1
|
Leonetti A, Perrone F, Puntoni M, Maglietta G, Bordi P, Bria E, Vita E, Gelsomino F, De Giglio A, Gelibter A, Siringo M, Mazzoni F, Caliman E, Genova C, Bertolini F, Guaitoli G, Passiglia F, Delcuratolo MD, Montrone M, Cerea G, Pasello G, Roca E, Belluomini L, Cecere FL, Guida A, Manzo A, Adamo V, Rastelli F, Bulotta A, Citarella F, Toschi L, Zoratto F, Cortinovis DL, Berardi R, Follador A, Carta A, Camerini A, Salerno F, Silva RR, Baldini E, Cortellini A, Brighenti M, Santoni M, Malorgio F, Caminiti C, Tiseo M. Real-world outcomes of Italian patients with advanced non-squamous lung cancer treated with first-line pembrolizumab plus platinum-pemetrexed. Eur J Cancer 2024; 202:114006. [PMID: 38489861 DOI: 10.1016/j.ejca.2024.114006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE The aim of this multi-center, retrospective/prospective cohort observational study was to evaluate outcomes in routine clinical practice of first-line chemo-immunotherapy with cis/carboplatin, pemetrexed and pembrolizumab in patients with advanced non-squamous non-small cell lung cancer (NSCLC) in 33 Italian centers. METHODS The outcome measure was to evaluate overall survival (OS) in a real-world patient population. Secondary endpoints were: progression-free survival (PFS), objective response rate (ORR), duration of response (DoR) and incidence of treatment-related adverse events (AEs). RESULTS 1068 patients were enrolled at the time of data cut-off (January 31st, 2023), and 812 (76.0%) belonged to the retrospective cohort. Median age was 66 years (27-85), ECOG PS was ≥ 2 in 91 (8.6%) patients; 254 (23.8%) patients had brain metastases at baseline; 38 (3.6%) patients had tumor with PD-L1 expression ≥ 50%. After a median follow-up of 17.0 months (95% CI, 16.1-17.9), median OS was 16.1 months (95% CI, 14.4-18.8) and PFS was 9.9 months (95% CI, 8.8-11.2). Median DoR (n = 493) was 14.7 months (95% CI, 13.6-17.1). ORR was 43.4% (95% CI, 40.4-46.4). Any-grade AEs occurred in 636 (59.6%) patients and grade ≥ 3 in 253 (23.7%) patients. Most common grade ≥ 3 AEs were neutropenia (6.3%) and anemia (6.3%). CONCLUSIONS First-line chemo-immunotherapy was effective and tolerable in this large, real-world Italian study of patients with advanced non-squamous NSCLC. Our results were in line with the KEYNOTE-189 registration study, also considering the low number of PD-L1 ≥ 50% patients included in our study.
Collapse
Affiliation(s)
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
| | - Matteo Puntoni
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Emilio Bria
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Vita
- UOSD Oncologia Toraco-Polmonare, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Medical Oncology, Department of Traslational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Gelsomino
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea De Giglio
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alain Gelibter
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Siringo
- Medical Oncology (B), Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | - Enrico Caliman
- Medical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Genova
- Academic Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Federica Bertolini
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Giorgia Guaitoli
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Francesco Passiglia
- Department of Oncology, University of Turin, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | | | - Michele Montrone
- Medical Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Pasello
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Elisa Roca
- Thoracic Oncology - Lung Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Lorenzo Belluomini
- Medical Oncology, Department of Medicine, University of Verona Hospital Trust, Verona, Italy
| | | | - Annalisa Guida
- Department of Medical Oncology, St. Mary's Hospital, Terni, Italy
| | - Anna Manzo
- Thoracic Medical Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit, Azienda Ospedaliera Papardo, Messina, Italy
| | - Francesca Rastelli
- Medical Oncology, AST (Azienda Sanitaria Territoriale) of Ascoli Piceno, Ascoli Piceno, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milan, Italy
| | - Fabrizio Citarella
- Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy
| | - Luca Toschi
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | | | - Diego Luigi Cortinovis
- SC Medical Oncology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Medicine and Surgery Department, University of Milano Bicocca, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica Delle Marche, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandro Follador
- Medical Oncology Unit San Daniele - Tolmezzo, ASUFC Azienda Sanitaria Universitaria Friuli Centrale, Italy
| | - Annamaria Carta
