declared, Abeer Najem: None declared, Marc Porneuf: None declared, Laetitia-Shanna Rajpar: None declared, Jérôme Meunier: None declared, Tévy San: None declared, Laure Chauvenet: None declared, Ariane DARUT JOUVE: None declared, Sabrina FALKOWSKI: None declared, Claudia Rizzo: None declared, Noémie Litrowski: None declared, Anthony Canellas: None declared, Jean-François Paitel: None declared, Marc Pracht: None declared, Jacques Cadranel: None declared, Laurence Weiss: None declared, Christos Chouaid: None declared, Thomas Aparicio: None declared, Stephane Nancey: None declared, Cécile Arnold: None declared, Erik Sauleau: None declared, Jaqcues-Eric Gottenberg: None declared
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Excoffier JB, Salaün-Penquer N, Ortala M, Raphaël-Rousseau M, Chouaid C, Jung C. Analysis of COVID-19 inpatients in France during first lockdown of 2020 using explainability methods. Med Biol Eng Comput 2022; 60:1647-1658. [PMID: 35426076 PMCID: PMC9009979 DOI: 10.1007/s11517-022-02540-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/23/2022] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic rapidly puts a heavy pressure on hospital centers, especially on intensive care units. There was an urgent need for tools to understand typology of COVID-19 patients and identify those most at risk of aggravation during their hospital stay. Data included more than 400 patients hospitalized due to COVID-19 during the first wave in France (spring of 2020) with clinical and biological features. Machine learning and explainability methods were used to construct an aggravation risk score and analyzed feature effects. The model had a robust AUC ROC Score of 81%. Most important features were age, chest CT Severity and biological variables such as CRP, O2 Saturation and Eosinophils. Several features showed strong non-linear effects, especially for CT Severity. Interaction effects were also detected between age and gender as well as age and Eosinophils. Clustering techniques stratified inpatients in three main subgroups (low aggravation risk with no risk factor, medium risk due to their high age, and high risk mainly due to high CT Severity and abnormal biological values). This in-depth analysis determined significantly distinct typologies of inpatients, which facilitated definition of medical protocols to deliver the most appropriate cares for each profile. Graphical abstract represents main methods used and results found with a focus on feature impact on aggravation risk and identified groups of patients ![]()
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Mahé I, Mayeur D, Chouaid C, Gaudry J, Foist M, Pertus D, Spiess N. PO-33: Real-world VTE and implemented treatments in patients with cancer: an observational study in the French EGB database. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00223-7] [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: 11/16/2022]
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Garassino M, Mazieres J, Reck M, Chouaid C, Bischoff H, Reinmuth N, Cove-Smith L, Mansy T, Cortinovis D, Migliorino M, Delmonte A, Garcia Sánchez J, Chara Velarde L, Bernabe R, Paz-Ares L, Diaz Perez I, Trunova N, Foroutanpour K, Faivre-Finn C. 108MO Safety and efficacy outcomes with durvalumab after sequential chemoradiotherapy (sCRT) in stage III, unresectable NSCLC (PACIFIC-6). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jung C, Excoffier JB, Raphaël-Rousseau M, Salaün-Penquer N, Ortala M, Chouaid C. Evolution of hospitalized patient characteristics through the first three COVID-19 waves in Paris area using machine learning analysis. PLoS One 2022; 17:e0263266. [PMID: 35192649 PMCID: PMC8863256 DOI: 10.1371/journal.pone.0263266] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/14/2022] [Indexed: 12/16/2022] Open
Abstract
Characteristics of patients at risk of developing severe forms of COVID-19 disease have been widely described, but very few studies describe their evolution through the following waves. Data was collected retrospectively from a prospectively maintained database from a University Hospital in Paris area, over a year corresponding to the first three waves of COVID-19 in France. Evolution of patient characteristics between non-severe and severe cases through the waves was analyzed with a classical multivariate logistic regression along with a complementary Machine-Learning-based analysis using explainability methods. On 1076 hospitalized patients, severe forms concerned 29% (123/429), 31% (66/214) and 18% (79/433) of each wave. Risk factors of the first wave included old age (≥ 70 years), male gender, diabetes and obesity while cardiovascular issues appeared to be a protective factor. Influence of age, gender and comorbidities on the occurrence of severe COVID-19 was less marked in the 3rd wave compared to the first 2, and the interactions between age and comorbidities less important. Typology of hospitalized patients with severe forms evolved rapidly through the waves. This evolution may be due to the changes of hospital practices and the early vaccination campaign targeting the people at high risk such as elderly and patients with comorbidities.
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Affiliation(s)
- Camille Jung
- Clinical Research Center, CHI Créteil, Créteil, France
| | | | | | | | | | - Christos Chouaid
- Department of pneumology, CHI Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, Créteil, France
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Rousseau M, Excoffier JB, Salaun-Penquer N, Ortala M, Chouaid C, Jung C. Evolution des facteurs de risque de forme grave de la COVID-19 à travers les trois vagues à partir des données du PMSI. Rev Epidemiol Sante Publique 2022. [PMCID: PMC8907805 DOI: 10.1016/j.respe.2022.01.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction De nombreuses études ont établi une typologie des patients à risque de développer une forme grave de COVID-19. La grande majorité de ces études ne portent que sur la première vague de la COVID-19 alors que les profils à risque de développer des formes graves évoluent après les campagnes de vaccination. Cette étude a pour but d'analyser l’évolution des facteurs de risque cliniques de COVID-19 graves lors des différentes vagues afin d'ajuster l'offre de soins au contexte actuel. Méthodes Les données du PMSI du Centre hospitalier intercommunal de Créteil ont été analysées pendant les trois premières vagues de l'épidémie. Les variables cliniques disponibles étaient l’âge, le sexe et les comorbidités connues comme à risque de forme grave. Les formes graves étaient définies par le passage en réanimation, le recours à un support ventilatoire non invasif ou le décès du patient. L'évolution de la typologie des patients à risque a été analysée avec des méthodes classiques comme la régression multivariée ainsi qu'avec des techniques provenant de l'apprentissage automatique et de son sous-domaine qu'est l'explicabilité. Résultats Sur 1076 patients hospitalisés, les formes sévères concernaient 29 % (123/429) des patients de la vague 1, 31 % (66/214) de la vague 2 et 18 % (79/433) de la vague 3. Les facteurs de risque de la vague 1 étaient l'âge élevé ( ≥ 70 ans), le sexe masculin, le diabète et l'obésité, tandis que les problèmes cardiovasculaires apparaissaient comme des facteurs protecteurs. Les impacts de l'âge, du sexe étaient moins marqués pour la vague 3, de même que l'interaction entre l'âge et les comorbidités. Discussion/Conclusion Le profil des patients à risque a rapidement évolué au cours des vagues, la troisième vague ayant eu un écart bien moins net entre les formes sévères et non-sévères. Cette évolution peut provenir des changements des procédures médicales hospitalières ainsi que du début de la campagne de vaccination ciblant en premier lieu les personnes avec un risque élevé telles les personnes âgées ou présentant certaines comorbidités.
