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Tsukita Y, Tozuka T, Kushiro K, Hosokawa S, Sumi T, Uematsu M, Honjo O, Yamaguchi O, Asao T, Sugisaka J, Saito G, Shiihara J, Morita R, Katakura S, Yasuda T, Hisakane K, Miyauchi E, Morita S, Kobayashi K, Asahina H. Immunotherapy or Chemoimmunotherapy in Older Adults With Advanced Non-Small Cell Lung Cancer. JAMA Oncol 2024; 10:439-447. [PMID: 38451530 PMCID: PMC10921348 DOI: 10.1001/jamaoncol.2023.6277] [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] [Received: 03/20/2023] [Accepted: 09/29/2023] [Indexed: 03/08/2024]
Abstract
Importance Immune checkpoint inhibitor (ICI) plus chemotherapy combination treatment (ICI-chemotherapy) is now a standard treatment for non-small cell lung cancer (NSCLC) without targetable oncogene alterations, but there are few data on ICI-chemotherapy for patients 75 years and older. Objective To inform the choice of first-line drugs in clinical practice and assess the safety and efficacy of ICI-chemotherapy combination treatment in older adult patients with previously untreated advanced NSCLC. Design, Setting, and Participants This retrospective cohort study included 58 centers in Japan. The cohort consisted of patients 75 years and older with clinical stage IIIB, IIIC, IV, postoperative or radiotherapy recurrent NSCLC. Patients started first-line systemic therapy between December 2018 and March 2021. Those receiving first-line molecular targeted drugs were excluded. The data were analyzed from February 2022 to October 2022. Exposures Systemic therapy. Main Outcomes and Measures The main outcomes were overall survival (OS), progression-free survival (PFS), and safety. Results A total of 1245 patients (median [range] age, 78 [75-95] years; 967 [78%] male) with NSCLC were included in the cohort. Programmed death ligand-1 (PD-L1) expression of less than 1% occurred in 268 tumors (22%); 1% to 49% in 387 tumors (31%); 50% and higher in 410 tumors (33%), and unknown expression in 180 tumors (14%). Median OS was 20.0 (95% CI, 17.1-23.6) months for the 354 patients receiving ICI-chemotherapy (28%); 19.8 (95% CI, 16.5-23.8) months for the 425 patients receiving ICI alone (34%); 12.8 (95% CI, 10.7-15.6) months for the 311 patients receiving platinum-doublet chemotherapy (25%); and 9.5 (95% CI, 7.4-13.4) months for the 155 patients receiving single-agent chemotherapy (12%). After propensity score matching, no differences in OS and PFS were found between the patients receiving ICI-chemotherapy vs ICI alone. Each group consisted of 118 patients. For PD-L1 expression of 1% and higher the OS hazard ratio (HR) was 0.98 (95% CI, 0.67-1.42; P = .90), and the PFS HR was 0.92 (95% CI, 0.67-1.25; P = .59). Significance was also not reached when separately analyzed for lower or higher PD-L1 expression (1%-49% or ≥50%). However, grade 3 or higher immune-related adverse events occurred in 86 patients (24.3%) treated with ICI-chemotherapy and 76 (17.9%) with ICI alone (P = .03). Conclusions and Relevance In this study, ICI-chemotherapy combination treatment did not improve survival and increased the incidence of grade 3 and higher immune-related adverse events compared with ICI alone in patients 75 years and older. Based on these results, ICI alone may be recommended for older adult patients with PD-L1-positive NSCLC.
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Affiliation(s)
- Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehiro Tozuka
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kohei Kushiro
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shinobu Hosokawa
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Toshiyuki Sumi
- Department of Respiratory Medicine, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Mao Uematsu
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Osamu Honjo
- Department of Respiratory Medicine, Sapporo Minami-Sanjo Hospital, Sapporo, Japan
| | - Ou Yamaguchi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jun Sugisaka
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Go Saito
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Shiihara
- Department of Respiratory Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kousei Medical Center, Akita, Japan
| | - Seigo Katakura
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takehiro Yasuda
- Department of Respiratory Medicine, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Kakeru Hisakane
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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2
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Saito Y, Takekuma Y, Asahina H, Hisada R, Sugawara M. Significantly Delayed Development of Polyarthritis with Active Tenosynovitis after Possible Temporary Neutropenic Immune-Related Adverse Events Caused by Atezolizumab Treatment: A Novel Case Report. Case Rep Oncol Med 2024; 2024:1566299. [PMID: 38361964 PMCID: PMC10869192 DOI: 10.1155/2024/1566299] [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: 08/15/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
Immune checkpoint inhibitors have drastically improved cancer treatment. However, they may induce immune-related adverse events (irAEs). Here, we report a case of significantly delayed rheumatic irAEs (Rh-irAEs) with prior possible temporary neutropenic irAEs in a patient with atezolizumab-treated non-small-cell lung cancer and its management. A man in his sixties received atezolizumab monotherapy as the sixth-line treatment. He experienced an infusion-related reaction (fever) during the first cycle. On day 22 of cycle 2, grade 4 neutropenia suddenly appeared, but it disappeared on the next day. Cycle 3 was initiated after seven days; the patient did not exhibit any symptoms for approximately 500 days. However, on day 534 (day 1 of cycle 21), the patient complained of pain in the shoulders, back, and wrists. On day 644, the shoulder and back pain worsened with obvious swelling of the fingers. We thus suspended treatment and consulted a rheumatologist. A diagnosis of polyarthritis with active tenosynovitis was made based on joint ultrasound and laboratory tests. Prednisolone 15 mg attenuated the symptoms, allowing suspension of analgesics; however, dose reduction from 15 mg/day was difficult because of symptom flares. Finally, iguratimod 25 mg twice daily was initiated on day 764; prednisolone was reduced to 10 mg without flares, and its dosage was slowly reduced to 5 mg/day. Although irAEs exhibit multisystem features, delayed development of polyarthritis with active tenosynovitis after possible temporary neutropenic irAEs is rare. Thus, irAEs need to be monitored for a long time in patients with suspected irAE development even if it appears transiently.
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Affiliation(s)
- Yoshitaka Saito
- Department of Clinical Pharmaceutics & Therapeutics, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 4-1, Maeda 7-jo 15-chome, Teine-ku, Sapporo 006-8585, Japan
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo 060-8648, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo 060-8648, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Kita 15-jo, Nishi 7-chome, Kita-ku, Sapporo 060-8638, Japan
| | - Ryo Hisada
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15-jo, Nishi 7-chome, Kita-ku, Sapporo 060-8638, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo 060-8648, Japan
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-jo, Nishi 6-chome, Kita-ku, Sapporo 060-0812, Japan
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Fujita K, Arai R, Shoji S, Saito R, Nomura M, Hotta T, Asahina H, Kawakami M, Nakachi I, Hasegawa Y, Okafuji K, Suzuki A, Miyanaga A, Sunaga N, Nagashima H, Ikeda N, Watanabe S, Nagai Y, Furuta M, Kage H, Arai D, Fukuhara T, Nakayama M, Morita S, Kobayashi K, Hagiwara K. Detection of multiple druggable mutations of lung cancer from cytology specimens by MINtS: An advanced medicine A trial. Cancer Sci 2023; 114:3342-3351. [PMID: 37139543 PMCID: PMC10394136 DOI: 10.1111/cas.15831] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023] Open
Abstract
Most multigene mutation tests require tissue specimens. However, cytological specimens are easily obtained in the clinical practice and provide high-quality DNA and RNA. We aimed to establish a test that utilizes cytological specimens and performed a multi-institutional study to investigate the performance of MINtS, a test based on next-generation sequencing. A standard procedure for specimen isolation was defined. The specimens were considered suitable for the test if >100 ng DNA and >50 ng RNA could be extracted from them. In total, 500 specimens from 19 institutions were investigated. MINtS detected druggable mutations in 63% (136 of 222) of adenocarcinomas. Discordant results between MINtS and the companion diagnostics were observed in 14 of 310 specimens for the EGFR gene, and 6 of 339 specimens for the ALK fusion genes. Confirmation by other companion diagnostics for the EGFR mutations or the clinical response to an ALK inhibitor all supported the results obtained by MINtS. MINtS along with the isolation procedure presented in the current study will be a platform to establish multigene mutation tests that utilize cytological specimens. UMIN000040415.
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Affiliation(s)
- Kazutaka Fujita
- Division of Pulmonary Medicine, Department of Internal MedicineJichi Medical UniversityTochigiJapan
| | - Ryo Arai
- Department of Pulmonary and Clinical ImmunologyDokkyo Medical University School of Medicine, Shimotsuga‐gun Mibu‐machiTochigiJapan
| | - Satoshi Shoji
- Department of Respiratory Medicine and Infectious DiseasesNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Ryota Saito
- Department of Respiratory MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Motoko Nomura
- Division of Pulmonary Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Takamasa Hotta
- Department of Internal Medicine. Division of Medical Oncology and Respiratory MedicineShimane UniversityIzumoJapan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Masanori Kawakami
- Department of Respiratory MedicineThe University of Tokyo HospitalTokyoJapan
| | - Ichiro Nakachi
- Pulmonary Division, Department of Internal MedicineSaiseikai Utsunomiya HospitalTochigiJapan
| | - Yukihiro Hasegawa
- Department of Respiratory MedicineAomori Prefectural Central HospitalAomoriJapan
| | - Kohei Okafuji
- Department of Pulmonary MedicineSt. Luke's International HospitalTokyoJapan
| | - Aya Suzuki
- Miyagi Cancer CenterDepartment of Respiratory MedicineNatoriJapan
| | - Akihiko Miyanaga
- Department of Pulmonary Medicine and OncologyGraduate School of Medicine, Nippon Medical SchoolTokyoJapan
| | - Noriaki Sunaga
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiJapan
| | - Hiromi Nagashima
- Division of Pulmonary Medicine, Department of Internal MedicineIwate Medical UniversityIwateJapan
| | - Naoya Ikeda
- Department of Pulmonary and Clinical ImmunologyDokkyo Medical University School of Medicine, Shimotsuga‐gun Mibu‐machiTochigiJapan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious DiseasesNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
| | - Yoshiaki Nagai
- Division of Pulmonary Medicine, Saitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Megumi Furuta
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Hidenori Kage
- Department of Respiratory MedicineThe University of Tokyo HospitalTokyoJapan
| | - Daisuke Arai
- Pulmonary Division, Department of Internal MedicineSaiseikai Utsunomiya HospitalTochigiJapan
| | - Tatsuro Fukuhara
- Miyagi Cancer CenterDepartment of Respiratory MedicineNatoriJapan
| | - Masayuki Nakayama
- Division of Pulmonary Medicine, Department of Internal MedicineJichi Medical UniversityTochigiJapan
| | - Satoshi Morita
- Department of Biomedical Statistics and BioinformaticsKyoto University Graduate School of MedicineKyotoJapan
| | - Kunihiko Kobayashi
- Department of Respiratory MedicineSaitama Medical University, International Medical CenterSaitamaJapan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Internal MedicineJichi Medical UniversityTochigiJapan
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4
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Morinaga D, Asahina H, Ito S, Honjo O, Tanaka H, Honda R, Yokouchi H, Nakamura K, Takamura K, Hommura F, Kawai Y, Ito K, Sukoh N, Yokoo K, Morita R, Harada T, Takashina T, Goda T, Dosaka-Akita H, Isobe H. Real-world data on the efficacy and safety of immune-checkpoint inhibitors in elderly patients with non-small cell lung cancer. Cancer Med 2023. [PMID: 36999734 DOI: 10.1002/cam4.5889] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/03/2023] [Accepted: 03/19/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Immune-checkpoint inhibitors (ICIs) are effective against advanced non-small cell lung cancer (NSCLC). However, whether the efficacy and safety of ICI treatment in elderly patients are similar to those in younger patients is unclear. This study was designed to address this question. METHODS We enrolled patients who received ICI monotherapy in Japan between December 2015 and December 2017; those ≥75 years of age comprised the elderly group. We compared the efficacy and safety of ICI monotherapy in elderly patients with those in younger patients and explored prognostic factors in elderly patients. RESULTS We enrolled 676 patients; 137 (20.3%) were assigned to the elderly group. The median age of the elderly and younger groups was 78 (range, 75-85) and 66 (range, 34-74) years. The median progression-free survival (4.8 months vs. 3.3 months, p = 0.1589) and median overall survival (12.3 months vs. 13.0 months, p = 0.5587) were similar between the elderly and younger groups. Multivariate analysis revealed that a significantly better OS in the elderly group was associated with better responses to first- or second-line ICI treatment (p = 0.011) and more immune-related adverse events (irAEs) (p = 0.02). IrAEs that led to ICI discontinuation occurred in 34 of 137 patients (24.8%) in the elderly group, and their survival was significantly higher than that in those who did not have irAEs. CONCLUSION ICI is also effective in elderly NSCLC patients, and treatment discontinuation due to irAEs may be a good prognostic marker.
