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Mitchell P, Thatcher N, Socinski MA, Wasilewska-Tesluk E, Horwood K, Szczesna A, Martín C, Ragulin Y, Zukin M, Helwig C, Falk M, Butts C, Shepherd FA. Tecemotide in unresectable stage III non-small-cell lung cancer in the phase III START study: updated overall survival and biomarker analyses. Ann Oncol 2015; 26:1134-1142. [PMID: 25722382 DOI: 10.1093/annonc/mdv104] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [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: 11/26/2014] [Accepted: 02/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tecemotide is a MUC1-antigen-specific cancer immunotherapy. The phase III START study did not meet its primary end point but reported notable survival benefit with tecemotide versus placebo in an exploratory analysis of the predefined patient subgroup treated with concurrent chemoradiotherapy. Here, we attempted to gain further insight into the effects of tecemotide in START. PATIENTS AND METHODS START recruited patients who did not progress following frontline chemoradiotherapy for unresectable stage III non-small-cell lung cancer. We present updated overall survival (OS) data and exploratory analyses of OS for baseline biomarkers: soluble MUC1 (sMUC1), antinuclear antibodies (ANA), neutrophil/lymphocyte ratio (NLR), lymphocyte count, and HLA type. RESULTS Updated OS data are consistent with the primary analysis: median 25.8 months (tecemotide) versus 22.4 months (placebo) (HR 0.89, 95% CI 0.77-1.03, P = 0.111), with ∼20 months additional median follow-up time compared with the primary analysis. Exploratory analysis of the predefined subgroup treated with concurrent chemoradiotherapy revealed clinically relevant prolonged OS with tecemotide versus placebo (29.4 versus 20.8 months; HR 0.81, 95% CI 0.68-0.98, P = 0.026). No improvement was seen with sequential chemoradiotherapy. High sMUC1 and ANA correlated with a possible survival benefit with tecemotide (interaction P = 0.0085 and 0.0022) and might have future value as biomarkers. Interactions between lymphocyte count, NLR, or prespecified HLA alleles and treatment effect were not observed. CONCLUSION Updated OS data support potential treatment benefit with tecemotide in patients treated with concurrent chemoradiotherapy. Exploratory biomarker analyses suggest that elevated sMUC1 or ANA levels correlate with tecemotide benefit. CLINICALTRIALSGOV NUMBER NCT00409188.
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Affiliation(s)
- P Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Melbourne, Australia.
| | - N Thatcher
- Christie Hospital NHS Trust, Manchester, UK
| | | | | | - K Horwood
- Princess Alexandra Hospital, Woolloongabba, Australia
| | - A Szczesna
- Mazowieckie Centrum Leczenia Chorób Pluc i Gruzlicy, Otwock, Poland
| | - C Martín
- Division of Clinical Oncology, Instituto Especializado Alexander Fleming, Buenos Aires, Argentina
| | - Y Ragulin
- Medical Radiological Research Center, Obninsk, Russia
| | - M Zukin
- Clinical Oncology, Instituto Nacional do Câncer-INCA, Rio de Janeiro, Brazil
| | | | - M Falk
- Merck KGaA, Darmstadt, Germany
| | - C Butts
- Cancer Care, Cross Cancer Institute, Edmonton
| | - F A Shepherd
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
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Gatzemeier U, Ardizzoni A, Horwood K, van Meerbeeck J, Magyar P, Gottfried M, Arrieta O, Krzakowski M, Franke F, van Zandwijk N. Erlotinib in non-small cell lung cancer (NSCLC): Interim safety analysis of the TRUST study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7645] [Citation(s) in RCA: 5] [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
7645 Background: In patients (pts) with relapsed NSCLC, erlotinib 150 mg/d significantly prolonged survival, delayed symptom progression, and improved quality of life versus placebo (Shepherd et al, N Engl J Med 2005;353:123–32). TRUST is an open label, non- randomized trial initiated to provide erlotinib access to pts with advanced NSCLC. Methods: Eligible pts had stage IIIb/IV NSCLC, and had failed or were unsuitable for chemotherapy. Erlotinib (150 mg/d p.o.) was given until disease progression or unacceptable toxicity. Pts were monitored monthly. Results: In November 2006, data were available for 5,015 pts (ITT population) from 51 countries. Median age was 63y (range 19–95). Pt characteristics (%) were: male/female 62/38; Caucasian/Oriental/other 76/19/5; non-smoker/ex- or current-smoker 28/71 (no data 1); ECOG PS 0/1/2/3 21/53/20/6; adenocarcinoma/squamous cell/other 53/25/21; stage IIIb/IV 22/78; erlotinib 1st/2nd/3rd-line/other 14/48/37/1. Safety data were available for 4,423 pts, 55% of whom had at least one adverse event (AE). Only 5% had one or more erlotinib- related serious AEs, the most common being gastrointestinal (GI) disorders (86 pts; 63 grade [gr] 3/4). 6% of pts discontinued treatment due to erlotinib-related AEs: GI disorders in 96 pts (54 gr 3/4), skin disorders in 92 (50 gr 3/4). Unexpected erlotinib-related AEs occurred in 10% of pts (4% gr 1, 3% gr 2, 3% gr 3/4). As expected, rash was observed in 70% of pts, with the majority (84%) being of gr 1/2. 80% pts received >4 weeks of erlotinib. Among 4,405 pts, only 14% had dose reductions, mainly due to rash (83%) and diarrhea (21%). Similar safety results were seen for 2nd-line pts only. Efficacy for all and 2nd-line pts will be presented. Conclusions: These results, achieved through routine clinical use of erlotinib in unselected pts with advanced NSCLC, confirm the favorable tolerability profile seen with erlotinib in selected patients in the clinical trial setting. [Table: see text]
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Affiliation(s)
- U. Gatzemeier
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - A. Ardizzoni
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - K. Horwood
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - J. van Meerbeeck
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - P. Magyar
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - M. Gottfried
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - O. Arrieta
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - M. Krzakowski
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - F. Franke
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
| | - N. van Zandwijk
- Hospital Grosshansdorf, Grosshansdorf, Germany; University Hospital, Parma, Italy; John Flynn-Gold Coast Private Hospital, Tugun, Queensland, Australia; University Hospital, Ghent, Belgium; Semmelweis University of Medicine, Budapest, Hungary; Meir-Sapir Medical Center, Kfar Saba, Israel; Instituto Nacional de Cancerología, Mexico City, Mexico; Centrum Onkologii Instytut, Warsaw, Poland; Hospital de Caridade de Ijui, Ijui, Brazil; Netherlands Cancer Inst/Antoni van Leeuwenhoe Hosp, Amsterdam, The
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