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Van Sanden S, Murton M, Bobrowska A, Rahhali N, Sermon J, Rodrigues B, Goff-Leggett D, Chouaid C, Sebastian M, Greystoke A. Prevalence of Epidermal Growth Factor Receptor Exon 20 Insertion Mutations in Non-small-Cell Lung Cancer in Europe: A Pragmatic Literature Review and Meta-analysis. Target Oncol 2022; 17:153-166. [PMID: 35226283 PMCID: PMC8995294 DOI: 10.1007/s11523-022-00868-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 12/21/2022]
Abstract
Background Information on the epidemiology of uncommon EGFR mutations including exon 20 insertions amongst non-small-cell lung cancer (NSCLC) is lacking. Objective The objective of this pragmatic literature review (PLR) and meta-analysis was to generate robust prevalence and incidence estimates based on ranges of exon 20 insertion mutations reported in the literature. Materials and methods Searches of MEDLINE, Embase, congresses and reference lists for articles published from 2013 in key European countries of interest (Belgium, France, Germany, Italy, The Netherlands, Spain, Sweden, Switzerland, United Kingdom) were performed. Articles were reviewed against pre-specified criteria and their quality was appraised using a published checklist. Prevalence estimates were synthesised by random-effects meta-analyses. Results Eighty unique studies of moderate-to-high quality were included in the PLR. The meta-analysed prevalence for EGFR mutations was 12.5% (95% confidence interval [CI]: 11.0, 14.1) in any stage NSCLC and 14.8% (12.8, 17.1) in advanced/metastatic NSCLC. The prevalence of exon 20 insertions was 0.7% (0.4, 1.1) in any stage NSCLC and 6.1% (4.0, 9.4) in any stage EGFR-positive NSCLC. Mutation status was primarily measured using direct sequencing or a combination of methods. One study reporting exon 20 insertions in advanced/metastatic disease was identified, which reported a prevalence of 0.5% in overall NSCLC and 4.0% in EGFR-positive NSCLC. Conclusions EGFR exon 20 insertion mutations are rare in NSCLC. There is a high unmet need in patients with exon 20 insertions, including effective therapies. Prospective cohort studies are needed to better clinically characterise these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11523-022-00868-z.
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Affiliation(s)
| | | | | | | | | | | | | | - Christos Chouaid
- Department of Pneumology and Thoracic Oncology, Intermunicipal Hospital Centre of Créteil, Créteil, France
| | - Martin Sebastian
- Department of Medicine, Hematology and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Alastair Greystoke
- Sir Bobby Robson Clinical Trials Unit, Freeman Hospital, Newcastle upon Tyne, UK
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Avrillon V, Daniel C, Boisselier P, Le Péchoux C, Chouaid C. Nationwide Real-Life Safety and Treatment Exposure Data on Durvalumab After Concurrent Chemoradiotherapy in Unresectable Stage III, Locally Advanced, Non-small Cell Lung Cancer: Analysis of Patients Enrolled in the French Early Access Program. Lung 2022; 200:95-105. [PMID: 35141799 DOI: 10.1007/s00408-022-00511-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/02/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Consolidation immunotherapy with the PD-L1 inhibitor durvalumab following concurrent chemoradiotherapy (cCRT) has shown a significant survival improvement and is now a standard of care in patients with unresectable stage III or non-operable non-small cell lung cancer (NSCLC). METHODS In this early access program cohort, demographic, disease characteristics and safety data were collected for 576 patients from 188 centers, who received durvalumab 10 mg/kg intravenous infusion every 2 weeks, until disease progression or unacceptable toxicity or for a maximum of 12 months following cCRT. Durvalumab exposure data were available for 402 patients. RESULTS Overall, 576 patients were included, 72.9% were men, median age 64.0 years, 52.3% had a stage IIIB disease. PD-L1 status captured in 445 (77%) patients was positive (48.1%), negative (32.6%), unknown (19.3%). At the end of cCRT, adverse events (AEs) all grade ≤ 2, were reported in 22.7% of patients, mainly esophagitis (6.3%). The main reasons of discontinuation were completion of the planned 12 months of consolidation treatment (42.1% patients), disease progression (28.6%) and adverse events (19.5%). Treatment completion was similar in PDL-1 positive and PDL-1 negative patients groups. 20.7% patients had a SAE drug reaction and 17.7% stopped treatment mainly due to SAE. ADR rate and early treatment discontinuation were higher in patients > 70 years old. Death due to AEs occurred in 7 patients, 2 had interstitial lung disease. CONCLUSION Safety data with durvalumab consolidation after cCRT in a large cohort of patients with stage III NSCLC are reported in this real-life cohort. Consistent data were reported both in the PD-L1 positive and PD-L1 negative NSCLC patients in daily practice.