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Affiliation(s)
- Daisuke Morinaga
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shotaro Ito
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Osamu Honjo
- Department of Respiratory Medicine, Sapporo Minami-Sanjo Hospital, Sapporo, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan
| | - Ryoichi Honda
- Department of Respiratory Medicine, Asahi General Hospital, Asahi, Japan
| | - Hiroshi Yokouchi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Keiichi Nakamura
- Department of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, Asahikawa, Japan
| | - Kei Takamura
- Department of Respiratory Medicine, Obihiro-Kosei General Hospital, Obihiro, Japan
| | - Fumihiro Hommura
- Department of Respiratory Medicine, Sapporo City General Hospital, Sapporo, Japan
| | - Yasutaka Kawai
- Department of Respiratory Medicine, Oji General Hospital, Tomakomai, Japan
| | - Kenichiro Ito
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Sapporo, Japan
| | - Noriaki Sukoh
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Keiki Yokoo
- Department of Respiratory Medicine, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kousei Medical Center, Akita, Japan
| | - Toshiyuki Harada
- Department of Respiratory Medicine, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Taichi Takashina
- Department of Respiratory Medicine, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Tomohiro Goda
- Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Japan
| | - Hirotoshi Dosaka-Akita
- Department of Medical Oncology, Hokkaido University Graduate School of Medicine, Japan
- Research Division of Cancer Immunotherapy, Hokkaido University Hospital, Japan
| | - Hiroshi Isobe
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Sapporo, Japan
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5
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Saito R, Sugawara S, Ko R, Azuma K, Morita R, Maemondo M, Oizumi S, Takahashi K, Kagamu H, Tsubata Y, Seike M, Kikuchi T, Okamoto I, Satoshi M, Asahina H, Tanaka K, Sugio K, Kobayashi K. Phase 2 Study of Osimertinib in Combination with Platinum and Pemetrexed in Patients with Previously Untreated EGFR-Mutated Advanced Non-Squamous Non-Small Cell Lung Cancer: The OPAL Study. Eur J Cancer 2023; 185:83-93. [PMID: 36966696 DOI: 10.1016/j.ejca.2023.02.023] [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: 12/26/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND This multicenter phase 2 trial evaluated the safety and efficacy of osimertinib and platinum-based chemotherapy (OPP) in patients with previously untreated EGFR-mutated advanced non-squamous non-small cell lung cancer (NSCLC). PATIENTS AND METHODS Patients received osimertinib 80 mg once daily (QD), with either cisplatin 75 mg/m2 (arm A) or carboplatin (area under the curve [AUC] = 5; arm B), plus pemetrexed 500 mg/m2 for four cycles and maintenance therapy of osimertinib 80 mg QD with pemetrexed 500 mg/m2 every 3 weeks. The primary end-points were safety and objective response rate (ORR), and the secondary end-points were complete response rate (CRR), disease control rate (DCR), and progression-free survival (PFS). RESULTS In total, 67 patients (34 in arm A and 33 in arm B) were enrolled between July 2019 and February 2020. At the data cutoff (28th February 2022), 35 (52.2%) patients had discontinued the protocol treatment, including 10 (14.9%) due to adverse events. No treatment-related deaths occurred. In the full analysis set, the ORR, CRR, and DCR were 90.9% (95% confidence interval [CI], 84.0-97.8), 3.0% (0.0-7.2), and 97.0% (92.8-100.0), respectively. Based on updated survival data (data cutoff on August 31, 2022, median follow-up time: 33.4 months), the median PFS was 31.0 months (95% CI, 26.8 months-not reached) and median overall survival was not reached. CONCLUSIONS This is the first study to show that OPP has excellent efficacy with acceptable toxicity in previously untreated EGFR-mutated advanced non-squamous NSCLC patients.
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Affiliation(s)
- Ryota Saito
- Department of Respiratory Medicine, Tohoku University, Sendai, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Ryo Ko
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kousei Medical Center, Akita, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Isamu Okamoto
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Morita Satoshi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Tanaka
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan.
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Miyanaga A, Asahina H, Watanabe S, Shukuya T, Tsubata Y, Hosomi Y, Sugawara S, Maemondo M, Okano T, Morita S, Matsuyama K, Kobayashi K, Seike M. A Phase I/II Study of Necitumumab Plus Pembrolizumab, Nab-Paclitaxel, and Carboplatin for Previously Untreated Advanced Squamous Non-Small Cell Lung Cancer Study: (NEJ048A/NEXUS). Clin Lung Cancer 2023; 24:371-375. [PMID: 36849264 DOI: 10.1016/j.cllc.2023.01.008] [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: 12/06/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Platinum-based combination therapy plus a programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitor is a standard treatment for patients with stage IV non-small cell lung cancer. However, necitumumab is used with gemcitabine and cisplatin as a first-line treatment option for squamous cell lung cancer (SqCLC). Furthermore, the combination of necitumumab with immune checkpoint inhibitors has the potential to enhance tumor immunity and improve the therapeutic effect. Thus, we planned and initiated this phase I/II study to evaluate the safety and efficacy of necitumumab plus pembrolizumab, nanoparticle albumin-bound (nab)-paclitaxel), and carboplatin therapy for patients with previously untreated SqCLC. PATIENTS AND METHODS In phase I, the primary endpoint is the tolerability and recommended dose of necitumumab combined with pembrolizumab plus nab-paclitaxel and carboplatin. In phase II, the primary endpoint is the overall response rate. Secondary endpoints are disease control rate, progression-free survival, overall survival, and safety. Forty-two patients will be enrolled in phase II. CONCLUSION This is the first study to investigate the efficacy and safety of necitumumab plus pembrolizumab combined with platinum-based chemotherapy in patients with previously untreated SqCLC.
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Affiliation(s)
- Akihiko Miyanaga
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Yukari Tsubata
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yukio Hosomi
- Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Tetsuya Okano
- Department of Respiratory Medicine, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kotone Matsuyama
- Department of Health Policy and Management, Nippon Medical School, Tokyo, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
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7
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Kanno R, Saito Y, Takekuma Y, Asahina H, Sugawara M. Temporary Severe Neutropenia during Administration of Atezolizumab: A Novel Case Report. Case Rep Oncol 2023; 16:372-377. [PMID: 37384199 PMCID: PMC10293966 DOI: 10.1159/000530338] [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: 09/15/2022] [Accepted: 03/16/2023] [Indexed: 06/30/2023] Open
Abstract
Here, we describe a case of temporary severe neutropenia after atezolizumab monotherapy and its treatment course. Atezolizumab monotherapy was introduced as a 6th-line treatment for a man in his late 60s, who was diagnosed with stage Ⅳ lung adenocarcinoma. The first treatment cycle was administered during hospitalization, and the patient presented with a fever of 37.8°C on the first day. The fever resolved after the administration of acetaminophen and naproxen, and the white blood cell count, neutrophil count, and other white blood cell fractions were normal. However, grade 3 leukopenia and grade 4 neutropenia appeared at the beginning of the third cycle, and treatment was discontinued. After treatment, monocyte count in the leukocyte fraction increased from approximately 10% to 25.6%. Lenograstim 100 μg subcutaneous injection and oral levofloxacin 500 mg once daily were started of onset of neutropenia, and he was hospitalized the next day. Laboratory findings upon admission showed a significant improvement to 5,300/µL for leukocytes and 3,376/µL for neutrophils. Lenograstim was discontinued, with no further decrease in the neutrophil count. Atezolizumab therapy was resumed, and there was no further reduction in leukocyte, neutrophil, or leukocyte fractions over about a 2-year period. Concomitant drugs were maintained during the atezolizumab treatment, suggesting that they did not induce neutropenia. In conclusion, we observed temporary severe neutropenia during atezolizumab monotherapy. Neutrophil recovery with cautious monitoring has enabled longer efficacy. We should consider temporary symptom occurrence in cases of haematological immune-related adverse events.
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Affiliation(s)
- Ryota Kanno
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshitaka Saito
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
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Takashima Y, Shinagawa N, Morinaga D, Nakamura J, Furuta M, Shoji T, Asahina H, Kikuchi E, Kikuchi J, Sakakibara-Konishi J, Tsujino I, Konno S. Risk of bleeding associated with transbronchial biopsy using flexible bronchoscopy in patients with echocardiographic or chest CT evidence of pulmonary hypertension. BMC Pulm Med 2022; 22:449. [DOI: 10.1186/s12890-022-02245-y] [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] [Received: 07/07/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) facilitates the diagnosis of various respiratory diseases. The safety of performing EBUS-guided TBB in patients with a finding of pulmonary hypertension (PH) is controversial. Little is known about the relationship between the risk of bleeding associated with EBUS-guided TBB in the presence of PH suspected on echocardiography or chest CT.
Methods
To assess the risk of bleeding associated with EBUS-guided TBB in patients with presumed PH per echocardiography or chest CT, we retrospectively reviewed the medical records of 314 consecutive patients who underwent EBUS-guided TBB using a guide sheath (GS), as well as echocardiography and chest CT. Bleeding complication was defined as over one minute of suctioning; repeated wedging of the bronchoscope; instillation of cold saline, diluted vasoactive substances, or thrombin due to persistent bleeding. Findings of suspected PH were defined as peak tricuspid regurgitation velocity (TRV) > 2.8 m/s on echocardiography or pulmonary artery to aorta ratio (PA:A ratio) > 0.9 on chest CT.
Results
In total, 35 (11.1%) patients developed bleeding, and all cases were managed safely. Furthermore, 17 (5.4%) and 59 (18.8%) patients were suspected to have PH based on echocardiography and chest CT, respectively. Among the patients suspected to have PH on echocardiography, five (5/17 = 29.4%) patients developed bleeding. Among the patients suspected to have PH on chest CT, 11 (11/59 = 18.6%) patients developed bleeding. Univariate analysis revealed that long diameter (≥ 30 mm) of the lesion, lesion location (the biopsy site was inner than the segmental bronchus), bronchoscopic diagnosis of malignancy, and additional biopsy were potential predictive factors for bleeding. The finding of suspected PH on echocardiography correlated significantly with bleeding (p = 0.03). On multivariate analysis, long diameter (≥ 30 mm) of the lesion (p = .021) and findings of suspected PH on echocardiography (p = .049) were significantly associated with bleeding.
Conclusion
All cases of bleeding in the present study were managed safely. The risk of bleeding is moderately elevated when PH is suspected by echocardiography in patients undergoing EBUS-guided TBB using a GS.
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9
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Nakamura A, Saito R, Ko R, Azuma K, Morita R, Maemondo M, Oizumi S, Takahashi K, Kagamu H, Isobe T, Seike M, Kikuchi T, Okamoto I, Morita S, Asahina H, Tanaka K, Sugio K, Kobayashi K. A phase II study of osimertinib in combination with platinum plus pemetrexed in patients with EGFR-mutated, advanced non–small cell lung cancer: The OPAL study (NEJ032C/LOGIK1801). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9097] [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
9097 Background: Osimertinib (OSI), a third-generation EGFR-tyrosine kinase inhibitor (EGFR-TKI), is now a standard treatment for previously untreated EGFR-mutated (EGFRm) advanced non-small cell lung cancer (NSCLC). In the two randomized phase 3 studies, progression-free survival (PFS) and overall survival were statistically significant and clinically longer with gefitinib and platinum-based chemotherapy compared with gefitinib monotherapy. Based on these data, we have planned this phase 2 study to evaluate the safety and efficacy of OSI combined with platinum-based chemotherapy. Patients and Methods: This multicenter phase 2 study enrolled patients (pts) with clinical stage IIIB, IIIC, IVA, IVB or postoperative recurrent, previously untreated EGFRm NSCLC. Pts received oral OSI 80mg once daily (QD), with either cisplatin 75mg/m2 (arm A) or carboplatin [area under the curve (AUC) = 5, arm B], plus pemetrexed (PEM) 500 mg/ m2 every 3 weeks (Q3W) for four cycles. In both arms, maintenance was OSI 80mg QD with PEM 500 mg/ m2 Q3W until disease progression or discontinuation. The co-primary endpoints were the safety and the objective response rate (ORR), and the secondary endpoints included the complete response rate (CRR), disease control rate (DCR), and PFS. Results: From July 2019 to February 2020, 67 pts (34 pts in Arm A; 33 pts in arm B) were enrolled: median (range) age 67 (26-75) years; 43 (64.2%) female; 46 (68.7%) ECOG PS 0; 66 (98.5%) adenocarcinoma; 31 (46.3%) EGFR exon19 deletion, 35 (52.2) L858R, and 1 (1.5%) both. One pt did not comply with the eligibility criteria and was excluded from the efficacy analysis. At data cut off (August 31, 2021), 27 (40.3%) pts [15 (44.1%) in arm A and 12 (36.4%) in arm B] had discontinued the protocol treatment, including 9 (13.4%) pts [5 (14.7%) in arm A and 4 (12.1%) in arm B] due to the adverse event (AE). The rate of grade (G) ≥ 3 AEs were 91.0% (88.2% in arm A and 93.9% in arm B). For the safety, neutropenia, anemia and thromobocytopenia were numerically higher in arm B and the rates of G ≥ 3 were 29.4%/60.6%, 14.7%/27.3% and 0.0%/42.4% in arm A/B, respectively. G ≥ 3 QTc interval prolonged and G ≥ 2 anorexia were observed in 14.7%/21.2% and 26.5%/24.2%, respectively. For the efficacy, the ORR was 90.9% [95% confidence interval (CI); 84.0-97.8%]. The CRR/DCR were 3.0%/97.0% (95% CI; 0.0-7.2%/92.8%-100.0%), respectively. At a median follow-up time of 21.4 months (range, 18.2-25.7), median PFS was not reached in both A and B, with an estimated 12-/24-months PFS rate of 90.4%/70.0%. Conclusions: OSI combined with platinum-based chemotherapy for previously untreated EGFRm advanced NSCLC showed the excellent efficacy with tolerable toxicity. This combination treatment is highly promising and should be validated in the phase 3 study. Clinical trial information: jRCTs031180226.
