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Gamez Casado S, Benitez Fuentes JD, Álvarez Rodríguez B, García Ledo G. Achieving complete metabolic response in stage IV lung adenocarcinoma with chemotherapy, nivolumab, ipilimumab, and salvage SBRT: A case report. Respirol Case Rep 2024; 12:e01362. [PMID: 38660343 PMCID: PMC11042882 DOI: 10.1002/rcr2.1362] [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: 03/12/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
Oncogene-negative, PDL1-negative metastatic non-small cell lung cancer (NSCLC) presents significant treatment challenges due to its complexity and resistance to conventional therapies. The case report presented addresses a 55-year-old male patient with oncogene-negative, PDL1-negative stage IV lung adenocarcinoma, showcasing an exceptional complete metabolic response to a multimodality treatment combining double immune checkpoint inhibition (ICI) and chemotherapy, followed by salvage stereotactic body radiotherapy (SBRT). The patient underwent a treatment regimen incorporating two cycles of carboplatin, pemetrexed, nivolumab, and ipilimumab followed by nivolumab, and ipilimumab maintenance. After a partial response, SBRT was applied to persistent lesions, achieving a complete metabolic response. This case highlights the potential of combining dual ICI with chemotherapy and SBRT in treating oncogene-negative, PDL1-negative NSCLC underscoring the importance of multimodality treatment strategies.
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Affiliation(s)
- Salvador Gamez Casado
- Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (HM‐CIOCC)Department of Medical OncologyMadridSpain
| | - Javier David Benitez Fuentes
- Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (HM‐CIOCC)Department of Medical OncologyMadridSpain
- Hospital General Universitario de ElcheDepartment of Medical OncologyElcheSpain
| | - Beatriz Álvarez Rodríguez
- Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (HM‐CIOCC)Department of Radiation OncologyMadridSpain
| | - Gema García Ledo
- Hospital Universitario HM Sanchinarro, Centro Integral Oncológico Clara Campal (HM‐CIOCC)Department of Medical OncologyMadridSpain
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Andric Z, Gálffy G, Cobo Dols M, Szima B, Stojanovic G, Petrovic M, Felip E, Vicente Baz D, Ponce Aix S, Juan-Vidal O, Szalai Z, Losonczy G, Calles Blanco A, Bernabe R, García Ledo G, Aguilar Hernández A, Duecker K, Zhou D, Schroeder A, Guezel G, Ciardiello F. Avelumab in Combination With Cetuximab and Chemotherapy as First-Line Treatment for Patients With Advanced Squamous NSCLC. JTO Clin Res Rep 2023; 4:100461. [PMID: 36718142 PMCID: PMC9883276 DOI: 10.1016/j.jtocrr.2022.100461] [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: 10/26/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction We present the results of a phase 2a trial of first-line avelumab (anti-programmed death-ligand 1 antibody) plus cetuximab (anti-EGFR antibody) in patients with advanced squamous NSCLC. Methods Patients with recurrent or metastatic squamous NSCLC received avelumab 800 mg (d 1 and 8), cetuximab 250 mg/m2 (d 1) and 500 mg/m2 (d 8), cisplatin 75 mg/m2 (d 1), and gemcitabine 1250 mg/m2 (d 1 and 8) for four 3-week cycles, followed by avelumab 800 mg and cetuximab 500 mg/m2 every 2 weeks. The primary end point was the best overall response; the secondary end points were progression-free survival, duration of response, overall survival, and safety. Efficacy analyses were reported from an updated data cutoff. Results A total of 43 patients were enrolled. The median follow-up was 6.6 months for the primary analyses and 9.2 months for the efficacy analyses. In the efficacy analyses, 15 patients had a confirmed partial response (objective response rate, 34.9% [95% confidence interval: 21.0%-50.9%]), and the median duration of response was 7.1 months (95% confidence interval: 4.2-12.5 mo). The median progression-free survival and overall survival were 6.1 months and 10.0 months, respectively. In the safety analyses (primary analysis), 38 patients (88.4%) had a treatment-related adverse event, of whom 24 (55.8%) had a grade 3 or higher treatment-related adverse event. Conclusions The combination of avelumab + cetuximab and chemotherapy showed antitumor activity and tolerable safety; however, the ORR was not improved compared with those reported for current standards of care (NCT03717155).