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Gendarme S, Bylicki O, Chouaid C, Guisier F. ROS-1 Fusions in Non-Small-Cell Lung Cancer: Evidence to Date. Curr Oncol 2022; 29:641-658. [PMID: 35200557 PMCID: PMC8870726 DOI: 10.3390/curroncol29020057] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
The ROS-1 gene plays a major role in the oncogenesis of numerous tumors. ROS-1 rearrangement is found in 0.9–2.6% of non-small-cell lung cancers (NSCLCs), mostly lung adenocarcinomas, with a significantly higher rate of women, non-smokers, and a tendency to a younger age. It has been demonstrated that ROS-1 is a true oncogenic driver, and tyrosine kinase inhibitors (TKIs) targeting ROS-1 can block tumor growth and provide clinical benefit for the patient. Since 2016, crizotinib has been the first-line reference therapy, with two-thirds of the patients’ tumors responding and progression-free survival lasting ~20 months. More recently developed are ROS-1-targeting TKIs that are active against resistance mechanisms appearing under crizotinib and have better brain penetration. This review summarizes current knowledge on ROS-1 rearrangement in NSCLCs, including the mechanisms responsible for ROS-1 oncogenicity, epidemiology of ROS-1-positive tumors, methods for detecting rearrangement, phenotypic, histological, and molecular characteristics, and their therapeutic management. Much of this work is devoted to resistance mechanisms and the development of promising new molecules.
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Affiliation(s)
- Sébastien Gendarme
- INSERM, IMRB (Clinical Epidemiology and Ageing Unit), University Paris Est Créteil, F-94010 Créteil, France;
- Pneumology Department, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, F-94010 Créteil, France
- Correspondence:
| | - Olivier Bylicki
- Respiratory Disease Unit, HIA Sainte-Anne, 2, Boulevard Saint-Anne, F-83000 Toulon, France;
| | - Christos Chouaid
- INSERM, IMRB (Clinical Epidemiology and Ageing Unit), University Paris Est Créteil, F-94010 Créteil, France;
- Pneumology Department, Centre Hospitalier Intercommunal de Créteil, 40, Avenue de Verdun, F-94010 Créteil, France
| | - Florian Guisier
- Department of Pneumology, Rouen University Hospital, 1 Rue de Germont, F-76000 Rouen, France;
- Clinical Investigation Center, Rouen University Hospital, CIC INSERM 1404, 1 Rue de Germont, F-76000 Rouen, France
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Griesinger F, Pérol M, Durand-Zaleski I, Bosquet L, Zacharias S, Calleja A, Patel S, Waldenberger D, Reynaud D, Carroll R, Daumont M, Penrod J, Lacoin L, Chouaid C. 109P Treatment patterns in patients with advanced non-small cell lung cancer (aNSCLC) after discontinuing an immune checkpoint inhibitor (ICI) therapy in second-line or later in Germany and France. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.127] [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: 10/19/2022] Open
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Assie JB, Chouaid C, Nunes H, Reynaud D, Gaudin AF, Grumberg V, Jolivel R, Jouaneton B, Cotté FE, Duchemann B. 101P Nivolumab outcomes in interstitial lung disease patients with advanced non-small cell lung cancer in French real-world setting. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.119] [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: 11/16/2022] Open
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Girard N, Perol M, Simon G, Audigier Valette C, Gervais R, Debieuvre D, Schott R, Quantin X, Coudert B, Lena H, Carton M, Robain M, Filleron T, Chouaid C. Treatment strategies for unresectable locally advanced non-small cell lung cancer in the real-life ESME cohort. Lung Cancer 2021; 162:119-127. [PMID: 34775215 DOI: 10.1016/j.lungcan.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cisplatin-based chemotherapy administered concurrently to thoracic radiation therapy is the recommended treatment for fit patients with unresectable stage III NSCLC. The aim of this study was to describe patient profiles and clinical outcomes for the different treatment strategies in a real-word setting. METHODS The epidemio-strategy and medical economics (ESME) database for advanced and metastatic lung cancer is a French, national, multicenter, observational cohort. Out of 8514 Patients, 822 patients with unresectable locally advanced NSCLC in 2015-016 were selected (mean age, 65.3 years; male gender, 69%; performance status 0-1, 77%; smokers or former smokers, 89%). RESULTS Treatment was initiated for 736 (90%) of patients (concurrent chemoradiotherapy, n = 283; sequential chemoradiotherapy, n = 121; chemotherapy alone, n = 194; radiotherapy alone, n = 121; targeted therapy alone, n = 8; other, n = 9). Compared to the other treatment strategy groups, patients with radiotherapy alone appeared the most fragile (e.g. higher age, lower body weight or higher frequency of chronic obstructive pulmonary disease). OS rates at 12 and 24 months were 79.5% (95% CI, 73.4-84.3) and 55.3% (95% CI, 44.9-64.5) for concurrent chemoradiotherapy, and 64.3% (95% CI, 52.8-73.8) and 53.2 (95% CI, 33.2-69.6) for sequential chemoradiotherapy. CONCLUSIONS Real-world evidence shows that concurrent chemoradiotherapy is administered to the most fit patients with non resectable locally-advanced NSCLC. Clinical outcomes are actually higher than those reported in landmark clinical trials, which suggests that an optimized and individualized selection of patients allows for prolonged survival. Long-term outcomes are similar after sequential or concurrent chemoradiotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Xavier Quantin