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Affiliation(s)
- Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Ryo Ko
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kousei Medical Center, Akita, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Kagamu
- Division of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takeshi Isobe
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Tanaka
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kunihiko Kobayashi
- Department of Pulmonary Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
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10
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Yamamoto G, Asahina H, Iwata H, Takakuwa E, Ito S, Kunisaki M, Takashima Y, Kikuchi J, Kikuchi E, Sakakibara-Konishi J, Shinagawa N, Konno S. Necrolytic migratory erythema-like eruptions induced by zinc deficiency during osimertinib treatment of EGFR-mutant non-small cell lung cancer: A case report. Current Problems in Cancer: Case Reports 2021. [DOI: 10.1016/j.cpccr.2021.100121] [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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11
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Ito S, Asahina H, Honjo O, Tanaka H, Honda R, Oizumi S, Nakamura K, Takamura K, Hommura F, Kawai Y, Ito K, Sukoh N, Yokoo K, Morita R, Harada T, Takashina T, Goda T, Dosaka-Akita H, Isobe H. Prognostic factors in patients with advanced non-small cell lung cancer after long-term Anti-PD-1 therapy (HOT1902). Lung Cancer 2021; 156:12-19. [PMID: 33872943 DOI: 10.1016/j.lungcan.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/19/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Limited information is available on the appropriate treatment duration of immune checkpoint inhibitors (ICIs). We aimed to identify candidates who would benefit from ICI discontinuation after one year of treatment for metastatic non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This retrospective multi-institutional observational study examined medical records of all consecutive patients with advanced or recurrent NSCLC, who started ICI monotherapy at 15 institutions in Japan between December 2015 and December 2017. Patients who received initial ICI therapy for >1 year without progressive disease were defined as the long-term treatment (LT) group; others were defined as the non-long-term treatment (NLT) group. Primary outcomes included the prognostic factors in the LT group, whereas secondary outcomes included efficacy of ICI rechallenge, safety, and survival outcomes in the overall population. RESULTS In total, 676 patients were enrolled, and 114 (16.9 %) were assigned to the LT group. The median time interval from the start of initial ICI administration to data cutoff was 34.3 months (range, 24.1-47.8); thus, all surviving patients were followed-up for at least 2 years from the start of initial ICI. Median progression-free survival (PFS) was longer in the LT than in the NLT group (33.6 months vs. 2.7 months; p < 0.001). On multivariate analysis, significantly better PFS was associated with smoking (hazard ratio [HR]=0.36, p = 0.04), and complete response (CR; HR=uncomputable, p < 0.001) in the LT group. Thirty-seven patients (5.5 %) received ICI rechallenge, including 10 in the LT group. Among patients receiving rechallenge treatment, the median PFS was 2.2 months, with no difference between the LT and NLT groups. CONCLUSIONS In the LT group, smoking and achieving CR were significantly associated with better PFS. Since rechallenge treatment was not effective, careful consideration is required for discontinuing ICI. However, these prognostic factors are helpful in considering candidates for ICI discontinuation. TRIAL REGISTRATION UMIN ID, UMIN000041403.
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Affiliation(s)
- Shotaro Ito
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Osamu Honjo
- Department of Respiratory Medicine, Sapporo Minami-Sanjo Hospital, Sapporo, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryoichi Honda
- Department of Respiratory Medicine, Asahi General Hospital, Asahi, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Keiichi Nakamura
- Department of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, Asahikawa, Japan
| | - Kei Takamura
- Department of Respiratory Medicine, Obihiro-Kosei General Hospital, Obihiro, Japan
| | - Fumihiro Hommura
- Department of Respiratory Medicine, Sapporo City General Hospital, Sapporo, Japan
| | - Yasutaka Kawai
- Department of Respiratory Medicine, Oji General Hospital, Tomakomai, Japan
| | - Kenichiro Ito
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Sapporo, Japan
| | - Noriaki Sukoh
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Keiki Yokoo
- Department of Respiratory Medicine, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ryo Morita
- Department of Respiratory Medicine, Akita Kousei Medical Center, Akita, Japan
| | - Toshiyuki Harada
- Department of Respiratory Medicine, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Taichi Takashina
- Department of Respiratory Medicine, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Tomohiro Goda
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirotoshi Dosaka-Akita
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Isobe
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Sapporo, Japan
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12
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Tanaka K, Asahina H, Kishimoto J, Miyata Y, Uchida T, Watanabe K, Hamai K, Harada T, Tsubata Y, Sugawara S, Kobayashi K, Sugio K, Oizumi S, Okamoto I. Osimertinib versus osimertinib plus chemotherapy for non-small cell lung cancer with EGFR (T790M)-associated resistance to initial EGFR inhibitor treatment: An open-label, randomised phase 2 clinical trial. Eur J Cancer 2021; 149:14-22. [PMID: 33813328 DOI: 10.1016/j.ejca.2021.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Osimertinib is now a standard treatment for patients with previously untreated EGFR-mutated advanced non-small cell lung cancer (NSCLC). We here investigated whether the combination of osimertinib with cytotoxic chemotherapy might hold additive efficacy, as well as tolerability. PATIENTS AND METHODS We conducted an open-label randomised phase 2 study to evaluate osimertinib and carboplatin-pemetrexed combination in comparison with osimertinib monotherapy in EGFR mutation-positive NSCLC patients who experienced disease progression associated with the emergence of the T790M resistance mutation of EGFR during first-line EGFR-TKI therapy. The primary endpoint was PFS, with secondary endpoints, including OS, response, and safety. Given that osimertinib was approved as a first-line treatment during the study, patient accrual was discontinued, and a final analysis was performed for the 62 enrolled patients. RESULTS Median PFS was 15.8 months for the osimertinib monotherapy group and 14.6 months for the combination therapy group (hazard ratio of 1.09, with a 95% confidence interval of 0.51-2.32; P = .83). Median OS was not reached in either group. The overall response rate was 71.4% in the osimertinib monotherapy group and 53.6% in the combination group. The frequency or severity of known adverse events in the combination group was comparable to those with carboplatin and pemetrexed previously reported, and novel adverse events were not observed in this study. CONCLUSION This is the first randomised study to investigate the efficacy and safety of the combination of osimertinib and cytotoxic chemotherapy for EGFR-mutated NSCLC. The addition of chemotherapy to osimertinib as a second-line treatment did not prolong survival, while it was found to be generally tolerable. This combination strategy will be further validated in the first-line setting. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCT) identifier: jRCTs071180062.
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Affiliation(s)
- Kentaro Tanaka
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshihiro Miyata
- Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takahiro Uchida
- Division of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kana Watanabe
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Kosuke Hamai
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Taishi Harada
- Department of Respiratory Medicine, JCHO Kyushu Hospital, Kita-Kyushu, Japan
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Kunihiko Kobayashi
- Division of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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13
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Mouri A, Tanaka K, Asahina H, Kishimoto J, Okada M, Watanabe K, Hamai K, Harada T, Tsubata Y, Sugawara S, Kobayashi K, Sugio K, Oizumi S, Okamoto I. FP14.02 A Phase II Study of Osimertinib versus Combination of Osimertinib and Chemotherapy for EGFR and T790M-Mutation Positive NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.145] [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: 11/17/2022]
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14
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Asahina H, Tanaka K, Morita S, Maemondo M, Seike M, Okamoto I, Oizumi S, Kagamu H, Takahashi K, Kikuchi T, Isobe T, Sugio K, Kobayashi K. A Phase II Study of Osimertinib Combined With Platinum Plus Pemetrexed in Patients With EGFR-Mutated Advanced Non-Small-cell Lung Cancer: The OPAL Study (NEJ032C/LOGIK1801). Clin Lung Cancer 2021; 22:147-151. [PMID: 33199228 DOI: 10.1016/j.cllc.2020.09.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 03/13/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is now a standard treatment of previously untreated EGFR-mutated advanced non-small-cell lung cancer (NSCLC). However, disease progression occurs within 19 months of treatment. In the NEJ009 study, gefitinib plus carboplatin plus pemetrexed demonstrated significantly better progression-free and overall survival compared with gefitinib monotherapy. Furthermore, the Lung Oncology Group in Kyushu and North East Japan Study Group, major clinical trial groups in Japan, conducted a randomized phase II study to evaluate the efficacy and safety of second-line osimertinib plus carboplatin plus pemetrexed versus osimertinib monotherapy for patients with disease progression during first-line EGFR tyrosine kinase inhibitor therapy and the EGFR T790M resistance mutation (TAKUMI trial; trial registration no., jRCTs071180062). In the first treatment course for the initial 24 patients, no safety issues were reported in the combination arm. Thus, we have planned this phase II study to evaluate the safety and preliminary efficacy of osimertinib plus cisplatin/carboplatin plus pemetrexed therapy for patients with previously untreated EGFR-mutated NSCLC. PATIENTS AND METHODS A total of 66 patients will be enrolled, because this sample size will be adequate for assessing treatment safety and efficacy. The co-primary endpoints include safety and the objective response rate, and the secondary endpoints include the complete response rate, disease control rate, and progression-free survival. CONCLUSIONS This is the first study to explore the efficacy and safety of osimertinib combined with platinum-based chemotherapy in previously untreated NSCLC patients with EGFR-sensitizing mutations. Our findings could provide valuable information for phase III studies such as FLAURA2 and for developing treatment strategies for EGFR-mutated NSCLC.
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Affiliation(s)
- Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Tanaka
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Makoto Maemondo
- Division of Pulmonary Medicine, Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Hiroshi Kagamu
- Division of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takeshi Isobe
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kunihiko Kobayashi
- Division of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
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15
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Ito S, Asahina H, Yamaguchi N, Tomaru U, Hasegawa T, Hatanaka Y, Hatanaka KC, Taguchi H, Harada T, Ohira H, Ikeda D, Mizugaki H, Kikuchi E, Kikuchi J, Sakakibara-Konishi J, Shinagawa N, Konno S. A case of radio-insensitive SMARCA4-deficient thoracic undifferentiated carcinoma with severe right heart failure. Respir Med Case Rep 2021; 32:101364. [PMID: 33665078 PMCID: PMC7906892 DOI: 10.1016/j.rmcr.2021.101364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/09/2021] [Accepted: 02/13/2021] [Indexed: 11/27/2022] Open
Abstract
SMARCA4-deficient thoracic sarcomatoid tumors were characterized by inactivating mutations of SMARCA4 and often found in the chest of young and middle-aged males with a smoking history. Recently, SMARCA4-deficient thoracic sarcomatoid tumors were reported to represent primarily smoking-associated undifferentiated/de-differentiated carcinomas rather than primary thoracic sarcomas. The main complication of this tumor is compression of the respiratory tract and/or blood vessels. A 39-year-old man presented with a 2-month history of fever and dyspnea. Computed tomography revealed a mediastinal tumor invading the right and left pulmonary arteries. Because of severe right heart failure, we considered him ineligible for bronchoscopy. We scheduled palliative irradiation with 40 Gy/20 Fr to improve hemodynamics and perform endobronchial ultrasound transbronchial needle aspiration later. However, irradiation was ineffective, and his general condition deteriorated quickly and he died after a 7-week hospitalization. An autopsy revealed that the diagnosis was SMARCA4-deficient thoracic undifferentiated carcinoma. It has been reported that this tumor is insensitive to radiotherapy and there were some cases which responded to an immune checkpoint inhibitor. Therefore, when caring for patients with mediastinal tumors that invade and compress the trachea and large vessels, it is important to consider this tumor as a differential diagnosis and try to make a pathological diagnosis as soon as possible.