- Pathology and Oncology Unit, Businco Oncological Hospital, Cagliari, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital, Azienda USL Toscana Nord Ovest, Lido di Camaiore, Italy
| | - Flavio Salerno
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Rosa Rita Silva
- Department of Oncology, ASUR Marche, Area Vasta 2, Fabriano, Italy
| | | | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Roma, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, UK
| | | | | | | | - Caterina Caminiti
- Clinical & Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
2
|
Rossi S, Pagliaro A, Finocchiaro G, Marinello A, Giordano L, Bria E, Stefani A, Vitale A, Toschi L, D'Argento E, Santoro A. Response to first-line pembrolizumab in metastatic KRAS-mutated non-small-cell lung cancer. Future Oncol 2024; 20:373-380. [PMID: 38445372 DOI: 10.2217/fon-2023-0952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Aims: This retrospective study aims to identify a possible predictive role of KRAS mutations in non-small-cell lung cancer in response to first-line pembrolizumab, either as monotherapy or combined with chemotherapy. Methods: Patients received pembrolizumab alone (n = 213) or associated with chemotherapy (n = 81). Results: A mutation in the KRAS gene was detected in 27% of patients. In patients on pembrolizumab alone, median progression-free survival in KRAS-mutated cases was longer than in wild-type cases (11.3 vs 4.4 months; p = 0.019), whereas median overall survival did not reach statistical significance (22.1 vs 12.5 months; p = 0.119). Patients receiving chemo-immunotherapy with KRAS-positive tumors had a similar progression-free survival (9.7 vs 7.3 months; p = 0.435); overall survival data were immature. Conclusion: This study suggests a correlation between KRAS status and response to pembrolizumab.
Collapse
Affiliation(s)
- Sabrina Rossi
- Medical Oncology & Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, 20089, Italy
| | - Arianna Pagliaro
- Medical Oncology & Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, 20072, Italy
| | - Giovanna Finocchiaro
- Medical Oncology & Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, 20089, Italy
| | - Arianna Marinello
- Medical Oncology & Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, 20072, Italy
| | - Laura Giordano
- Biostatistic Unit, IRCSS Humanitas Research Hospital - Humanitas Cancer Center, Rozzano, Milan, 20089, Italy
| | - Emilio Bria
- U.O.C. Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, 00168, Italy
| | - Alessio Stefani
- U.O.C. Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, 00168, Italy
| | - Antonio Vitale
- U.O.C. Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, 00168, Italy
| | - Luca Toschi
- Medical Oncology & Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, 20089, Italy
| | - Ettore D'Argento
- U.O.C. Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, 00168, Italy
| | - Armando Santoro
- Medical Oncology & Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, 20072, Italy
| |
Collapse
|
3
|
Prelaj A, Ganzinelli M, Provenzano L, Mazzeo L, Viscardi G, Metro G, Galli G, Agustoni F, Corte CMD, Spagnoletti A, Giani C, Ferrara R, Proto C, Brambilla M, Dumitrascu AD, Inno A, Signorelli D, Pizzutilo EG, Brighenti M, Biello F, Bennati C, Toschi L, Russano M, Cortellini A, Catania C, Bertolini F, Berardi R, Cantini L, Pecci F, Macerelli M, Emili R, Bareggi C, Verderame F, Lugini A, Pisconti S, Buzzacchino F, Aieta M, Tartarone A, Spinelli G, Vita E, Grisanti S, Trovò F, Auletta P, Lorenzini D, Agnelli L, Sangaletti S, Mazzoni F, Calareso G, Ruggirello M, Greco GF, Vigorito R, Occhipinti M, Manglaviti S, Beninato T, Leporati R, Ambrosini P, Serino R, Silvestri C, Zito E, Pedrocchi ACL, Miskovic V, de Braud F, Pruneri G, Lo Russo G, Genova C, Vingiani A. APOLLO 11 Project, Consortium in Advanced Lung Cancer Patients Treated With Innovative Therapies: Integration of Real-World Data and Translational Research. Clin Lung Cancer 2024; 25:190-195. [PMID: 38262770 DOI: 10.1016/j.cllc.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Despite several therapeutic efforts, lung cancer remains a highly lethal disease. Novel therapeutic approaches encompass immune-checkpoint inhibitors, targeted therapeutics and antibody-drug conjugates, with different results. Several studies have been aimed at identifying biomarkers able to predict benefit from these therapies and create a prediction model of response, despite this there is a lack of information to help clinicians in the choice of therapy for lung cancer patients with advanced disease. This is primarily due to the complexity of lung cancer biology, where a single or few biomarkers are not sufficient to provide enough predictive capability to explain biologic differences; other reasons include the paucity of data collected by single studies performed in heterogeneous unmatched cohorts and the methodology of analysis. In fact, classical statistical methods are unable to analyze and integrate the magnitude