- Institut de Cancérologie de Montpellier, Montpellier, France
| | | | - Hervé Lena
- Centre Hospitalier Universitaire de Rennes, Rennes, France
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Scotte F, Simon H, Laplaige P, Antoine EC, Spasojevic C, Texier N, Gouhier K, Chouaid C. Febrile neutropenia prophylaxis, G-CSF physician preferences: discrete-choice experiment. BMJ Support Palliat Care 2021:bmjspcare-2021-003082. [PMID: 34706865 DOI: 10.1136/bmjspcare-2021-003082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Febrile neutropenia (FN) commonly occurs during cancer chemotherapy. Prophylaxis with granulocyte colony-stimulating factors (G-CSFs) is known to reduce the severity and incidence of FN and infections in patients with cancer. Despite the proven efficacy, G-CSFs are not always prescribed as recommended. We performed a discrete-choice experiment (DCE) to determine what factors drive the physician preference for FN prophylaxis in patients with cancer undergoing chemotherapy. METHODS Attributes for the DCE were selected based on literature search and on expert focus group discussions and comprised pain at the injection site, presence of bone pain, associated fever/influenza syndrome, efficacy of prophylaxis, biosimilar availability, number of injections per chemotherapy cycle and cost. Oncologists, in a national database, were solicited to participate in an online DCE. The study collected the responses to the choice scenarios, the oncologist characteristics and their usual prescriptions of G-CSFs in the context of breast, lungs and gastrointestinal cancers. RESULTS Overall, the responses from 205 physicians were analysed. The physicians were mainly male (61%), with ≤20 years of experience (76%) and working only in public hospitals (73%). The physicians prescribe G-CSF primary prophylaxis for 32% of patients: filgrastim in 46% and pegfilgrastim in 54%. The choice of G-CSF for primary and secondary prophylaxis was driven by cost and number of injections. Biosimilars were well accepted. CONCLUSION Cost and convenience of G-CSF drive the physician decision to prescribe or not G-CSF for primary and secondary FN prophylaxes. It is important that these results be incorporated in the optimisation of G-CSF prescription in the clinical setting.
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Affiliation(s)
- Florian Scotte
- Interdisciplinary patient pathway department, Gustave Roussy Institute, Villejuif, France
| | | | | | | | | | | | | | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
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Chouaid C, Filleron T, Debieuvre D, Pérol M, Girard N, Dansin E, Lena H, Gervais R, Cousin S, Otto J, Schott R, Planchard D, Madroszyk A, Kaderbhai C, Dubray-Longeras P, Hiret S, Pichon E, Clément-Duchêne C, Chenuc G, Simon G, Bosquet L, QUantin X. A Real-World Study of Patients with Advanced Non-squamous Non-small Cell Lung Cancer with EGFR Exon 20 Insertion: Clinical Characteristics and Outcomes. Target Oncol 2021; 16:801-811. [PMID: 34661827 DOI: 10.1007/s11523-021-00848-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Europe, few data regarding the characteristics of EGFR exon 20 insertion (20ins) mutations in non-small cell lung cancer (NSCLC) are available. OBJECTIVE Using a large real-world cohort, we assessed the incidence, characteristics, and outcomes of patients with non-squamous (nsq) NSCLC harboring EGFR exon 20ins. PATIENTS AND METHODS The Epidemio-Strategy and Medical Economics advanced and metastatic lung cancer data platform including advanced/metastatic nsqNSCLC patients from January 2015 was analyzed (cut-off date: June 30, 2020). Characteristics, epidermal growth factor receptor (EGFR) mutation and other mutations, treatment patterns, and clinical outcomes were assessed for patients harboring EGFR exon 20ins, common EGFR mutations, other EGFR mutations, and wild-type EGFR. Survival parameters were estimated by the Kaplan-Meier method in these four groups. RESULTS Out of 9435 nsqNSCLC patients tested for EGFR, 1549 (16.4%) had a mutation, including 61 with EGFR exon 20ins (3.9% of all mutated EGFR). These 61 patients had a mean age of 63.6 years, were mostly female (68.9%) and non-smokers (55.7%), with de novo stage IV disease (73.8%) and performance status 0-1 (76.9%). Almost all patients (95.1%) with exon 20ins received systemic therapy (median, three lines). First-line systemic treatments consisted mainly of combination chemotherapy (70.7%), single-agent EGFR tyrosine kinase inhibitors (10.3%), and single-agent immunotherapy (5.2%). After a median follow-up of 25.0 (95% confidence interval [CI] 22.3-32.4) months, the median real-world overall survival was 24.3 (19.1-32.6) months in patients with exon 20ins compared to 35.4 (95% CI 32.6-37.5) in patients with common EGFR mutation (n = 1049) (p = 0.049) and 19.6 (95% CI 18.6-20.5) in patients with wild-type EGFR (n = 7866) (p = 0.2). CONCLUSIONS This large national study in nsqNSCLC patients confirms that EGFR exon 20ins is a rare condition (0.6%). The prognosis associated with exon 20ins appears to be in line with that of wild-type EGFR, but worse than common EGFR mutations, highlighting the need for advancements for this rare population.
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Affiliation(s)
- Christos Chouaid
- Service de Pneumologie, Pneumology, Intercommunal Hospital, 40 avenue de Verdun, 94010, Créteil, France.