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Affiliation(s)
- Shotaro Ito
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Naoko Yamaguchi
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Utano Tomaru
- Department of Pathology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, South 1 West 16, Chuou-ku, Sapporo, 060-8543, Japan
| | - Yutaka Hatanaka
- Research Division of Genome Companion Diagnostics, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Kanako C Hatanaka
- Research Division of Genome Companion Diagnostics, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan.,Clinical Biobank, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, 060-8648 Japan
| | - Taisuke Harada
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Ohira
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Daisuke Ikeda
- Department of Cardiovascular Medicine, Chitose City Hospital, Hokko 2-1-1, Chitose, 066-8550, Japan
| | - Hidenori Mizugaki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Eiki Kikuchi
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Junko Kikuchi
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Jun Sakakibara-Konishi
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Naofumi Shinagawa
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
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Tanaka K, Asahina H, Okada M, Uchida T, Watanabe K, Hamai K, Harada T, Tsubata Y, Sugawara S, Kobayashi K, Sugio K, Oizumi S, Okamoto I. Final analysis of a phase II, open label, randomized study of osimertinib versus osimertinib plus carboplatin/pemetrexed for patients with locally advanced or metastatic non-small cell lung cancer whose disease has progressed with previous EGFR-TKI and whose tumours harbour a T790M mutation (LOGIK1604/NEJ032A). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21594] [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
e21594 Background: Osimertinib is now available not only as a second line treatment for the patients with EGFR and T790M-mutation positive non-small cell lung cancer (NSCLC) after initial tyrosine kinase inhibitors (TKIs) but as a first line treantment for those who are TKI-naive. The efficacy and the safety of osimertinib plus palatinum-based chemotherapy has not yet been evaluated. Methods: This phase 2, open-label, randomized study enrolled adult patients (pts) with clinical stage IIIB or IV, or postoperative recurrent NSCLC harbouring susceptible EGFR and T790M mutations after preceded EGFR-TKI failure. Pts were randomly assigned to receive either an osimertinib [80 mg/day 1-21; q3w] or a combination of osimertinib [80 mg/day 1-21] with carboplatin/pemetrexed (hereafter combination) [area under the curve (AUC) = 5 and 500 mg/m2 day 1; q3w]. The primary endpoint was progression-free survival (PFS). Secondary endpoints included incidence of adverse events, response rate and overall survival. As indiction of osimertinib was expanded to a first line, we amended the protocol to discontinue the enrollment and perform final analyses. Results: From October 2016 to January 2019, 62 pts were enrolled [31 pts osimertinib; 31 pts combination] (median age 68 (37-80); 53.2% male; 83.3% stage IV; 100% adenocarcinoma; 59.7% exon 19 deletion and 40.3% L858R; 45.2% never smoker). The rate of grade (G) ≥ 3 treatment-related adverse events was 32.2% in the osimertinib group and 83.9% in the combination group. Neutropenia, anemia and thrombocytopenia were more common in the combination group and the rates of G ≥ 3 were 0%, 0% and 6.4% in the osimertinib group and 38.7%, 25.8% and 29.1% in the combination group, respectively. Three episodes (9.7%) of G ≥ 3 infection and one episode (3.2%) of G ≥ 3 febrile neutropenia were uniquely observed in the combination group, however, these were well managed. Two episodes (6.5%) of G ≥ 3 pneumonitis was observed only in the osimertinib group. Exaggeration of adverse events specific for osimertinib or any unknown adverse event was not observed in the combination group. Final PFS analysis is to be demonstrated in the presentation. Conclusions: Combination of osimertinib with carboplatin and pemetrexed demonstrated safety in patients with EGFR and T790M mutation-positive NSCLC and the efficacy should be validated in the future phase 3 study. Clinical trial information: 000024438.
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Affiliation(s)
| | | | - Morihito Okada
- Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Takahiro Uchida
- Division of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kana Watanabe
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Kosuke Hamai
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Taishi Harada
- Department of Respiratory Medicine, JCHO Kyushu Hospital, Kita-Kyushu, Japan
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Izumo, Japan
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Kunihiko Kobayashi
- Division of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Satoshi Oizumi
- National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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17
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Sakakibara-Konishi J, Sato M, Sato MT, Kasahara K, Onozawa M, Mizugaki H, Kikuchi E, Asahina H, Shinagawa N, Konno S. Nivolumab-induced immune thrombocytopenia in a patient with malignant pleural mesothelioma. Respir Med Case Rep 2020; 31:101170. [PMID: 32714828 PMCID: PMC7378269 DOI: 10.1016/j.rmcr.2020.101170] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare and highly aggressive tumor. Nivolumab showed durable antitumor effect in patients with recurrent MPM and was approved for those patients in Japan in 2018. Immune related adverse event (irAE) is occurred in various organs and is suggestive to be related to better outcome of nivolumab. Frequency of hematological irAE is low and there are few reports about hematological irAE and association between irAE and outcome of nivolumab in patients with MPM. We present a case of recurrent MPM who responded to nivolumab treatment and experienced nivolumab-induced immune thrombocytopenia (ITP). Although high dose dexamethasone was administered and platelet count increased transiently, re-administration of dexamethasone was required to maintain normal count of platelet. The careful and intensive management of ITP treatment is necessary in cases who show no response or relapse to initial glucocorticoids treatment. This is the first report about nivolumab-induced ITP and association with response to nivolumab in MPM. Frequency of hematological immune related adverse event (irAE) is low and there are only a few reports of hematological irAE in patients with MPM. This patient needed repeated administration of dexamethasone for nivolumab-induced immune thrombocytopenia (ITP) treatment. Careful and intensive management of ITP treatment is necessary in patients who show no response or who relapse after initial glucocorticoid treatment. A clinical response to nivolumab was observed in this patient. This is the first report of nivolumab-induced ITP and its association with response to nivolumab treatment in a patient with MPM.
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Yokouchi H, Asahina H, Oizumi S, Takamura K, Harada T, Harada M, Kanazawa K, Fujita Y, Kojima T, Sugaya F, Tanaka H, Honda R, Ogi T, Kikuchi E, Ikari T, Dosaka-Akita H, Isobe H, Nishimura M. MA13.10 A Phase II Study of Carboplatin and Nab-Paclitaxel for Advanced Non-Small Cell Lung Cancer with Interstitial Lung Disease (HOT1302). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Harada T, Asahina H, Oizumi S, Takamura K, Harada M, Kanazawa K, Fujita Y, Kojima T, Sugaya F, Tanaka H, Ryoichi H, Ogi T, Ikari T, Yokouchi H, Kikuch E, Akita H, Isobe H, Nishimura M. A prospective phase II trial of carboplatin (CBDCA) and nab-paclitaxel (nabPTX) for advanced non-small cell lung cancer (NSCLC) with interstitial lung disease (ILD). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Asahina H, Oizumi S, Takamura K, Harada T, Harada M, Yokouchi H, Kanazawa K, Fujita Y, Kojima T, Sugaya F, Tanaka H, Honda R, Kikuchi E, Ikari T, Ogi T, Shimizu K, Suzuki M, Konno S, Dosaka-Akita H, Isobe H, Nishimura M. A prospective phase II study of carboplatin and nab-paclitaxel in patients with advanced non-small cell lung cancer and concomitant interstitial lung disease (HOT1302). Lung Cancer 2019; 138:65-71. [PMID: 31654836 DOI: 10.1016/j.lungcan.2019.09.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 06/30/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Patients with concomitant advanced non-small cell lung cancer (NSCLC) and interstitial lung disease (ILD) are excluded from most clinical chemotherapy trials because of the high risk of exacerbating the latter condition. This study prospectively investigated the efficacy and safety of albumin-bound paclitaxel (nab-paclitaxel) in combination with carboplatin in patients with both advanced NSCLC and ILD. PATIENTS AND METHODS The enrolled patients had treatment-naïve, advanced NSCLC with ILD. Patients received 100 mg/m2nab-paclitaxel weekly and carboplatin at an area under the concentration-time curve of 6 once every 3 weeks for 4-6 cycles. The primary endpoint was the overall response rate (ORR); secondary endpoints included toxicity, progression-free survival (PFS), and overall survival (OS). RESULTS Thirty-six patients were enrolled between April 2014 and September 2017. Sixteen patients (44.4%) had adenocarcinoma, 15 (41.7%) had squamous cell carcinoma (Sq), and 5 (13.9%) had non-small cell carcinoma. The median number of cycles administered were 4 (range: 1-6). The ORR was 55.6% (95% confidence interval [CI]: 39.6-70.5). The median PFS and OS were 5.3 months (95% CI: 3.9-8.2) and 15.4 months (95% CI: 9.4-18.7), respectively. A greater proportion of patients with Sq experienced improvements than did those with non-Sq: ORRs, 66.7% (95% CI: 41.7-84.8) vs. 47.6% (95% CI: 28.3-67.6) (P = 0.254); median PFS, 8.2 months (95% CI: 4.0-10.2) vs. 4.1 months (95% CI: 3.3-5.4) (HR, 0.60 [95% CI, 0.30-1.20]; P = 0.15); and median OS, 16.8 months (95% CI: 9.8-not reached) vs. 11.9 months (95% CI: 7.3-17.4) (HR, 0.56 [95% CI, 0.24-1.28]; P = 0.17). Two patients (5.6%) experienced grade ≥2 pneumonitis and 1 patient (2.8%) died. CONCLUSION Weekly nab-paclitaxel combined with carboplatin showed favorable efficacy with acceptable toxicity in patients with both advanced NSCLC and ILD.
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Affiliation(s)
- Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Satoshi Oizumi
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Kei Takamura
- Department of Respiratory Medicine, Obihiro-Kosei General Hospital, Obihiro, Japan
| | - Toshiyuki Harada
- Center for Respiratory Diseases, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Masao Harada
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Hiroshi Yokouchi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan; Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuka Fujita
- Department of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, Asahikawa, Japan
| | - Tetsuya Kojima
- Department of Medical Oncology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Fumiko Sugaya
- Department of Respiratory Medicine, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryoichi Honda
- Department of Respiratory Medicine, Asahi Chuo Hospital, Asahi, Japan
| | - Eiki Kikuchi
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomoo Ikari
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Center for Respiratory Diseases, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Takahiro Ogi
- Department of Respiratory Medicine, Obihiro-Kosei General Hospital, Obihiro, Japan; Department of Medical Oncology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hirotoshi Dosaka-Akita
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Isobe
- Department of Medical Oncology, KKR Sapporo Medical Center, Sapporo, Japan
| | - Masaharu Nishimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Tsuji K, Shinagawa N, Kitai H, Ikari T, Sato M, Takahashi H, Kunisaki M, Shoji T, Takashima Y, Furuta M, Mizugaki H, Asahina H, Kikuchi J, Kikuchi E, Oi Y, Nakajo S, Hatanaka K, Hatanaka Y, Matsuno Y, Sakakibara J. Performance of ROS1 fusion gene test using FFPE tissue and bronchoscopic cytologic specimen. Lung Cancer 2019. [DOI: 10.1183/13993003.congress-2019.pa4680] [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: 11/05/2022]
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22
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Becker JH, Gao Y, Soucheray M, Pulido I, Kikuchi E, Rodríguez ML, Gandhi R, Lafuente-Sanchis A, Aupí M, Alcácer Fernández-Coronado J, Martín-Martorell P, Cremades A, Galbis-Caravajal JM, Alcácer J, Christensen CL, Simms P, Hess A, Asahina H, Kahle MP, Al-Shahrour F, Borgia JA, Lahoz A, Insa A, Juan O, Jänne PA, Wong KK, Carretero J, Shimamura T. CXCR7 Reactivates ERK Signaling to Promote Resistance to EGFR Kinase Inhibitors in NSCLC. Cancer Res 2019; 79:4439-4452. [PMID: 31273063 DOI: 10.1158/0008-5472.can-19-0024] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/10/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
Abstract
Although EGFR mutant-selective tyrosine kinase inhibitors (TKI) are clinically effective, acquired resistance can occur by reactivating ERK. We show using in vitro models of acquired EGFR TKI resistance with a mesenchymal phenotype that CXCR7, an atypical G protein-coupled receptor, activates the MAPK-ERK pathway via β-arrestin. Depletion of CXCR7 inhibited the MAPK pathway, significantly attenuated EGFR TKI resistance, and resulted in mesenchymal-to-epithelial transition. CXCR7 overexpression was essential in reactivation of ERK1/2 for the generation of EGFR TKI-resistant persister cells. Many patients with non-small cell lung cancer (NSCLC) harboring an EGFR kinase domain mutation, who progressed on EGFR inhibitors, demonstrated increased CXCR7 expression. These data suggest that CXCR7 inhibition could considerably delay and prevent the emergence of acquired EGFR TKI resistance in EGFR-mutant NSCLC. SIGNIFICANCE: Increased expression of the chemokine receptor CXCR7 constitutes a mechanism of resistance to EGFR TKI in patients with non-small cell lung cancer through reactivation of ERK signaling.