of information from multiple biological and clinical sources (eg, genomics, transcriptomics, and radiomics). METHODS AND OBJECTIVES APOLLO11 is an Italian multicentre, observational study involving patients with a diagnosis of advanced lung cancer (NSCLC and SCLC) treated with innovative therapies. Retrospective and prospective collection of multiomic data, such as tissue- (eg, for genomic, transcriptomic analysis) and blood-based biologic material (eg, ctDNA, PBMC), in addition to clinical and radiological data (eg, for radiomic analysis) will be collected. The overall aim of the project is to build a consortium integrating different datasets and a virtual biobank from participating Italian lung cancer centers. To face with the large amount of data provided, AI and ML techniques will be applied will be applied to manage this large dataset in an effort to build an R-Model, integrating retrospective and prospective population-based data. The ultimate goal is to create a tool able to help physicians and patients to make treatment decisions. CONCLUSION APOLLO11 aims to propose a breakthrough approach in lung cancer research, replacing the old, monocentric viewpoint towards a multicomprehensive, multiomic, multicenter model. Multicenter cancer datasets incorporating common virtual biobank and new methodologic approaches including artificial intelligence, machine learning up to deep learning is the road to the future in oncology launched by this project.
Collapse
Affiliation(s)
- Arsela Prelaj
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy; Electronic, Information e Bio-engeenering, Politecnico di Milano, Milan, Italy
| | - Monica Ganzinelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Leonardo Provenzano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy.
| | - Laura Mazzeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Giuseppe Viscardi
- Oncology Department, Ospedale Monaldi, Azienda Ospedaliera Dei Colli, Napoli, Italy
| | - Giulio Metro
- Oncology Unit, Azienda Ospedaliera Santa Maria della Misercordia, Perugia, Italy
| | - Giulia Galli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Agustoni
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carminia Maria Della Corte
- Dipartimento di Medicina di Precisione, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Andrea Spagnoletti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Claudia Giani
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Roberto Ferrara
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Claudia Proto
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Marta Brambilla
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Andra Diana Dumitrascu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Alessandro Inno
- Oncology Department, IRCCS Ospedale Sacro Cuore don Calabria, Verona, Italy
| | - Diego Signorelli
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Federica Biello
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Chiara Bennati
- Oncology Unit, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Luca Toschi
- Oncology Department, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - Marco Russano
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy; Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Alessio Cortellini
- Operative Research Unit of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
| | - Chiara Catania
- Oncology Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Luca Cantini
- Clinica Oncologica, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Federica Pecci
- Clinica Oncologica, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Marianna Macerelli
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Santa Maria Della Misericordia, Udine, Italy
| | - Rita Emili
- Oncology Unit, Ospedale Santa Maria della Misericordia, Urbino, Italy
| | - Claudia Bareggi
- Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Antonio Lugini
- Oncology Unit, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | | | | | - Michele Aieta
- Oncology Unit, IRCCS CROB, Rionero in Vulture, Italy
| | | | | | - Emanuele Vita
- Oncology Department, Policlinico Universitario Fondazione "A.Gemelli" IRCCS, Rome, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, ASST Spedali Civili di Breascia, University of Brescia, Brescia, Italy
| | - Francesco Trovò
- Electronic, Information e Bio-engeenering, Politecnico di Milano, Milan, Italy
| | - Pietro Auletta
- IPOP onlus - Associazione Insieme per i Pazienti di Oncologia Polmonare, Milan, Italy
| | - Daniele Lorenzini
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Luca Agnelli
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Sabina Sangaletti
- Sperimental Oncology and Molecular Medicine Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | | | - Giuseppina Calareso
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Margherita Ruggirello
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | | | - Raffaella Vigorito