| | | | | | | | | | | | | | | | | | | | - Roland Schott
- Institut de Cancérologie Strasbourg Europe ICANS, Strasbourg, France
| | | | | | | | | | - Sandrine Hiret
- Institut de Cancérologie de l'Ouest, Angers, Nantes, France
| | | | - Christelle Clément-Duchêne
- Institut de Cancérologie de Lorraine, Nancy, France.,Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine, Nancy, France
| | | | | | | | - Xavier QUantin
- Institut Régional du Cancer de Montpellier, Montpellier, France
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Martel-Lafay I, Monnet I, Lardy-Cleaud A, Danhier S, Salem N, Gallocher O, Fournel P, Chouaid C, Bylicki O. Feasibility of Stereotactic Body Radiation Therapy on Unresectable Stage III NSCLC with Peripheral Primary Tumor: A Prospective Study (GFPC 01-14). Curr Oncol 2021; 28:3804-3811. [PMID: 34677242 PMCID: PMC8534340 DOI: 10.3390/curroncol28050324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
Concomitant radiochemotherapy (RTCT) is the standard treatment for unresectable stage III non-small cell lung cancer (NSCLC). However, in patients with a peripheral primary tumor, the irradiated volume may include a large portion of normal lung and RT-CT is not possible. This multicenter phase II trial in unresectable stage III NSCLC with peripheral primary tumor evaluated the feasibility of stereotactic body radiation therapy (SBRT) in peripheral tumor after concomitant radio-chemotherapy (RT-CT). Nineteen patients were included and analyzed (median age, 60.9 years; male, 78%; adenocarcinoma, 74%; median size of peripheral primary tumor, 19 mm). At 6 months, the disease control rate was 79% (15/19). SBRT toxicity was generally mild with one (5%) patient having grade 3 lung toxicity. Recruitment for this study was stopped prior to completion, firstly due to the approval of adjuvant durvalumab after RT-CT, which was not anticipated in the design, and secondly due to the small number of stage III NSCLC patients with a peripheral tumor that was accessible to SBRT. Nevertheless, the combination of RT-CT and SBRT appeared to be feasible and safe.
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Affiliation(s)
| | | | - Audrey Lardy-Cleaud
- Centre Léon Bérard, Direction de la Recherche Clinique et de l′Innovation, 69008 Lyon, France;
| | | | - Naji Salem
- Institute Paoli Calmettes, 13009 Marseille, France;
| | | | | | - Christos Chouaid
- Inserm U955, UPEC, IMRB, équipe CEpiA, Créteil, CHI Créteil, 94010 Créteil, France
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41
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Descourt R, Pérol M, Rousseau-Bussac G, Planchard D, Mennecier B, Wislez M, Cadranel J, Cortot A, Guisier F, Galland L, Do P, Schott R, Dansin E, Arrondeau J, Auliac J, Chouaid C. 1200P BrigALK2 study: A multicentric real-world study evaluating brigatinib in ALK positive advanced pre-treated non-small cell lung cancers: Long-term follow-up with focus on lorlatinib efficacy after brigatinib. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1805] [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: 11/28/2022] Open
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42
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Seban RD, Assié JB, Giroux-Leprieur E, Massiani MA, Bonardel G, Chouaid C, Deleval N, Richard C, Mezquita L, Girard N, Champion L. Prognostic value of inflammatory response biomarkers using peripheral blood and [18F]-FDG PET/CT in advanced NSCLC patients treated with first-line chemo- or immunotherapy. Lung Cancer 2021; 159:45-55. [PMID: 34311344 DOI: 10.1016/j.lungcan.2021.06.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We aimed to compare the prognostic value of inflammatory biomarkers extracted from pretreatment peripheral blood and [18F]-FDG PET for estimating outcomes in non-small cell lung cancer (NSCLC) patients treated with first-line immunotherapy (IT) or chemotherapy (CT). MATERIALS AND METHODS In this retrospective multicenter study, we evaluated 111 patients with advanced NSCLC who underwent baseline [18F]-FDG PET/CT before IT or CT between 2016 and 2019. Several blood inflammatory indices were evaluated: derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP) and systemic immune-inflammation index (SII). FDG-PET inflammatory parameters were extracted from lymphoid tissues (BLR and SLR: bone marrow or spleen-to-Liver SUVmax ratios). Association with survival and relationships between parameters were evaluated using Cox prediction models and Spearman's correlation respectively. RESULTS Overall, 90 patients were included (IT:CT) (51:39pts). Median PFS was 8.6:6.6 months and median OS was not reached:21.2 months. In the IT cohort, high dNLR (>3), high SII (≥1,270) and high SLR (0.77) were independent statistically significant prognostic factors for one-year progression-free survival (1y-PFS) and two-year overall survival (2y-OS) on multivariable analysis. In the CT cohort, high BLR (≥0.80) and high dNLR (>3) were associated with shorter 1y-PFS (HR 2.2, 95% CI 1.0-4.9) and 2y-OS (HR 3.4, 95CI 1.1-10.3) respectively, on multivariable analysis. Finally, BLR significantly but moderately correlated with most blood-based inflammatory indices (CRP, PLR and SII) while SLR was only associated with CRP (p < 0.01 for all). CONCLUSION In advanced NSCLC patients undergoing first-line IT or CT, pretreatment blood and inflammatory factors evaluating the spleen or bone marrow on [18F]-FDG PET/CT provided prognostic information for 1y-PFS and 2y-OS. These biomarkers should be further evaluated for potential clinical application.
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Affiliation(s)
- Romain-David Seban
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France; Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401, Orsay, France.