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Affiliation(s)
- Jeffrey H Becker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois.,University of Illinois Hospital & Health Sciences System Cancer Center, University of Illinois at Chicago, Chicago, Illinois.,Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Yandi Gao
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Margaret Soucheray
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Ines Pulido
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain
| | - Eiki Kikuchi
- First department of Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - María L Rodríguez
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain
| | - Rutu Gandhi
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | | | - Miguel Aupí
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain
| | | | | | - Antonio Cremades
- Department of Pathology, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - José M Galbis-Caravajal
- Department of Thoracic Surgery, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - Javier Alcácer
- Department of Pathology, Hospital Quirónsalud Valencia, Valencia, Spain
| | - Camilla L Christensen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts.,Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Ludwig Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patricia Simms
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Ashley Hess
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Hajime Asahina
- First department of Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Michael P Kahle
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Fatima Al-Shahrour
- Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Jeffrey A Borgia
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Agustín Lahoz
- Biomarkers and Precision Medicine Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Amelia Insa
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Oscar Juan
- Biomarkers and Precision Medicine Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Department of Medical Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Pasi A Jänne
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts.,Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Kwok-Kin Wong
- Laura and Isaac Perlmutter Cancer Center, Division of Hematology and Medical Oncology, New York University, New York, New York
| | - Julian Carretero
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain.
| | - Takeshi Shimamura
- Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois. .,University of Illinois Hospital & Health Sciences System Cancer Center, University of Illinois at Chicago, Chicago, Illinois.,Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
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Ikari T, Sakakibara-Konishi J, Yamamoto G, Kitai H, Mizugaki H, Asahina H, Kikuchi E, Shinagawa N. Response to First-Line Osimertinib Treatment in Non-Small-Cell Lung Cancer With Coexisting G719A and Primary T790M Epidermal Growth Factor Receptor Mutations. Clin Lung Cancer 2019; 20:e531-e533. [PMID: 31164318 DOI: 10.1016/j.cllc.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/03/2019] [Revised: 04/02/2019] [Accepted: 05/04/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Tomoo Ikari
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Gaku Yamamoto
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hidenori Kitai
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hidenori Mizugaki
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Hajime Asahina
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Eiki Kikuchi
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Naofumi Shinagawa
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
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Yamamoto G, Sakakibara-Konishi J, Ikari T, Kitai H, Mizugaki H, Asahina H, Kikuchi E, Shinagawa N. Response of BRAFV600E-Mutant Lung Adenocarcinoma With Brain Metastasis and Leptomeningeal Dissemination to Dabrafenib Plus Trametinib Treatment. J Thorac Oncol 2019; 14:e97-e99. [DOI: 10.1016/j.jtho.2018.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022]
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Goda T, Kinoshita I, Oizumi S, Nakano K, Harada T, Kawai Y, Sakakibara-Konishi J, Yokouchi H, Morikawa N, Yamada N, Yamazaki S, Sugawara S, Asahina H, Amano T, Hatanaka Y, Matsuno Y, Nishihara H, Isobe H, Nishimura M, Dosaka-Akita H. A prospective observational study of HER2 alterations in NSCLCs: HOT1303-A. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Kinoshita I, Goda T, Watanabe K, Maemondo M, Oizumi S, Amano T, Hatanaka Y, Matsuno Y, Nishihara H, Asahina H, Harada T, Goto K, Isobe H, Nishimura M, Dosaka-Akita H. A phase II study of trastuzumab monotherapy in pretreated patients with non-small cell lung cancers (NSCLCs) harboring HER2 alterations: HOT1303-B trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Takahashi H, Shinagawa N, Hatanaka Y, Kunisaki M, Furuta M, Takashima Y, Shouji T, Kitai H, Kikuchi H, Mizugaki H, Asahina H, Kikuchi E, Kikuchi J, Sakakibara J, Matsuno Y, Nishimura M. Retrospective analysis of tumor programmed death-ligand 1 expression in transbronchial biopsy samples. Lung Cancer 2018. [DOI: 10.1183/13993003.congress-2018.pa2806] [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: 11/05/2022]
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28
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Kitajima S, Asahina H, Chen T, Guo S, Quiceno LG, Cavanaugh JD, Merlino AA, Tange S, Terai H, Kim JW, Wang X, Zhou S, Xu M, Wang S, Zhu Z, Thai TC, Takahashi C, Wang Y, Neve R, Stinson S, Tamayo P, Watanabe H, Kirschmeier PT, Wong KK, Barbie DA. Overcoming Resistance to Dual Innate Immune and MEK Inhibition Downstream of KRAS. Cancer Cell 2018; 34:439-452.e6. [PMID: 30205046 PMCID: PMC6422029 DOI: 10.1016/j.ccell.2018.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 12/15/2022]
Abstract
Despite extensive efforts, oncogenic KRAS remains resistant to targeted therapy. Combined downstream RAL-TBK1 and MEK inhibition induces only transient lung tumor shrinkage in KRAS-driven genetically engineered mouse models (GEMMs). Using the sensitive KRAS;LKB1 (KL) mutant background, we identify YAP1 upregulation and a therapy-induced secretome as mediators of acquired resistance. This program is reversible, associated with H3K27 promoter acetylation, and suppressed by BET inhibition, resensitizing resistant KL cells to TBK1/MEK inhibition. Constitutive YAP1 signaling promotes intrinsic resistance in KRAS;TP53 (KP) mutant lung cancer. Intermittent treatment with the BET inhibitor JQ1 thus overcomes resistance to combined pathway inhibition in KL and KP GEMMs. Using potent and selective TBK1 and BET inhibitors we further develop an effective therapeutic strategy with potential translatability to the clinic.
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MESH Headings
- AMP-Activated Protein Kinase Kinases
- AMP-Activated Protein Kinases
- Adaptor Proteins, Signal Transducing/immunology
- Adaptor Proteins, Signal Transducing/metabolism
- Animals
- Antineoplastic Agents, Immunological/pharmacology
- Antineoplastic Agents, Immunological/therapeutic use
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/immunology
- Carcinoma, Non-Small-Cell Lung/pathology
- Cell Line, Tumor
- Disease Models, Animal
- Drug Resistance, Neoplasm/genetics
- Drug Resistance, Neoplasm/immunology
- HEK293 Cells
- Humans
- Immunity, Innate/drug effects
- Insulin-Like Growth Factor I/immunology
- Insulin-Like Growth Factor I/metabolism
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/immunology
- Lung Neoplasms/pathology
- Mice
- Mice, Transgenic
- Mitogen-Activated Protein Kinase Kinases/antagonists & inhibitors
- Mitogen-Activated Protein Kinase Kinases/metabolism
- Phosphoproteins/immunology
- Phosphoproteins/metabolism
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Protein Serine-Threonine Kinases/genetics
- Protein Serine-Threonine Kinases/immunology
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins p21(ras)/genetics
- Proto-Oncogene Proteins p21(ras)/metabolism
- Transcription Factors
- YAP-Signaling Proteins
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Affiliation(s)
- Shunsuke Kitajima
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Hajime Asahina
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; First Department of Medicine, Hokkaido University School of Medicine, Sapporo 060-8638, Japan
| | - Ting Chen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY 10016, USA
| | - Sujuan Guo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Laura Gutierrez Quiceno
- Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY 10016, USA
| | - Jillian D Cavanaugh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ashley A Merlino
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Shoichiro Tange
- Department of Human Genetics, Graduate School of Biomedical Science, Tokushima University, Tokushima 770-8503, Japan
| | - Hideki Terai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jong Wook Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Xiaoen Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Shan Zhou
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Man Xu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Stephen Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Zehua Zhu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Tran C Thai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Chiaki Takahashi
- Division of Oncology and Molecular Biology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-1192, Japan
| | - Yujin Wang
- Gilead Sciences, Foster City, CA 94404, USA
| | | | | | - Pablo Tamayo
- Moores Cancer Center and School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Hideo Watanabe
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Paul T Kirschmeier
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Belfer Center for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Kwok-Kin Wong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA; Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY 10016, USA
| | - David A Barbie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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29
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Shoji T, Mizugaki H, Ikezawa Y, Furuta M, Takashima Y, Kikuchi H, Goudarzi H, Asahina H, Kikuchi J, Kikuchi E, Sakakibara-Konishi J, Shinagawa N, Tsujino I, Nishimura M. Successful Application of Edoxaban in the Treatment of Venous Thromboembolism Recurrence in a Patient with Non-small Cell Lung Cancer after Tumor Shrinkage. Intern Med 2018; 57:1769-1772. [PMID: 29434159 PMCID: PMC6047974 DOI: 10.2169/internalmedicine.9741-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This report describes the case of a 66-year-old man with non-small cell lung cancer and venous thromboembolism (VTE). Unfractionated heparin (UFH) was initially used to control VTE before chemotherapy. However, switching UFH to warfarin or edoxaban, a novel oral anticoagulant (NOAC), failed. Chemotherapy was then administered to control the tumor which was thought to have been the main cause of VTE, which had been treated by UFH. After tumor shrinkage was achieved by chemotherapy, we were able to successfully switch from UFH to edoxaban. Controlling the tumor size and activity enabled the use of edoxaban as maintenance therapy for VTE.
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Affiliation(s)
- Tetsuaki Shoji
- First Department of Medicine, Hokkaido University Hospital, Japan
| | | | - Yasuyuki Ikezawa
- First Department of Medicine, Hokkaido University Hospital, Japan
| | - Megumi Furuta
- First Department of Medicine, Hokkaido University Hospital, Japan
| | - Yuta Takashima
- First Department of Medicine, Hokkaido University Hospital, Japan
| | - Hajime Kikuchi
- First Department of Medicine, Hokkaido University Hospital, Japan
| | - Houman Goudarzi
- First Department of Medicine, Hokkaido University Hospital, Japan
| | - Hajime Asahina
- First Department of Medicine, Hokkaido University Hospital, Japan
| | - Junko Kikuchi
- First Department of Medicine, Hokkaido University Hospital, Japan
| | - Eiki Kikuchi
- First Department of Medicine, Hokkaido University Hospital, Japan
| | | | | | - Ichizo Tsujino
- First Department of Medicine, Hokkaido University Hospital, Japan
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30
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Okada M, Tanaka K, Asahina H, Harada T, Hamai K, Watanabe K, Kobayashi K, Sugio K, Oizumi S, Okamoto I. Safety analysis of an open label, randomized phase 2 study of osimertinib alone versus osimertinib plus carboplatin-pemetrexed for patients with non–small cell lung cancer (NSCLC) that progressed during prior epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy and which harbors a T790M mutation of EGFR. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | | | - Hajime Asahina
- First Department of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Taishi Harada
- Japan Community Healthcare Organization Kyushu Hospital, Kitakyushu, Japan
| | - Kosuke Hamai
- Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kana Watanabe
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Oita University, Oita, Japan
| | - Satoshi Oizumi
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
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31
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Kawai Y, Asahina H, Ikezawa Y, Oizumi S, Ogi T, Watanabe M, Amano T, Dosaka-Akita H, Isobe H, Nishimura M. P2.01-005 A Randomized Phase II Trial of Erlotinib vs S-1 in Patients with NSCLC as Third- or Fourth-Line Therapy (HOT1002). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1107] [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: 10/18/2022]
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32
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Ikezawa Y, Asahina H, Oizumi S, Watanabe M, Takamura K, Kawai Y, Yamada N, Harada T, Kinoshita I, Fujita Y, Miyauchi E, Ogi T, Amano T, Furuta M, Sakakibara-Konishi J, Nishihara H, Dosaka-Akita H, Isobe H, Nishimura M. A randomized phase II trial of erlotinib vs. S-1 as a third- or fourth-line therapy for patients with wild-type EGFR non-small cell lung cancer (HOT1002). Cancer Chemother Pharmacol 2017; 80:955-963. [PMID: 28905108 DOI: 10.1007/s00280-017-3432-4] [Citation(s) in RCA: 9] [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] [Received: 08/21/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE A high proportion of patients with wild-type EGFR non-small cell lung cancer (NSCLC) receive third-line therapy and beyond, with no prospective randomized trials addressing the issue. This study aimed to select the most suitable regimen as a third- or fourth-line therapy for wild-type EGFR NSCLC. METHODS This multicenter, randomized phase II study in Japan included patients with recurrent or advanced NSCLC with wild-type or unknown EGFR, who progressed after two or three previous chemotherapies. The patients were randomly assigned to erlotinib (150 mg/day, days 1-21) or S-1 (80-120 mg/day, days 1-14) every 3 weeks until disease progression or unacceptable toxicity. The primary endpoint was disease control rate (DCR). The secondary endpoints included overall survival (OS), progression-free survival (PFS), objective response rate (ORR), toxicity, and quality of life (QOL). RESULTS From 2011 to 2016, 37 patients were randomly assigned to receive erlotinib (E arm, n = 19) and S-1 (S arm, n = 18). This study was terminated prematurely because of poor patient accrual. DCR/ORR were 42.1%/15.8% in the E arm and 66.7%/16.7% in the S arm. Median PFS/OS were 1.6 months/8.0 months in the E arm and 3.3 months/12.2 months in the S arm. In both groups, the most commonly reported grade 3-4 toxicities were fatigue, anorexia, and nausea. One grade 5 pneumonitis occurred in the S arm. No significant difference was seen in QOL. CONCLUSIONS S-1 as a third- or fourth-line therapy for wild-type EGFR NSCLC showed numerically better clinical outcomes than erlotinib. CLINICAL TRIAL REGISTRATION NO UMIN000005308.