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Mario Occhipinti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Sara Manglaviti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Teresa Beninato
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Rita Leporati
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Paolo Ambrosini
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Roberta Serino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Cecilia Silvestri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Emanuela Zito
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | | | - Vanja Miskovic
- Electronic, Information e Bio-engeenering, Politecnico di Milano, Milan, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Giancarlo Pruneri
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Giuseppe Lo Russo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| | - Carlo Genova
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Vingiani
- Pathology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milan, Italy
| |
Collapse
|
4
|
Rossi S, Pagliaro A, Michelini A, Navarria P, Clerici E, Franceschini D, Toschi L, Finocchiaro G, Scorsetti M, Santoro A. The Era of Immunotherapy in Small-Cell Lung Cancer: More Shadows Than Light? Cancers (Basel) 2023; 15:5761. [PMID: 38136306 PMCID: PMC10741846 DOI: 10.3390/cancers15245761] [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: 09/26/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Small-cell lung cancer is an extremely chemo-sensitive disease; the addition of immunotherapy to chemotherapy has demonstrated a slight clinical benefit in pivotal trials, even with a statistically significant difference in terms of survival outcomes when compared to chemotherapy alone. In this scenario, the role of radiotherapy as a consolidation treatment in thoracic disease or as a prophylactic therapy in the brain should be clarified. In addition, due to the frailty and the poor prognostic characteristics of these patients, the need for predictive biomarkers that could support the use of immunotherapy is crucial. PD-L1 and TMB are not actually considered definitive biomarkers due to the heterogeneity of results in the literature. A new molecular classification of small-cell lung cancer based on the expression of key transcription factors seems to clarify the disease behavior, but the knowledge of this molecular subtype is still insufficient and the application in clinical practice far from reality; this classification could lead to a better understanding of SCLC disease and could provide the right direction for more personalized treatment. The aim of this review is to investigate the current knowledge in this field, evaluating whether there are predictive biomarkers and clinical patient characteristics that could help us to identify those patients who are more likely to respond to immunotherapy.
Collapse
Affiliation(s)
- Sabrina Rossi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.P.); (A.M.); (L.T.); (G.F.); (A.S.)
| | - Arianna Pagliaro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.P.); (A.M.); (L.T.); (G.F.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| | - Angelica Michelini
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.P.); (A.M.); (L.T.); (G.F.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.N.); (E.C.); (D.F.)
| | - Elena Clerici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.N.); (E.C.); (D.F.)
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.N.); (E.C.); (D.F.)
| | - Luca Toschi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.P.); (A.M.); (L.T.); (G.F.); (A.S.)
| | - Giovanna Finocchiaro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.P.); (A.M.); (L.T.); (G.F.); (A.S.)
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.N.); (E.C.); (D.F.)
| | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (A.P.); (A.M.); (L.T.); (G.F.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy;
| |
Collapse
|
5
|
Pasello G, Lorenzi M, Crivellaro G, Capelletto E, Butticè S, Perrone F, Tiseo M, Scotti V, Polo V, Favaretto A, Montrone M, Berardi R, Zustovich F, Toschi L, Bearz A, Milella M, Frega S, Bonanno L, Guarneri V. 21P Bevacizumab plus atezolizumab and chemotherapy in NSCLC harbouring EGFR mutation previously treated with EGFR tyrosine kinase inhibitor: The BACH-NET study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00275-7] [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: 04/03/2023]
|
6
|