| | - Jean-Baptiste Assié
- Department of Pneumology, Paris-Est University, Centre Hospitalier Inter-Communal de Créteil, Inserm U955, UPEC, IMRB, équipe CEpiA, 94010 Créteil, France; Inserm, Centre de Recherche des Cordeliers, Sorbonne University, Université de Paris, Functionnal Genomics of Solid Tumors Laboratory, F-75006 Paris, France
| | - Etienne Giroux-Leprieur
- Department of Respiratory Diseases and Thoracic Oncology, APHP, Hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | | | - Gérald Bonardel
- Department of Nuclear Medicine, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Christos Chouaid
- Department of Pneumology, Paris-Est University, Centre Hospitalier Inter-Communal de Créteil, Inserm U955, UPEC, IMRB, équipe CEpiA, 94010 Créteil, France
| | - Nicolas Deleval
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France
| | - Capucine Richard
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France
| | - Laura Mezquita
- Department of Medical Oncology, Hospital Clínic, Laboratory of Translational Genomics and Target Therapeutics in Solid Tumors, IDIBAPS, 08036 Barcelona, Spain
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, F-75006 Paris, France
| | - Laurence Champion
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France; Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm, Institut Curie, 91401, Orsay, France
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Descourt R, Chouaid C, Pérol M, Besse B, Greillier L, Bylicki O, Ricordel C, Guisier F, Gervais R, Schott R, Auliac JB, Robinet G, Decroisette C. First-line pembrolizumab with or without platinum doublet chemotherapy in non-small-cell lung cancer patients with PD-L1 expression ≥50. Future Oncol 2021; 17:3007-3016. [PMID: 34156285 DOI: 10.2217/fon-2020-1202] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pembrolizumab plus chemotherapy is currently used in the first-line treatment of advanced non-small-cell lung cancer without EGFR mutations or ALK rearrangements, regardless of PD-L1 expression status. A study comparing chemotherapy plus pembrolizumab versus pembrolizumab alone has never been performed in patients with PD-L1 ≥50%. The aim of this trial is to perform such a comparison as first-line treatment in patients not eligible for locally advanced treatment who have expression of PD-L1 on ≥50% of tumor cells. The expected results are a reduction in the risk of early progression. A higher objective tumor response is also expected with the combination of chemotherapy and pembrolizumab compared with pembrolizumab alone. The study will allow a direct comparison of the proportion of patients who derive long-term benefit from the treatment. Clinical trial number: EudraCT (2020-002626-86); ClinicalTrials.gov (NCT04547504).
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Affiliation(s)
- Renaud Descourt
- Cancer institue, A. Morvan Hospital, CHRU, 29200, Brest, France
| | - Christos Chouaid
- Department of Pneumology, CHI Créteil, 94000, Créteil, France.,Inserm U955, UPEC, IMRB, équipe CEpiA, 94000, Créteil, France
| | | | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy, Villejuif, Université Paris-Saclay, Orsay, 94805, Villejuif, France
| | - Laurent Greillier
- Department of Multidisciplinary Oncology & Therapeutic Innovations, APHM, Hôpital Nord, Aix-Marseille, University, 13000, Marseille, France
| | - Olivier Bylicki
- Department of Pneumology, Military hospital, Sainte-Anne, 83800, Toulon, France
| | | | - Florian Guisier
- Pneumology, Thoracic Oncology & Respiratory Intensive Care Medicine & CIC INSERM U 1404, Rouen University Hospital, 76000, Rouen, France
| | - Radj Gervais
- Francois Baclesse Anticancer Center, 14000, Caen, France
| | - Roland Schott
- Paul Strauss Anticancer Center, 67000, Strasbourg, France
| | | | - Gilles Robinet
- Cancer institue, A. Morvan Hospital, CHRU, 29200, Brest, France
| | - Chantal Decroisette
- Department of Pneumology & Thoracic Oncology, CH Annecy-Genevois, 74370, Metz-Tessy, France
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Bouteiller F, Cousin S, Sofeu C, Perrocheau G, Gervais R, Perol M, Girard N, Chamorey E, Pasquier D, Dubray Longeras P, Kaderbhai C, Schott R, Filleron T, Chouaid C, Debieuvre D, Valette CA, Quantin X, Bosquet L, Martin A, Bellera C. Exploratory analyses of surrogate endpoints in metastatic non-small cell lung cancer. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.056] [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] Open
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45
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Doubre H, Monnet I, Azarian R, Girard P, Meyer G, Trichereau J, Devillier P, Van Dreden P, Couderc LJ, Chouaid C, Vasse M. Association of high level of plasma tissue factor activity with venous thromboembolism and early death in lung cancers. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8532] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8532 Background: Venous thromboembolism (VTE) is associated with tumor aggressiveness and mortality in cancers. Tissue Factor is the main activator of the coagulation but its variations in lung cancers (LC) have been less studied than D-dimers (DDi). We assessed plasma Tissue Factor Activity (TFa) and DDi and VTE events and mortality in patients with LC. Methods: This prospective study included patients, from 5 hospitals, recently diagnosed LC, without prior VTE or anticoagulant therapy within the last 2 months. Clinical and tumor data, Khorana score (KS), VTE events and overall survival (OS) were assessed (follow up 2 years). Blood samples were collected before any cancer treatment (V1): DDi (HemosIL) and TFa (chromogenic assay, Diagnostica Stago) were analyzed in a central lab. Independent nonparametric tests were used for group comparisons. A relevant clinical threshold of both markers was determined :1500 μg/ml for DDi and 1.2 ng/ml for TFa. Early death was compared using Cox model and Kaplan Meier curves and logrank tests. All tests were two-tailed tests and 0.05 was considered as significant. Results: Between 12/2014 and 01/2017, 302 consecutive patients (pts) were included (mean age 64 years, 61% males, 89% smokers, 85% NSCLC, 67% stage IV). At V1, TFa levels increased with cancer stage (p = 0.004) but not DDi. VTE incidence was 13,9%: 39 events (62% incidental and 51% pulmonary embolism) with 33 events within 6 months. KS failed to predict VTE (KS > 3 in 23% of the pts in VTE group vs 21% of the 302 pts, p = 0.42). DDi and TFa levels were not significantly different in VTE pts than in no VTE pts. But, a TFa > 1.2 ng/ml was significantly predictive in occurrence of VTE within the first 6 months (57.6% of the VTE pts vs 38.8% of no VTE pts, p = 0.04), and also within the first year (p = 0.03). Median OS was 17,6 months (m) in VTE pts and 19.5 m in no VTE pts (p = 0,97). Compared to survivors, higher levels of DDi and TFa were observed for the 38 pts who died within 6 months : 1.82 vs 0.67 μg/ml (p < 0.001) and 1.95 vs 0.33 ng/ml (p < 0.001) respectively. These differences were observed for the 97 pts who died during the first year, too. With thresholds of TFa > 1.2 ng/ml and DDi > 1500 μg/ml, median OS was significantly shorter: 14.4 m vs > 29.8 m ( p < 0,001) and 13.8 m vs 22.6 m (p < 0.001), respectively. Conclusions: High TFa level discriminates a population with high risk to VTE and early death in LC. This biomarker could take place in a predictive score. Clinical trial information: NCT02853188.