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Affiliation(s)
- Yasuyuki Ikezawa
- First Department of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Respiratory Medicine, Oji General Hospital, 3-4-8 Wakakusa-cho, Tomakomai, Hokkaido, 053-8506, Japan
| | - Hajime Asahina
- First Department of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Satoshi Oizumi
- First Department of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, 003-0804, Japan
| | - Masahiro Watanabe
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, 003-0804, Japan
| | - Kei Takamura
- Department of Respiratory Medicine, Obihiro-Kosei General Hospital, 1 West 6, North 8, Obihiro, Hokkaido, 080-0016, Japan
| | - Yasutaka Kawai
- Department of Respiratory Medicine, Oji General Hospital, 3-4-8 Wakakusa-cho, Tomakomai, Hokkaido, 053-8506, Japan
| | - Noriyuki Yamada
- Department of Respiratory Medicine, National Hospital Organization Hokkaido Cancer Center, 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, 003-0804, Japan.,Department of Respiratory Medicine, Iwamizawa Municipal General Hospital, 2 West 7, 9-jo, Iwamizawa, Hokkaido, 068-8555, Japan
| | - Toshiyuki Harada
- Center for Respiratory Diseases, JCHO Hokkaido Hospital, 3-18, 8-chome, Nakanoshima 1-jo, Sapporo, Hokkaido, 062-8618, Japan
| | - Ichiro Kinoshita
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yuka Fujita
- Department of Respiratory Medicine, National Hospital Organization Asahikawa Medical Center, 7-4048 Hanasaki-cho, Asahikawa, Hokkaido, 070-8644, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University School of Medicine, 1-1 Seiryou-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takahiro Ogi
- Department of Respiratory Medicine, Obihiro-Kosei General Hospital, 1 West 6, North 8, Obihiro, Hokkaido, 080-0016, Japan
| | - Toraji Amano
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Megumi Furuta
- First Department of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Jun Sakakibara-Konishi
- First Department of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hiroshi Nishihara
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hirotoshi Dosaka-Akita
- Department of Medical Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hiroshi Isobe
- Department of Respiratory Medicine, KKR Sapporo Medical Center, 3-40, 6-chome, Hiragishi 1-jo, Toyohira-ku, Sapporo, Hokkaido, 062-0931, Japan
| | - Masaharu Nishimura
- First Department of Medicine, Hokkaido University Hospital, North 15, West 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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33
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Nokihara H, Yamamoto N, Yamada Y, Honda K, Asahina H, Tamura Y, Hozak RR, Gao L, Suzukawa K, Enatsu S, Tamura T. A phase 1 study of ramucirumab in Japanese patients with advanced solid tumors. Jpn J Clin Oncol 2017; 47:298-305. [PMID: 28158463 DOI: 10.1093/jjco/hyx008] [Citation(s) in RCA: 7] [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: 09/25/2016] [Accepted: 01/15/2017] [Indexed: 12/16/2023] Open
Abstract
OBJECTIVE Ramucirumab is a recombinant human immunoglobulin G1 monoclonal antibody targeting the vascular endothelial growth factor receptor-2. The aim of this phase 1 study was to evaluate the safety and tolerability of ramucirumab monotherapy in Japanese patients with advanced solid tumors. METHODS Patients with solid tumors who had not responded to standard therapy or for whom no standard therapy was available received escalating doses of ramucirumab, administered once every 2 (Q2W) or 3 (Q3W) weeks. The primary objective was to establish the safety and pharmacokinetic profiles of ramucirumab. Secondary and exploratory objectives included assessment of immunogenicity and antitumor activity. ClinicalTrials.gov: NCT01005355. RESULTS Fifteen patients were treated with ramucirumab at a dose of 6 mg/kg Q2W (N = 3), 8 mg/kg Q2W (N = 6) or 10 mg/kg Q3W (N = 6). There were no dose-limiting toxicities and the maximum tolerated dose was not reached. The most common ramucirumab-related adverse events were headache, pyrexia, hypertension and increased aspartate aminotransferase. Following single-dose administration of ramucirumab, there appeared to be a dose-proportional increase in maximum observed drug concentration but not in area under the curve. Treatment-emergent anti-ramucirumab antibodies were not detected in any patient. CONCLUSIONS Ramucirumab monotherapy was well tolerated and feasible at the doses and schedules used in this study population of Japanese patients with advanced solid tumors.
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Affiliation(s)
| | | | | | - Kazunori Honda
- National Cancer Center Hospital, Tokyo, Japan
- Present address: Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hajime Asahina
- National Cancer Center Hospital, Tokyo, Japan
- Present address: Hokkaido University Hospital, Sapporo, Japan
| | - Yosuke Tamura
- National Cancer Center Hospital, Tokyo, Japan
- Present address: Osaka Medical College Hospital, Osaka, Japan
| | | | - Ling Gao
- Eli Lilly and Company, Bridgewater, NJ, USA
| | | | | | - Tomohide Tamura
- National Cancer Center Hospital, Tokyo, Japan
- Present address: St Luke's International Hospital, Tokyo, Japan
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34
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Stinson S, He J, Hollenback D, Jia J, Kaplan J, Venkataramani C, Babusis D, Guevara F, Nelson T, Cavanaugh J, Asahina H, Ray A, Sicinska E, Fuchs C, Barbie D, Wong K, Ng K, Dornan D. Anti-tumor activity of a TBK1/IKBKE inhibitor in combination with a MEK inhibitor in KRAS mutant colorectal and non-small cell lung cancer models. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)33033-7] [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: 11/30/2022]
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35
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Kitajima S, Asahina H, Cavanaugh JD, Chen T, Merlino AA, Tran TC, Wong KK, Barbie DA. Abstract 297: Epigenetic activation of IGF1R signaling promotes resistance to momelotinib and MEK inhibition in KRAS-driven lung cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-297] [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: 11/16/2022]
Abstract
Abstract
KRAS is the most frequently mutated oncogene in non-small cell lung cancer (NSCLC), yet remains resistant to targeted therapy. Previously, we reported that RAL-TBK1 activation downstream of KRAS promotes an autocrine cytokine circuit that fuels tumorigenesis. Interruption of this signaling by treatment with momelotinib, an inhibitor of TBK1/IKKϵ and JAK kinases, together with MEK inhibition, was effective in the aggressive Kras-p53 (KP) mouse lung cancer model. These findings have prompted a human clinical trial of momelotinib and trametinib in advanced refractory KRAS mutant NSCLC. Because this combination leads to acquired resistance in mice, we sought to understand additional pathways that could compensate for TBK1/JAK and MEK inhibition. Receptor tyrosine kinase (RTK) profiling of A549 cells treated with momelotinib revealed delayed activation of IGF1 receptor (IGF1R) signaling. Indeed, IGF1 supplementation partially rescued momelotinib-induced growth arrest of A549 cells, while combination of momelotinib with the dual IGF1R/insulin receptor (IR) inhibitor linsitinib cooperated to impair cell viability, which was more pronounced in KRAS/STK11 (encoding LKB1) mutant cell lines compared with LKB1 wild type cell lines. Triple momelotinib/trametinib/linsitinib therapy also improved tumor shrinkage in Kras-Lkb1 (KL) mice compared with KP mice. However, chronic treatment with this triple combination required pulse therapy due to toxicity, and was inferior to momelotinib/trametinib dosed daily, which itself promoted deep responses in KL mice lasting 6 weeks.
In parallel, we analyzed mediators of acquired resistance to chronic momelotinib and MEK inhibitor exposure in A549 cells. Interestingly, IGF1 expression was dramatically upregulated in resistant cells, in contrast to IGF2, and enhanced autocrine activation of IGF1R signaling. Importantly, both IGF1 upregulation and inhibitor resistance were completely reversible after drug withdrawal for several passages, yet reappeared quickly upon drug readdition, suggesting epigenetic reprogramming. Consistent with this hypothesis, whereas global H3K27 histone acetylation was decreased in resistant cells, this epigenetic mark was strongly enriched at the IGF1 promoter and linked tightly with both IGF1 levels and drug resistance. Treatment of resistant A549 cells with the BRD4 inhibitor JQ1 completely suppressed IGF1 expression and downstream IGF1R activation, and impaired cell viability. Combination JQ1 treatment also prevented momelotinib/MEK inhibitor induction of IGF1 in A549 cells, synergized to reduce outgrowth of resistant cells, and was well tolerated as daily triple combination therapy in mice. Together, these findings suggest the potential of BET inhibition to synergize with and prevent the development of acquired resistance to momelotinib and MEK inhibitor treatment in KRAS mutant NSCLC.
Citation Format: Shunsuke Kitajima, Hajime Asahina, Jillian D. Cavanaugh, Ting Chen, Ashley A. Merlino, Thai C. Tran, Kwonk-Kin Wong, David A. Barbie. Epigenetic activation of IGF1R signaling promotes resistance to momelotinib and MEK inhibition in KRAS-driven lung cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 297.
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Affiliation(s)
| | | | | | - Ting Chen
- Dana-Farber Cancer Institute, Boston, MA
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36
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Koyama S, Akbay EA, Li YY, Herter-Sprie GS, Buczkowski KA, Richards WG, Gandhi L, Redig AJ, Rodig SJ, Asahina H, Jones RE, Kulkarni MM, Kuraguchi M, Palakurthi S, Fecci PE, Johnson BE, Janne PA, Engelman JA, Gangadharan SP, Costa DB, Freeman GJ, Bueno R, Hodi FS, Dranoff G, Wong KK, Hammerman PS. Adaptive resistance to therapeutic PD-1 blockade is associated with upregulation of alternative immune checkpoints. Nat Commun 2016; 7:10501. [PMID: 26883990 PMCID: PMC4757784 DOI: 10.1038/ncomms10501] [Citation(s) in RCA: 1062] [Impact Index Per Article: 132.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/21/2015] [Indexed: 12/11/2022] Open
Abstract
Despite compelling antitumour activity of antibodies targeting the programmed death 1 (PD-1): programmed death ligand 1 (PD-L1) immune checkpoint in lung cancer, resistance to these therapies has increasingly been observed. In this study, to elucidate mechanisms of adaptive resistance, we analyse the tumour immune microenvironment in the context of anti-PD-1 therapy in two fully immunocompetent mouse models of lung adenocarcinoma. In tumours progressing following response to anti-PD-1 therapy, we observe upregulation of alternative immune checkpoints, notably T-cell immunoglobulin mucin-3 (TIM-3), in PD-1 antibody bound T cells and demonstrate a survival advantage with addition of a TIM-3 blocking antibody following failure of PD-1 blockade. Two patients who developed adaptive resistance to anti-PD-1 treatment also show a similar TIM-3 upregulation in blocking antibody-bound T cells at treatment failure. These data suggest that upregulation of TIM-3 and other immune checkpoints may be targetable biomarkers associated with adaptive resistance to PD-1 blockade. Blocking immune checkpoints is a promising strategy to treat lung cancer, but patients often become resistant to the therapy. Here, the authors analyse resistance in mouse models of lung cancer and show in mice and two patients, an increase in the expression of TIM3, which is also involved in the immune response to cancer.
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Affiliation(s)
- Shohei Koyama
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Esra A Akbay
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Yvonne Y Li
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Grit S Herter-Sprie
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Kevin A Buczkowski
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - William G Richards
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Leena Gandhi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Amanda J Redig
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Hajime Asahina
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Robert E Jones
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Meghana M Kulkarni
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Mari Kuraguchi
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Sangeetha Palakurthi
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Peter E Fecci
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - Bruce E Johnson
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Pasi A Janne
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Jeffrey A Engelman
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA
| | | | - Daniel B Costa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
| | - Gordon J Freeman
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Raphael Bueno
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - F Stephen Hodi
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Glenn Dranoff
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Kwok-Kin Wong
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Peter S Hammerman
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
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Koyama S, Akbay EA, Li YY, Herter-Sprie GS, Buczkowski KA, Richards WG, Gandhi L, Redig AJ, Rodig SJ, Asahina H, Jones RE, Kulkarni MM, Kuraguchi M, Palakurthi S, Fecci PE, Johnson BE, Janne PA, Engelman JA, Gangadharan SP, Costa DB, Freeman GJ, Bueno R, Hodi FS, Dranoff G, Wong KK, Hammerman PS. Adaptive resistance to therapeutic PD-1 blockade is associated with upregulation of alternative immune checkpoints. Nat Commun 2016. [PMID: 26883990 DOI: 10.1038/ncomms10501.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Despite compelling antitumour activity of antibodies targeting the programmed death 1 (PD-1): programmed death ligand 1 (PD-L1) immune checkpoint in lung cancer, resistance to these therapies has increasingly been observed. In this study, to elucidate mechanisms of adaptive resistance, we analyse the tumour immune microenvironment in the context of anti-PD-1 therapy in two fully immunocompetent mouse models of lung adenocarcinoma. In tumours progressing following response to anti-PD-1 therapy, we observe upregulation of alternative immune checkpoints, notably T-cell immunoglobulin mucin-3 (TIM-3), in PD-1 antibody bound T cells and demonstrate a survival advantage with addition of a TIM-3 blocking antibody following failure of PD-1 blockade. Two patients who developed adaptive resistance to anti-PD-1 treatment also show a similar TIM-3 upregulation in blocking antibody-bound T cells at treatment failure. These data suggest that upregulation of TIM-3 and other immune checkpoints may be targetable biomarkers associated with adaptive resistance to PD-1 blockade.