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Affiliation(s)
- Zoran Andric
- Department of Medical Oncology, Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | | | - Manuel Cobo Dols
- Department of Medical Oncology, Hospital Regional Universitario de Málaga, Institute of Biomedical Research of Málaga (IBIMA), Málaga, Spain
| | - Barna Szima
- Department of Pulmonology, Markusovszky Hospital, Szombathely, Hungary
| | - Goran Stojanovic
- Institute of Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Marina Petrovic
- Clinic for Pulmonology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Enriqueta Felip
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Vicente Baz
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Santiago Ponce Aix
- Medical Oncology Department, H120-CNIO Lung Cancer Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Oscar Juan-Vidal
- Department of Medical Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Zsuzsanna Szalai
- Department of Pulmonology, Aladar Petz University Teaching Hospital, Győr, Hungary
| | - Gyorgy Losonczy
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Antonio Calles Blanco
- Medical Oncology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Reyes Bernabe
- Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Gema García Ledo
- Centro Integral Oncológico Clara Campal HM CIOCC, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | | | - Klaus Duecker
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Dongli Zhou
- Merck Serono (Beijing) Pharmaceutical R&D Co., Ltd., Beijing, China
| | | | | | - Fortunato Ciardiello
- Division of Medical Oncology, Department of Precision Medicine, The University of Campania Luigi Vanvitelli, Naples, Italy,Corresponding author. Address for correspondence: Fortunato Ciardiello, MD, PhD, Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.
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Felip E, Majem M, Doger B, Clay TD, Carcereny E, Bondarenko I, Peguero JA, Cobo-Dols M, Forster M, Ursol G, García Ledo G, Vilà L, Krebs M, Iams WT, Mueller C, Triebel F. A phase II study (TACTI-002) in first-line metastatic non–small cell lung carcinoma investigating eftilagimod alpha (soluble LAG-3 protein) and pembrolizumab: Updated results from a PD-L1 unselected population. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9003] [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
9003 Background: Eftilagimod alpha (E) is a soluble LAG-3 protein binding to a subset of MHC class II molecules to mediate antigen presenting cell (APC)/CD8 T-cell activation. Stimulation of the APCs and subsequent T cell recruitment with E may lead to stronger anti-tumor responses than observed with pembrolizumab (P) alone. We hereby report results of the extended first-line non-small cell lung carcinoma (NSCLC) cohort of the TACTI-002 (“Two ACTive Immunotherapies”) phase II trial. Methods: Pts with untreated metastatic NSCLC, unselected for PD-L1 expression were recruited. Objective response rate (ORR) by iRECIST was the primary endpoint (EP) and secondary EPs include ORR by RECIST 1.1, tolerability, disease control rate (DCR), progression free survival (PFS), overall survival (OS) and exploratory biomarker. Pts received 30 mg E SC q2w for 8 cycles (1 cycle= 3 weeks) and then q3w for up to 1 year with P (200 mg IV q3w for up to 2 years). Imaging was done every 8 weeks. PD-L1 was assessed centrally. This has been approved by relevant CAs, ECs, and IRBs. Results: From Mar 2019 to Nov 2021 114 pts were enrolled. Median age was 67 years (44-85) and 74% were male. ECOG PS was 0 and 1 in 37% and 63% of pts, respectively. Pts presented squamous (35%) or non-squamous (62%) NSCLC with 88% of pts at stage IV at the time of study entry. All PD-L1 subgroups were represented (Table). Pts received median 6.0 (range 1–35) P and 7.0 (1-22) E administrations. 19 (17%) pts discontinued treatment due to adverse events (AEs). The most common (≥15%) AEs were dyspnea (33%), asthenia (30%), decreased appetite (22%), cough (20%), anemia (20%), fatigue (19%), pruritus (18%), constipation (17%) and diarrhea (15%). At data cut-off (Jan 2022), 75 pts with a minimum follow-up of 6 months were evaluated for efficacy. ORR (iRECIST) was 37.3% in the ITT and 41.8%% in the evaluable pts assessed by local read. DCR 73.3% was reported. Response rate for squamous and non-squamous pathology were 33.3 % and 40.3 %, respectively. Results according to RECIST 1.1 were comparable. Responses were observed in all PD-L1 subgroups (Table). 24/28 (86%) responses were already confirmed while median duration of response was not yet reached (5 events). Conclusions: E + P is safe and shows encouraging antitumor activity in first-line metastatic NSCLC patients unselected for PD-L1, warranting further investigation. Clinical trial information: NCT03625323. [Table: see text]
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Affiliation(s)
- Enriqueta Felip
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | | | - Enric Carcereny
- Institut Català d'Oncologia, Badalona-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Igor Bondarenko
- St. Luke's Hospital - Medical and Diagnostic Center "Acinus'', Kropyvnytskyi, Ukraine
| | | | - Manuel Cobo-Dols
- Hospital Universitario Regional Málaga, Medical Oncology Department, Instituto de Investigaciones Biomédicas Málaga (IBIMA), Málaga, Spain
| | - Martin Forster
- University College London Hospitals NHS Foundation, London, United Kingdom
| | | | | | - Laia Vilà
- Parc Taulí University Hospital, Parc Taulí Institute of Research and Innovation I3PT, Barcelona Autonomous University, Spain, Sabadell, Spain
| | - Matthew Krebs
- Division of Cancer Sciences, The University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wade Thomas Iams
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Chicago, IL