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Affiliation(s)
| | | | | | - Philippe Girard
- Thoracic Department,Institut Mutualiste Montsouris, Paris, France
| | | | - Julie Trichereau
- Direction Recherche Clinique et Innovation, HOPITAL FOCH, Suresnes, France
| | - Philippe Devillier
- Upres EA 220, Paris-Saclay University, Pneumology, Hopital Foch, Suresnes, France
| | | | | | - Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Demontrond P, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaid C, Decroisette C. First-line pembrolizumab monotherapy for PD-L1-positive (TPS ≥ 50%) advanced non-small cell lung cancer (aNSCLC) in the real world: A national French bispective multicentric cohort—ESCKEYP trial (GFPC 05-2018). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9091] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9091 Background: To determine real-world outcomes with first line pembrolizumab monotherapy, for aNSCLC with PD-L1 TPS ≥50%. Methods: Bispective, national and multicentric study including consecutively aNSCLC patients who initiated first-line pembrolizumab monotherapy from May 5, 2017 (marketing authorization of pembrolizumab monotherapy in France) to Nov 22, 2019 (marketing authorization of pembrolizumab-chemotherapy for non-squamous aNSCLC). Data were collected on medical charts. Responses were locally assessed according to RECIST v1.1; overall survival (OS) and real-world progression-free survival (rwPFS) were assessed by Kaplan-Meier method. Results: 845 patients (pts) were included by 33 centres: 67.8% were men, PS 0/1/≥2: 25.5%/46.9%/27.6%, active/former/nonsmokers: 39.1%/51.7%/6.4%, adenocarcinoma: 70.8%; stage IV at diagnosis: 91.6%; median number of metastatic sites at baseline: 2±1 (brain (20.8%), liver (13.9%) and bone (35%)); KRAS mutated: 27.7%, PDL1 TPS > 75%: 53.7% At the cut off date (31 December 2020), on the 783/845 (92.7%) evaluable pts, CR, PR, disease stabilization and progression were reported on 4.7%, 42.6%, 24.1% and 28.6% of cases, respectively; 588 (69.6%) pts had discontinued pembrolizumab, 390 (66.4%) had a first disease progression; 320/390 (82.1%) received a second line treatment, mainly platinum-based chemotherapy (90.6%). With a median follow up of 25,8 [95%CI: 24,8-26,7] months, median rwPFS and median OS were 8,2 [95%CI: 6,9-9,5] and 22,6 [95%CI: 18,5-27,4] months, respectively; 6, 12, 18-months survival rates were 76,8%, 64,8% and 54,3%. 835 adverse events were reported in 48% of the patients, grade ≥3 in 13.8% of cases, mainly asthenia, colitis, pneumonitis. For evaluable patients receiving a platinum-based doublet in second line (266/290, 89%), CR, PR, disease stabilization and progression were reported on 1.9%, 41%, 35.3% and 21.8% of cases, respectively. Uni and multivariate analysis of factors related to OS will be presented at the congress. Conclusions: Despite a less stringent selection of patients, pembrolizumab as a single agent achieves similar tumor shrinkage, rwPFS and OS than those of pivotal clinical trials.
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Affiliation(s)
- Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Marseille, France
| | - Maurice Perol
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | | | | | - Lionel Falchero
- Pneumology Department, Hopital Nord Ouest Villefranche Sur Saone, Villefranche Sur Saone, France
| | | | - Remi Veillon
- CHU Bordeaux, Service Des Maladies Respiratoires, Bordeaux, France
| | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-Sur-Yon, France
| | | | | | | | - Pierre Fournel
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | | | | | - Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
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Landre T, Justeau G, Assié JB, Chouahnia K, Taleb C, Chouaid C, Duchemann B. Anti PD-(L)1 in KRAS mutant advanced nsclcs: A meta-analysis of randomized controlled trials. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9025] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9025 Background: KRAS comprise the most frequently found oncogene driver mutation in non-small cell lung cancer (NSCLC), accounting for 20-25% of these patients. Single-agent Anti PD-(L)1 clinical efficacy against KRAS mutant NSCLC is a topic of debate. Methods: This meta-analysis examined randomized-trial data comparing first-or second line Anti PD-(L)1 +/- chemotherapy (CT) vs CT alone for KRAS mutant advanced NSCLCs. Outcome measures included overall survival (OS) and progression-free survival (PFS). Analyses were computed using the Cochrane method of collaboration for meta-analyses, with Review Manager software (RevMan version 5.3; Oxford, UK). Results: We analyzed 3 trials in first line (IMPOWER-150, KEYNOTE-189 and KEYNOTE-042), as well as 3 trials in second line (OAK, POPLAR and CHECKMATE-057) including 1313 NSCLCs (386 KRAS mutant and 927 KRAS wild-type tumor). Anti PD-(L)1 +/- CT was significantly associated (hazard ratio [95% confidence interval]) with prolonged OS (0.59 [0.49-0.72]; p < 0.00001) and PFS (0.58 [0.43-0.78]; p = 0.0003) compared to CT alone in KRAS mutant NSCLCs. Survival benefits occured in both first and second line. Survival benefits observed in KRAS wild-type NSCLCs were (0.87 [0.76-0.99]; p = 0.03) and (0.79 [0.56-1.11]; p = 0.17) respectively. OS benefit in KRAS mutant was significantly superior compared to OS benefit in KRAS wild-type (p = 0,001). Conclusions: Anti PD-(L)1 (+/- CT) appears superior to CT alone both for mutant and wild-type KRAS in advanced NSCLCs for OS and PFS with higher magnitude of benefit in KRAS mutated group for OS.