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Affiliation(s)
- Shohei Koyama
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Esra A Akbay
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Yvonne Y Li
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Grit S Herter-Sprie
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Kevin A Buczkowski
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - William G Richards
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Leena Gandhi
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Amanda J Redig
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Scott J Rodig
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - Hajime Asahina
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Robert E Jones
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Meghana M Kulkarni
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Mari Kuraguchi
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Sangeetha Palakurthi
- Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Peter E Fecci
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - Bruce E Johnson
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Pasi A Janne
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Jeffrey A Engelman
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA
| | | | - Daniel B Costa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
| | - Gordon J Freeman
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Raphael Bueno
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
| | - F Stephen Hodi
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Glenn Dranoff
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Kwok-Kin Wong
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | - Peter S Hammerman
- Depatment of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts 02215, USA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, Massachusetts 02142, USA
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38
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Koyama S, Akbay EA, Li YY, Aref AR, Skoulidis F, Herter-Sprie GS, Buczkowski KA, Liu Y, Awad MM, Denning WL, Diao L, Wang J, Parra-Cuentas ER, Wistuba II, Soucheray M, Thai T, Asahina H, Kitajima S, Altabef A, Cavanaugh JD, Rhee K, Gao P, Zhang H, Fecci PE, Shimamura T, Hellmann MD, Heymach JV, Hodi FS, Freeman GJ, Barbie DA, Dranoff G, Hammerman PS, Wong KK. STK11/LKB1 Deficiency Promotes Neutrophil Recruitment and Proinflammatory Cytokine Production to Suppress T-cell Activity in the Lung Tumor Microenvironment. Cancer Res 2016; 76:999-1008. [PMID: 26833127 DOI: 10.1158/0008-5472.can-15-1439] [Citation(s) in RCA: 396] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/06/2015] [Indexed: 01/05/2023]
Abstract
STK11/LKB1 is among the most commonly inactivated tumor suppressors in non-small cell lung cancer (NSCLC), especially in tumors harboring KRAS mutations. Many oncogenes promote immune escape, undermining the effectiveness of immunotherapies, but it is unclear whether the inactivation of tumor suppressor genes, such as STK11/LKB1, exerts similar effects. In this study, we investigated the consequences of STK11/LKB1 loss on the immune microenvironment in a mouse model of KRAS-driven NSCLC. Genetic ablation of STK11/LKB1 resulted in accumulation of neutrophils with T-cell-suppressive effects, along with a corresponding increase in the expression of T-cell exhaustion markers and tumor-promoting cytokines. The number of tumor-infiltrating lymphocytes was also reduced in LKB1-deficient mouse and human tumors. Furthermore, STK11/LKB1-inactivating mutations were associated with reduced expression of PD-1 ligand PD-L1 in mouse and patient tumors as well as in tumor-derived cell lines. Consistent with these results, PD-1-targeting antibodies were ineffective against Lkb1-deficient tumors. In contrast, treating Lkb1-deficient mice with an IL6-neutralizing antibody or a neutrophil-depleting antibody yielded therapeutic benefits associated with reduced neutrophil accumulation and proinflammatory cytokine expression. Our findings illustrate how tumor suppressor mutations can modulate the immune milieu of the tumor microenvironment, and they offer specific implications for addressing STK11/LKB1-mutated tumors with PD-1-targeting antibody therapies.
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Affiliation(s)
- Shohei Koyama
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Esra A Akbay
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yvonne Y Li
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Amir R Aref
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Ferdinandos Skoulidis
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grit S Herter-Sprie
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Kevin A Buczkowski
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yan Liu
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Mark M Awad
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Warren L Denning
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lixia Diao
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Wang
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edwin R Parra-Cuentas
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ignacio I Wistuba
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Tran Thai
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Hajime Asahina
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Shunsuke Kitajima
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Abigail Altabef
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Jillian D Cavanaugh
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Kevin Rhee
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Peng Gao
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Haikuo Zhang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Peter E Fecci
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Takeshi Shimamura
- Department of Molecular Pharmacology and Therapeutics, Oncology Research Institute, Loyola University Chicago, Illinois
| | - Matthew D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - F Stephen Hodi
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Gordon J Freeman
- Department of Medical Oncology and Cancer Vaccine Center, Dana Farber Cancer Institute, Boston, Massachusetts. Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A Barbie
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Glenn Dranoff
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts.
| | - Peter S Hammerman
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
| | - Kwok-Kin Wong
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts. Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts.
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Akbay EA, Koyama S, Li YY, Herter-Sprie GS, Buczkowski KA, Richards WG, Gandhi L, Redig AJ, Rodig SJ, Asahina H, Jones RE, Kulkarni MM, Fecci PE, Johnson BE, Janne PA, Engelman JA, Gangadharan SP, Costa DB, Freeman GJ, Bueno R, Hodi FS, Dranoff G, Wong KK, Hammerman PS. Abstract B96: Adaptive resistance to therapeutic PD-1:PD-L1 blockade is mediated by upregulation of the TIM-3 immune checkpoint. Mol Cancer Ther 2015. [DOI: 10.1158/1535-7163.targ-15-b96] [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: 11/16/2022]
Abstract
Abstract
Introduction:
Programmed death 1 (PD-1): Programmed death ligand 1 (PD-L1) immune checkpoint blockade has been demonstrated to be efficacious in a number of cancer types, including melanoma, renal cell carcinoma, bladder cancer, hematologic malignancies and non-small cell lung cancer (NSCLC) and anti-PD-1 antibodies have recently been approved for use in the United States and Asia. Anti-PD-1 therapeutic antibodies function through binding to PD-1 on tumor-reactive T cells and inhibiting the PD-1:PD-L1 interaction, thereby reinvigorating the anti-tumor T cell response. Expression of PDL1 in tumor cells and infiltrating immune cells and PD-1 in T cells has been associated with responsiveness to blockade of this immune checkpoint; however, mechanisms of both de novo and adaptive resistance to therapy are unclear.
Methods:
We used two genetically engineered mouse models of lung adenocarcinomas corresponding to the two most common oncogene drivers in human lung adenocarcinoma, Kirsten rat sarcoma viral oncogene homolog (KRAS) and EGFR. The EGFR and Kras models were treated with a therapeutic anti-PD-1 antibody until tumors demonstrated progression by MRI and evaluated immune profiles. To confirm the applicability of these findings in patients, we also analyzed immune cells from patients who showed an initial response to PD-1 blockade but developed progressive disease several months after the initiation of treatment.
Results:
We identified upregulation of Tim-3 checkpoint receptor on therapeutic antibody-bound T cells as a marker of treatment resistance in mouse tumors. To determine whether blockade of Tim-3 at the time of resistance might be therapeutically efficacious, we performed Tim-3 blocking treatment in these mice and demonstrated a clinical benefit. Specimens from the two patients who developed progressive disease after an initial response to anti-PD1 treatments also exhibited similar upregulation of TIM-3 on therapeutic antibody-bound T cells, further supporting TIM-3 as a marker of treatment resistance.
Conclusions:
TIM-3 is upregulated in anti-PD-1 antibody bound T cells at the time of tumor regrowth in both genetically engineered mouse models and non-small cell lung cancer patients who initially responded to PD-1 blocking treatment. Targeting TIM-3 could be a promising option to reinitiate tumor-reactive T cell activation in patients who have developed adaptive resistance to anti-PD-1 treatment.
Citation Format: Esra A. Akbay, Shohei Koyama, Yvonne Y. Li, Grit S. Herter-Sprie, Kevin A. Buczkowski, William G. Richards, Leena Gandhi, Amanda J. Redig, Scott J. Rodig, Hajime Asahina, Robert E. Jones, Meghana M. Kulkarni, Peter E. Fecci, Bruce E. Johnson, Pasi A. Janne, Jeffrey A. Engelman, Sidharta P. Gangadharan, Daniel B. Costa, Gordon J. Freeman, Raphael Bueno, F. Stephen Hodi, Glenn Dranoff, Kwok-Kin Wong, Peter S. Hammerman. Adaptive resistance to therapeutic PD-1:PD-L1 blockade is mediated by upregulation of the TIM-3 immune checkpoint. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr B96.
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40
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Watanabe M, Takashina T, Asahina H, Amano T, Yokouchi H, Takamura K, Harada T, Honjo O, Morikawa N, Kinoshita I. Phase II study of carboplatin/pemetrexed/bevacizumab followed by bev/erlotinib maintenance for non-squamous NSCLC with WT EGFR. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv471.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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41
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Xu C, Buczkowski KA, Zhang Y, Asahina H, Beauchamp EM, Terai H, Li YY, Meyerson M, Wong KK, Hammerman PS. NSCLC Driven by DDR2 Mutation Is Sensitive to Dasatinib and JQ1 Combination Therapy. Mol Cancer Ther 2015. [PMID: 26206333 DOI: 10.1158/1535-7163.mct-15-0077] [Citation(s) in RCA: 27] [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] [Indexed: 11/16/2022]
Abstract
Genetically engineered mouse models of lung cancer have demonstrated an important role in understanding the function of novel lung cancer oncogenes and tumor-suppressor genes identified in genomic studies of human lung cancer. Furthermore, these models are important platforms for preclinical therapeutic studies. Here, we generated a mouse model of lung adenocarcinoma driven by mutation of the discoidin domain receptor 2 (DDR2) gene combined with loss of TP53. DDR2(L63V);TP53(L/L) mice developed poorly differentiated lung adenocarcinomas in all transgenic animals analyzed with a latency of 40 to 50 weeks and a median survival of 67.5 weeks. Mice expressing wild-type DDR2 with combined TP53 loss did not form lung cancers. DDR2(L63V);TP53(L/L) tumors displayed robust expression of DDR2 and immunohistochemical markers of lung adenocarcinoma comparable with previously generated models, though also displayed concomitant expression of the squamous cell markers p63 and SOX2. Tumor-derived cell lines were not solely DDR2 dependent and displayed upregulation of and partial dependence on MYCN. Combined treatment with the multitargeted DDR2 inhibitor dasatinib and BET inhibitor JQ1 inhibited tumor growth in vitro and in vivo. Together, these results suggest that DDR2 mutation can drive lung cancer initiation in vivo and provide a novel mouse model for lung cancer therapeutics studies.
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Affiliation(s)
- Chunxiao Xu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Belfer Institute for Applied Cancer Sciences, Boston, MA, USA
| | - Kevin A Buczkowski
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yanxi Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Belfer Institute for Applied Cancer Sciences, Boston, MA, USA
| | - Hajime Asahina
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Belfer Institute for Applied Cancer Sciences, Boston, MA, USA
| | - Ellen M Beauchamp
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Hideki Terai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yvonne Y Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kwok-Kin Wong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Belfer Institute for Applied Cancer Sciences, Boston, MA, USA
| | - Peter S Hammerman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Cancer Program, Broad Institute of Harvard and MIT, Cambridge, MA, USA
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Nokihara H, Yamamoto N, Tamura Y, Tanabe Y, Honda K, Asahina H, Enatu S, Kurek R, Yamada Y, Tamura T. A Phase 1 Study of Necitumumab (Anti-Egfr Monoclonal Antibody) in Japanese Patients with Advanced Solid Tumors. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu435.108] [Citation(s) in RCA: 3] [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: 11/13/2022] Open
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43
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Harada T, Fukumoto S, Harada M, Nakano K, Sukoh N, Fuke S, Asahina H, Takamura K, Yamamoto M, Fujita Y, Akie K, Kinoshita I, Oizumi S, Akita H, Isobe H, Nishimura M. A Randomized Phase Ii Trial of Cisplatin Plus Gemcitabine Versus Carboplatin Plus Gemcitabine in Patients with Completely Resected Non-Small Cell Lung Cancer: Hokkaido Lung Cancer Clinical Study Group Trial (Hot0703). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu347.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Kawashima Y, Inoue A, Sugawara S, Oizumi S, Maemondo M, Okudera K, Suzuki T, Usui K, Harada M, Morikawa N, Hasegawa Y, Saito R, Ishimoto O, Sakakibara T, Asahina H, Nukiwa T. Phase II study of amrubicin combined with carboplatin for refractory relapsed small-cell lung cancer: North Japan Lung Cancer Group Trial 0802. Respir Investig 2014; 52:190-194. [PMID: 24853020 DOI: 10.1016/j.resinv.2013.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/10/2013] [Revised: 10/17/2013] [Accepted: 12/09/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Amrubicin (AMR), a new anthracycline agent, has shown promising results for advanced small-cell lung cancer (SCLC), although the efficacy of AMR alone against refractory relapsed SCLC is insufficient. This study was conducted to evaluate the safety and efficacy of the combination of AMR and carboplatin (CBDCA) in patients with refractory relapsed SCLC. METHODS Patients with advanced SCLC who relapsed within 90 days after the completion of first-line chemotherapy received AMR (30mg/m(2), days 1-3) and CBDCA (area under the curve 4.0mgmL(-1)min(-1), day 1) every 3 weeks. The primary endpoint of this study was the overall response rate (ORR), and the secondary endpoints were progression-free survival (PFS), overall survival, and the toxicity profile. Assuming that an ORR of 45% in eligible patients would indicate potential usefulness and an ORR of 20% would be the lower limit of interest, with α=0.10 and β=0.10, at least 24 patients were required. RESULTS Among 29 eligible patients, the ORR was 34% (90% confidence interval, 20-48). The median PFS was 3.5 months, whereas the median survival time was 7.3 months. The most common grade 3-4 toxicity was neutropenia (79%), although only one patient (3%) suffered from febrile neutropenia. Non-hematological toxicities were of moderate severity and no treatment-related death was observed. CONCLUSIONS This is the first prospective study of AMR combined with CBDCA for refractory relapsed SCLC, which was effective and well tolerated. However, further investigation of this regimen is warranted.