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Provencio M, Mazarico JM, Calles A, Antoñanzas M, Pangua C, Mielgo X, Nadal E, Lopez Castro R, López Martín A, del Barco E, Domine M, Calvo V, Diz P, Sandoval García C, Sais E, Sullivan I, Sala MA, García Ledo G, Baena Espinar J, Gonzalez Cao M. COVID-19 disease in patients with LUNG cancer in Spain: GRAVID LunG canceR pAtients coVid19 Disease (GRAVID STUDY). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18709] [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
e18709 Background: Patients with cancer may be more susceptible to infection and at increased risk of more severe COVID-19 disease; however, prognostic factors are not yet clearly identified. The LunG canceR pAtients coVid19 Disease (GRAVID) study aimed to describe clinical characteristics, outcomes, and predictors of poor outcome in patients with lung cancer and COVID-19. Methods: In this large nationwide study, we reviewed medical records of patients with lung cancer and confirmed COVID-19 diagnosis from 65 Spanish hospitals. Clinical features, treatments and disease outcomes were collected. The primary endpoint was to determine all-cause mortality; secondary endpoints were hospitalization and admission to intensive care units (ICU). Risk factors for poor prognosis were identified by univariate and multivariate logistic regression models. Results: Overall, 447 patients were included for analysis. Mean age was 67·1 ± 9·8 years; 332 (74·3%) were men, and 383 (85·7%) current/former smokers. NSCLC was the most frequent type of cancer (377, 84·5%), consisting mainly of adenocarcinoma (228, 51·0%), and stage III metastatic or unresectable disease (354, 79·2%). Two-hundred and sixty-six (59·5%) patients were receiving anticancer treatment, mostly first-line chemotherapy. In total, 350 (78·3%) patients were hospitalized for a mean of 13·4 ± 11·4 days, nine (2·0%) patients were admitted to the ICU, and 146 (32·7%) died. Advanced disease and the use of corticosteroids to treat COVID-19 during hospitalization were predictors of mortality. Hospitalized, non-end-of-life stage patients with lymphocytopenia and high LDH had an increased risk of death. Severity of COVID-19 correlated to higher mortality, ICU admission, and mechanical ventilation rates. Conclusions: Due to their underlying comorbidities and immunocompromised status, patients with lung cancer and COVID-19 show high hospitalization and mortality rates. These outcomes, alongside the identification of prognostic factors, may inform physicians on the risks and benefits in this population, in order to provide individualized oncological care.
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Affiliation(s)
| | | | | | | | | | - Xabier Mielgo
- Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - Ernest Nadal
- Institut Català d’Oncologia, L’Hospitalet, Barcelona, Spain
| | | | | | | | - Manuel Domine
- Instituto de Investigación Sanitaria, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Virginia Calvo
- Instituto Investigacion Sanitaria Puerta de Hierro-Segovia de Arana, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Pilar Diz
- University Health Care Complex of Leon, Leon, Spain
| | | | - Elia Sais
- Institut Catala d'Oncologia, Universitary Hospital Dr. Josep Trueta, Girona, Spain
| | - Ivana Sullivan
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Jimenez Munarriz B, Dantes Z, De Castro J, Navarro P, Yagüe M, Barquin A, Rodriguez-Moreno JF, Sevillano E, Ruiz S, del Barrio A, Ledo GG, Dorta M, Lorduy AC, Calvo E, García-Donas J, Serrano S, Manjunath A, Ferreira L, Hefel B, Remon J. Patient-derived lung cancer organoids for the selection of therapeutic options in an ALK-rearranged tumor. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
e21014 Background: ALK rearrangements are key targets in non-small-cell lung cancer (NSCLC). Unfortunately, the optimal sequential strategy of ALK-tyrosine kinase inhibitors (TKI) remains to be defined. Testing drug sensitivity in patient derived organoids (PDOs) could support a rational drug selection in this setting. Methods: We designed an observational study assessing the correlation between drug sensitivity of PDOs established in Invitrocue and the clinical outcome in our institution. To date, forty cases have been included, of which nine were lung cancers. Results: PDO was sucessfully established in 7/9 cases (77%). Three patients did not receive any of the drugs tested in vitro due to clinical deterioration. One patient was deemed as sensitive to carboplatin but tumor showed to be resistant. A meaningful correlation was observed in an oncogenic addicted tumor. A 54-year-old never-smoker man who had been diagnosed with lung adenocarcinoma stage IVa (T3N1M1a). He received standard first-line therapy with platinum-based chemotherapy, immunotherapy and antiangiogenics achieving tumor progression. A next-generation sequencing (NGS) panel revealed the presence of the EML4-ALK fusion variant 3a/b. The patient started alectinib but showed progression after 12 months. A second NGS panel did not identify any new ALK resistance mutation but acquiring TP53. Treatment was switched to brigatinib with no response. Finally, fresh tumor tissue was obtained from a liver biopsy to establish PDOs and drug sensitivity to 8 compounds was tested. The In vitro results demonstrated no activity of lorlatinib but a strong response to crizotinib. The patient started Crizotinib 250mg BID achieving partial response after 8 weeks and treatment duration of 6 months. A third liver biopsy for PDOs and NGS revealed acquired ALK C1156Y and I1171T mutations that confer resistance to crizotinib but sensitive to ceritinib, respectively. Conclusions: We present clinical evidence that PDOs are an alternative tool in oncogenic addicted tumors helping to guide treatment decisions and increasing a more personalized sequential treatment approach.