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Affiliation(s)
| | | | | | | | - Chérifa Taleb
- Geriatric Oncology, Hôpital René Muret, APHP, Sevran, France
| | - Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
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Chouaid C, Filleron T, Debieuvre D, Perol M, Girard N, Dansin E, Gervais R, Cousin S, Otto J, Schott R, Planchard D, Madroszyk A, Kaderbhai C, Dubray-Longeras P, Hiret S, Pichon E, Clement-Duchene CA, Martin AL, Simon G, Quantin X. EGFR Exon 20 insertion: Prognostic and predictive values in advanced non-small cell lung cancer, a real-world study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9062] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9062 Background: In Europe, 10-15% of non-squamous non-small cell lung cancer (nsqNSCLC) have EGFR mutations of which 5-12% are an Exon 20 insertion (20ins). Methods: Analysis of Epidemio-Strategy and Medical Economics (ESME) Advanced and Metastatic Lung cancer (AMLC) Data Platform (NCT03848052), a multicenter real-life database using a supervised, retrospective data collection process. The database includes 13737 advanced nsqNSCLC treated from January 2015 at participating centres. The cut-off date for patient follow-up for this analysis was June 30, 2020. The aim of the study was to assess real-world patient characteristics, treatment patterns and clinical outcomes of advanced nsqNSCLC EGFR 20ins. Overall survival (OS) of EGFR cohorts (20ins, 19del/L858R without 20ins, other EGFR mutations) and EGFR wild-type/not tested cohort were assessed. Results: 1549 (11.3%) nsqNSCLC had an EGFR mutation, 61 (3.9%) of whom being an EGFR 20ins. These 61 patients (pts) are mainly female (68.9%), non-smoker (55.7%), with de novo stage IIIB/IV disease (78.6%), PS 0-1 (76.9%). Median age was 68.0 years (q1-q3: 54-74). PD-L1 status was assessed in 34 (55.7%) pts, mainly (n = 20) before first line and 22 (64.7%) had negative result. Most (63.9%) pts had EGFR 20ins positive result available before first line. Almost all pts (95.1%, n = 58) received a systemic therapy with a median number of 3 (q1-q3: 1-4) lines. In first line setting, 74% of the pts received chemotherapy (mainly chemotherapy combination), 13.7% received EGFR TKI (mainly as monotherapy) and 8.6% received immunotherapy only. Median treatment duration for pts treated with CarboPem (n = 19), CisplatinPem (n = 16) and CarboTaxol (n = 6) were 4.7 (q1-q3: 2.6-6.6), 7.4 (q1-q3: 5.0-12.8) and 3.3 (q1-q3: 2.8-3.8) months, respectively. For afatinib (n = 3), erlotinib (n = 2) and gefitinib (n = 1), median treatment durations were 1.6 (q1-q3: 0.5-2.8); 1.8 (q1-q3: 1.4-2.1) and 2.3 months, respectively. After a median follow up of 36.3 (95%CI: 34.1-39.8) months, median OS was 24.3 (95%CI: 19.1-32.6) months; 1 and 2-years OS rates were 82.5% (95%CI: 69.7-90.2) and 52.6% (95%CI: 37.3-65.9), respectively. For pts with 19del/L858R without 20ins (n = 1049) and those with other EGFR mutations (n = 439) median OS were 35.4 (95%CI: 32.6-37.5) and 41.7 (95%CI: 31.9-53.5), respectively compared to 20.7 (95%CI: 20.0-21.8] months for pts EGFR wild type/not tested (n = 12188). Conclusions: This large, national real-world analysis based on medical chart data’s confirm that EGFR 20ins is a rare disease (0.4% of advanced nsqNSCLC). Currently available EGFR TKIs appear to have low efficacy and response to chemotherapy seems identical to that of EGFR wild-type/not tested pts. Prognosis for NSCLC pts with EGFR 20ins mutations was in line with that of EGFR wild type/not tested but worse than common EGFR mutations highlighting the need for advancements for this rare population.
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Affiliation(s)
- Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud-IUCT, Toulouse, France
| | - Didier Debieuvre
- Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Maurice Perol
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | - Nicolas Girard
- Institut Curie, Institut du Thorax Curie-Montsouris, Paris, France
| | - Eric Dansin
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Sophie Cousin
- Medical Oncology, Institute Bergonié, Bordeaux, France
| | - Josiane Otto
- Oncology, Centre Antoine Lacassagne, Nice, France
| | - Roland Schott
- Institut de Cancérologie Strasbourg Europe ICANS, Strasbourg, France
| | - David Planchard
- Gustave Roussy, Department of Medical Oncology, Villejuif, France
| | - Anne Madroszyk
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Sandrine Hiret
- Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | - Eric Pichon
- Centre Hospitalier Universitaire, Tours, France
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Pérol M, Quantin X, Lena H, Filleron T, Chouaid C, Valette CA, Kaderbhai C, Chenuc G, Santorelli M, Bensimon L, Burke T, Simon G, Martin AL, Debieuvre D, Gervais R, Schott R, Carton M, Courtinard C, Girard N. 110P Real-world evaluation of pembrolizumab monotherapy for previously treated PD-L1 positive (TPS>1%) advanced NSCLC in France. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01952-3] [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: 11/27/2022]
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McDonald F, Mornex F, Garassino M, Filippi A, Christoph D, Haakensen V, Agbarya A, Van den Heuvel M, Vercauter P, Chouaid C, Pichon E, Siva S, Steinbusch L, Peretz I, Solomon B, Decoster L, Sawyer W, Allen A, Licour M, Girard N. 79MO PACIFIC-R: Real-world characteristics of unresectable stage III NSCLC patients treated with durvalumab after chemoradiotherapy. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01921-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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