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Affiliation(s)
- Yosuke Kawashima
- Department of Pulmonary Medicine, Sendai Kousei Hospital, 4-15 Hirose-machi, Aoba-ku, Sendai 980-0873, Japan.
| | - Akira Inoue
- Department of Respiratory Medicine, Tohoku University Hospital, 1-1 Seiryou-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, 4-15 Hirose-machi, Aoba-ku, Sendai 980-0873, Japan.
| | - Satoshi Oizumi
- First Department of Medicine, Hokkaido University School of Medicine, Kita 15-jo Nishi 7-chome, Kita-ku, Sapporo 060-8638, Japan.
| | - Makoto Maemondo
- Department of Respiratory Medicine, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-shiote, Natori 981-1293, Japan.
| | - Koichi Okudera
- Department of Respiratory Medicine, Hirosaki Central Hospital, 3-1 Yoshino-machi, Hirosaki 036-8188, Japan.
| | - Toshiro Suzuki
- Department of Respiratory Medicine, Isawa Hospital, 61 Ryugababa, Mizusawa-ku, Oshu 023-0864, Japan.
| | - Kazuhiro Usui
- Division of Respirology, NTT Medical Center Tokyo, 5-9-22 Higashi Gotanda, Shinagawa-ku, Tokyo 141-8625, Japan.
| | - Masao Harada
- Department of Respiratory Medicine, Hokkaido Cancer Center, 2-3-54 Kikusui 4-jo, Shiroishi-ku, Sapporo 003-0804, Japan.
| | - Naoto Morikawa
- Division of Pulmonary Medicine, Allergy, and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan.
| | - Yukihiro Hasegawa
- Department of Respiratory Medicine, Aomori Prefectural Central Hospital, 2-1-1 Higashitukurimichi, Aomori 030-8553, Japan.
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University Hospital, 1-1 Seiryou-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Osamu Ishimoto
- Department of Pulmonary Medicine, Sendai Kousei Hospital, 4-15 Hirose-machi, Aoba-ku, Sendai 980-0873, Japan.
| | - Tomohiro Sakakibara
- Department of Respiratory Medicine, Tohoku University Hospital, 1-1 Seiryou-machi, Aoba-ku, Sendai 980-8574, Japan.
| | - Hajime Asahina
- First Department of Medicine, Hokkaido University School of Medicine, Kita 15-jo Nishi 7-chome, Kita-ku, Sapporo 060-8638, Japan.
| | - Toshihiro Nukiwa
- South Miyagi Medical Center, 38-1 Nishi, Ogawara, Shibata 989-1253, Japan.
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Yamada Y, Nokihara H, Yamamoto N, Fujiwara Y, Tamura Y, Wakui H, Honda K, Nakamichi S, Asahina H, Tanabe Y, Kitazono S, Mizugaki H, Yamazaki N, Suzuki S, Sasaki J, Matsuoka M, Tamura T. Phase I and pharmacokinetics/pharmacodynamics (PK/PD) study of MEK inhibitor, RO4987655, in Japanese patients with advanced solid tumors. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.116] [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
116 Background: RO4987655 is an oral and selective inhibitor of MEK, a key enzyme of the MAPK signaling pathway. This was a phase I, non-randomized, open-label, dose-escalation study in Japanese patients (pts) with advanced solid tumors. Primary objectives were determination of maximum tolerated dose (MTD) based on dose-limiting toxicities (DLTs), safety evaluation and PK analysis. Secondary objectives were PD analysis and exploratory analysis of RO4987655’s anti-tumor activity according to the RECIST 1.0 criteria. Methods: Patients received an oral single dose of RO4987655 (1, 2, 4, 5, and 6.5 mg) (Cycle 0) followed by continuous once daily dosing (QD, 1, 2, and 4 mg/day) then twice daily dosing (4, 5, and 6.5 mg BID, total daily dose: 8, 10 and 13 mg/day) in 28-day cycles. A 3 + 3 dose-escalation design was used. Blood samples for PK analysis were collected in Cycle 0 (Day 1, 2 and 3) and in Cycle 1 (Day 1, 8, 15 and 22). PD was evaluated by pERK inhibition in peripheral blood mononuclear cells (PBMCs) using FACS analysis. Results: In dose-escalation, 25 pts were enrolled. After the MTD was defined, 6 pts were added to the MTD dose for further confirmation of safety profile. Tumor types included esophageal (n=8), colorectal (n=8) and non-small cell lung cancer (NSCLC) (n=4). MTD was defined as 8 mg/day due to 4 DLTs of Grade 3 creatine phosphokinase (CPK) elevation. Most commonly related adverse events included dermatitis acneiform, CPK elevation, and eye disorders, particularly macular edema and visual impairment. Plasma concentration of RO4987655 appeared to increase in a dose-proportional manner with a plasma half-life of 4.32 to 21.1 hours. After multiple dose administration, steady-state conditions were reached by Cycle 1 Day 8. The inhibitory effects of RO4987655 on pERK in PBMCs increased in a dose-dependent manner. An esophageal cancer pt confirmed partial response with over 50% shrinkage and 6 pts including NSCLC noted as stable disease ≥16 weeks by independent assessment. Conclusions: RO4987655 is tolerable with a favorable PK/PD correlation in Japanese pts with advanced solid tumors. Exploratory analysis of biomarker is ongoing. Clinical trial information: JapicCTI-111490.
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Affiliation(s)
- Yasuhide Yamada
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Nokihara
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Noboru Yamamoto
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Fujiwara
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Tamura
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Wakui
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazunori Honda
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Nakamichi
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hajime Asahina
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Tanabe
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Kitazono
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hidenori Mizugaki
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoya Yamazaki
- Division of Dermatological Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Shigenobu Suzuki
- Division of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Tomohide Tamura
- Division of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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46
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Honda K, Yamamoto N, Nokihara H, Tamura Y, Asahina H, Yamada Y, Suzuki S, Yamazaki N, Ogita Y, Tamura T. Phase I and pharmacokinetic/pharmacodynamic study of RO5126766, a first-in-class dual Raf/MEK inhibitor, in Japanese patients with advanced solid tumors. Cancer Chemother Pharmacol 2013; 72:577-84. [PMID: 23860959 DOI: 10.1007/s00280-013-2228-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/29/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE RO5126766, a highly selective dual Raf and MEK inhibitor, is a first-in-class tandem mitogen-activated protein kinase signaling pathway inhibitor. The objectives of this phase I study were to determine maximum-tolerated dose (MTD) and to evaluate safety, pharmacokinetics (PK), pharmacodynamics (PD), and anti-tumor activity of RO5126766 in Japanese patients with advanced solid tumors. METHODS Patients received a single oral dose of RO5126766 (0.8, 1.2, 1.8, or 2.25 mg) followed by continuous once-daily dosing at the same dosage in 28-day cycles. A 3 + 3 dose-escalation design was used. PD was evaluated by pMEK and pERK inhibition in peripheral blood mononuclear cells (PBMCs). RESULTS A total of 12 patients were enrolled in cohorts of 0.8, 1.2, 1.8, and 2.25 mg/day. In the dose range tested, no dose-limiting toxicity was observed, and therefore, MTD was not defined. Main adverse events included acneiform dermatitis, creatine phosphokinase elevation, and ocular disorders. The plasma exposure of RO5126766 appeared to increase in a dose-proportional manner with a long plasma half-life (t 1/2) of 45.8-93.7 h. Following multiple dose administration, a steady-state condition was reached by Cycle 1 Day 8 (240 h). The inhibitory effects of RO5126766 on both pERK and pMEK in PBMCs increased in a dose-dependent manner. Five out of 12 patients achieved stable diseases, including a melanoma case with over 20 % shrinkage. CONCLUSIONS RO5126766 has a manageable safety profile up to 2.25 mg/day once daily with a favorable PK/PD profile in Japanese patients with advanced solid tumors.
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Affiliation(s)
- Kazunori Honda
- Division of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
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Kawashima Y, Inoue A, Sugawara S, Harada M, Kobayashi K, Kozuki T, Kuyama S, Sakakibara T, Maemondo M, Asahina H, Hisamoto A, Nakagawa T, Nukiwa T. Phase II study of amrubicin (AMR) and carboplatin (CBDCA) for invasive thymoma (IT) and thymic carcinoma (TC): NJLCG0803. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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
7530 Background: There has been no standard chemotherapy for advanced thymic malignancies including IT and TC although anthracycline or platinum agents have been commonly used for them. AMR, a new anthracycline agent, was approved for lung cancer in Japan and we had previously conducted some prospective studies of AMR combined with CBDCA for patients with small-cell lung cancer, which revealed this regimen was active with acceptable toxicity. The objective of this study is to evaluate the efficacy and safety of this combination for patients with advanced thymic malignancies. Methods: Patients with histologically confirmed thymic malignancies received AMR (35 mg/m2, day1-3) and CBDCA (AUC 4.0, day1) every 3 weeks. Patients who underwent previous chemotherapy received reduced dose of AMR (30 mg/m2). The primary endpoint was overall response rate (ORR), and secondary endpoints were progression-free survival (PFS), overall survival and toxicity profile. Assuming that ORR of 75% and 45% would indicate the potential usefulness while ORR of 50% and 20% would be the lower limit of interest, with alpha = 0.10 and beta = 0.20, for IT patients and TC patients, respectively, 18 IT patients and 16 TC patients were at least required. Results: From December 2008 to October 2012, 51 patients (18 IT and 33 TC) were enrolled from 20 institutions in Japan. Patients’ characteristics are as follows; male/female 35/16; median age 66 (range 39-78); performance status 0/1 24/27. The ORR and disease control rate were 17% and 89% in IT, and 30% and 85% in TC. Preliminary median PFS was 7.6 months in both groups. Toxicity was generally moderate and no treatment related death was observed. Conclusions: This is the largest prospective study of chemotherapy for advanced thymic malignancies. AMR combined with CBDCA was effective for TC patients with acceptable toxicities. Clinical trial information: R000001598.
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Affiliation(s)
| | | | | | - Masao Harada
- National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | | | - Toshiyuki Kozuki
- Department of Thoracic oncology and medicine, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, NHO Iwakuni Clinical Center, Iwakuni, Japan
| | | | - Makoto Maemondo
- Department of Respiratory Medicine, Miyagi Cancer Center, Natori, Japan
| | | | - Akiko Hisamoto
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
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48
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Oizumi S, Inoue A, Sakakibara T, Asahina H, Sugawara S, Maemondo M, Okudera K, Suzuki T, Usui K, Harada M, Morikawa N, Hasegawa Y, Ishimoto O, Nukiwa T. Phase II Study of Amrubicin (AMR) Combined with Carboplatin (CBDCA) for Refractory Relapsed Small Cell Lung Cancer (SCLC): North Japan Lung Cancer Group 0802. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32274-2] [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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49
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Yamamoto N, Nokihara H, Yamada Y, Asahina H, Shibata T, Tamura Y, Seki Y, Honda K, Tanabe Y, Wakui H, Tamura T. Phase I Study of Anti PD-1 Antibody Ono-4538 in Japanese Patients with Advanced Solid Tumors. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)31987-6] [Citation(s) in RCA: 3] [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: 11/30/2022] Open
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50
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Asahina H, Masuba A, Hirano S, Yuri K. Distribution of protocadherin 9 protein in the developing mouse nervous system. Neuroscience 2012; 225:88-104. [PMID: 22982106 DOI: 10.1016/j.neuroscience.2012.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/03/2012] [Accepted: 09/04/2012] [Indexed: 12/31/2022]
Abstract
Protocadherin 9 (Pcdh9) is a member of the protocadherin family, which includes many members involved in various phenomena, such as cell-cell adhesion, neural projection, and synapse formation. Here, we identified Pcdh9 protein in the mouse brain and examined its distribution during neural development. Pcdh9, with a molecular weight of approximately 180 kDa, was localized at cell-cell contact sites in COS-1 cells transfected with Pcdh9 cDNA. In cultured neurons, it was detected at the growth cone and at adhesion sites along neurites. In the E13.5 brain, prominent Pcdh9 immunoreactivity was detected in the dorsal thalamus along with other regions including the vestibulocochlear nerve. As development proceeded (E15.5-P1), Pcdh9 immunoreactivity became observable in various brain regions but was restricted to certain fiber tracts and brain nuclei. Interestingly, many Pcdh9-positive brain nuclei and fascicles belonged to the vestibular (e.g. vestibulocochlear nerve, vestibular nuclei, and the vestibulocerebellum) and oculomotor systems (medial longitudinal fascicles, oculomotor nucleus, trochlear nucleus, and interstitial nucleus of Cajal). In addition, we examined the distribution of Pcdh9 protein in the olfactory bulb, retina, spinal cord, and dorsal root ganglion. In these regions, Pcdh9 and OL-protocadherin proteins were differentially distributed, with the difference highlighted in the olfactory bulb, where they were enriched in different subsets of glomeruli. In the mature retina, Pcdh9 immunoreactivity was detected in distinct sublaminae of the inner and outer plexiform layers. In the dorsal root ganglion, only certain subsets of neurons showed Pcdh9 immunoreactivity. These results suggest that Pcdh9 might be involved in formation of specific neural circuits during neural development.
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Affiliation(s)
- H Asahina
- Department of Neurobiology and Anatomy, Kochi Medical School, Kochi University, Okoh-cho, Nankoku-City, Kochi 783-8505, Japan
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