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Affiliation(s)
| | | | - Javier De Castro
- Translational Oncology Unit at Medical Oncology Division, Hospital Universitario La Paz, IdipAZ, Madrid, Spain
| | | | - Monica Yagüe
- HM Hospitales-Centro Integral Oncológico Clara Campal, Madrid, Spain
| | - Arantzazu Barquin
- HM Hospitales-Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | | | | | | | | | | | | | - Emiliano Calvo
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Hospital Madrid Norte Sanchinarro, Madrid, Spain
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Provencio M, Mazarico Gallego JM, Calles A, Antoñanzas M, Pangua C, Mielgo Rubio X, Nadal E, Castro RL, López-Martín A, Del Barco E, Dómine M, Franco F, Diz P, Sandoval C, Girona ES, Sullivan I, Sala MÁ, Ledo GG, Cucurull M, Mosquera J, Martínez M, Chara LE, Arriola E, Herrera BE, Jarabo JR, Álvarez RÁ, Baena J, Cao MG. Lung cancer patients with COVID-19 in Spain: GRAVID study. Lung Cancer 2021; 157:109-115. [PMID: 34016490 PMCID: PMC8118702 DOI: 10.1016/j.lungcan.2021.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Patients with cancer may be at increased risk of more severe COVID-19 disease; however, prognostic factors are not yet clearly identified. The GRAVID study aimed to describe clinical characteristics, outcomes, and predictors of poor outcome in patients with lung cancer and COVID-19. METHODS Prospective observational study that included medical records of patients with lung cancer and PCR-confirmed COVID-19 diagnosis across 65 Spanish hospitals. The primary endpoint was all-cause mortality; secondary endpoints were hospitalization and admission to intensive care units (ICU). RESULTS A total of 447 patients with a mean age of 67.1 ± 9.8 years were analysed. The majority were men (74.3 %) and current/former smokers (85.7 %). NSCLC was the most frequent type of cancer (84.5 %), mainly as adenocarcinoma (51.0 %), and stage III metastatic or unresectable disease (79.2 %). Nearly 60 % of patients were receiving anticancer treatment, mostly first-line chemotherapy. Overall, 350 (78.3 %) patients were hospitalized for a mean of 13.4 ± 11.4 days, 9 (2.0 %) were admitted to ICU and 146 (32.7 %) died. Advanced disease and the use of corticosteroids to treat COVID-19 during hospitalization were predictors of mortality. Hospitalized, non-end-of-life stage patients with lymphocytopenia and high LDH had an increased risk of death. Severity of COVID-19 correlated to higher mortality, ICU admission, and mechanical ventilation rates. CONCLUSIONS Mortality rate was higher among patients treated with corticosteroids during hospitalization, while anticancer therapy was not associated with an increased risk of hospitalization or death. Tailored approaches are warranted to ensure effective cancer management while minimizing the risk of exposure to SARS-CoV-2.
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Affiliation(s)
| | | | - Antonio Calles
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Ernest Nadal
- Institut Catala d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Manuel Dómine
- Hospital Universitario Fundación Jiménez Diaz, IIS-FJD, Madrid, Spain
| | - Fernando Franco
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Pilar Diz
- Complejo Asistencial Universitario de León, León, Spain
| | | | | | | | | | | | - Marc Cucurull
- Institut Catala d'Oncologia (ICO), Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Barcelona, Spain
| | | | | | | | | | | | | | | | - Javier Baena
- Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - María González Cao
- Instituto Oncológico Dr Rosell, Hospital Universitario Dexeus, Barcelona, Spain
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