Lococo F, Cancellieri A, Chiappetta M, Leonetti A, Cardillo G, Zanelli F, Mangiameli G, Toschi L, Guggino G, Romano F, Leuzzi G, Proto C, Spaggiari L, De Marinis F, Vita E, Ampollini L, Margaritora S, Tiseo M, Bria E. Salvage surgery after first-line Alectinib for locally-advanced/metastatic ALK-rearranged NSCLC: pathological response and peri-operative results. Clin Lung Cancer 2023:S1525-7304(23)00044-X. [PMID: 37061413 DOI: 10.1016/j.cllc.2023.03.008] [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: 01/21/2023] [Revised: 02/20/2023] [Accepted: 03/05/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND The role of salvage surgery after tyrosine kinase inhibitors in advanced oncogene-addicted non-small cell lung cancer is largely unexplored. PATIENTS We aimed to describe the pathological features and surgical early-outcomes of Anaplastic Lymphome Kinase anaplastic lymphome kinase positive non-small cell lung cancer patients undergoing surgery after first-line alectinib treatment. We retrospectively collected and analyzed multicentric data of 10 patients treated with alectinib for advanced-stage anaplastic lymphome kinase positive lung adenocarcinoma who underwent anatomical surgical resection from January 2020 to Decemeber 2021. All patients were treatment naive and received alectinib (600 mg twice daily). Surgery was always proposed after multidisciplinary discussion. The primary endpoints were pathological response and surgical feasibility (technical intraoperative complications, postoperative outcomes). RESULTS Alectinib was received for a mean of 212 days before surgery (42-415 days) and was generally interrupted about one week before surgery (range: 0-32 days) with no patient experienced grade 4 toxicity. All patients received an R0 resection with surgery consisting of lobectomy in 8 cases with bilobectomy and (left) pneumonectomy in 1 case each. Intra-operative difficulties were described in 7 cases (70%), mostly due to perivascular fibrosis or thickening of mediastinal lymph nodal tissues. Major and minor complications occurred in 0 and 3 cases (30%), respectively. A pathological complete response and major pathological response (defined as 0% and < 10% viable tumor cells, respectively) were observed in 50% and 90% of cases, respectively. Despite short follow-up, only one tumor recurrence was observed (in the only patient who did not resume alectinib after surgery). INTERPRETATION Despite some technical intraoperative difficulties, salvage surgery was safe and feasible after Alectinib for advanced lung adenocarcinoma.
Collapse
|
7
|
Rossi S, Marinello A, Pagliaro A, Franceschini D, Navarria P, Finocchiaro G, Toschi L, Scorsetti M, Santoro A. Current treatment approaches for brain metastases in ALK/ ROS1/ NTRK-positive non-small-cell lung cancer. Expert Rev Anticancer Ther 2023; 23:29-41. [PMID: 36548111 DOI: 10.1080/14737140.2023.2162044] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Oncogene-addicted non-small cell lung cancer (NSCLC) patients present a high incidence of CNS metastases either at diagnosis or during the course of the disease. In this case, patients present with worse prognosis and are often excluded from clinical trials unless brain metastases are pre-treated or clinically stable. AREAS COVERED As a result of the discovery of several oncogenic drivers in ALK/ROS1/NTRK-positive NSCLC, targeted agents have been tested in several trials. We evaluate and compare the intracranial efficacy of available targeted agents in ALK/ROS1/NTRK-positive NSCLC based on subgroup analysis from pivotal trials. EXPERT OPINION Last-generation ALK inhibitors have shown slightly superior intracranial activity but pivotal trials do not consider the same endpoints for intracranial efficacy, therefore data are not comparable. Local treatments for BM including surgical resection, stereotactic radiosurgery (SRS) and WBRT, should be integrated with systemic therapies basing on specific criteria like presence of oligoprogression or symptomatic progression.
Collapse
Affiliation(s)
- Sabrina Rossi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Arianna Marinello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Arianna Pagliaro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanna Finocchiaro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Toschi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Armando Santoro
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
8
|
Lococo F, Chiappetta M, Cancellieri A, Cardillo G, Zanelli F, Mangiameli G, Toschi L, Guggino G, Romano F, Leuzzi G, Proto C, Spaggiari L, De Marinis F, Vita E, Menna E, Margaritora S, Bria E. EP05.03-008 Surgery after First-Line Alectinib for (Locally) Advanced ALK-rearranged NSCLC: Pathological Response and Peri-Operative Results. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
F. Perrone AL, Puntoni M, Bordi P, Maglietta G, Carpana C, Gelsomino F, Passiglia F, Genova C, Montrone M, Caliman E, Cerea G, Pasello G, Cecere F, Manzo A, Adamo V, Citarella F, Toschi L, Gelibter A, Rastelli F, Carta A, Guida A, Camerini A, Paoloni F, Bertolini F, Tiseo M. EP08.01-007 Real-World Outcomes of Patients with Advanced Lung Adenocarcinoma Treated with First-Line Chemo-Immunotherapy in Italy. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Meng R, Besse B, Johnson M, Bennouna J, Toschi L, Abbadessa G, Amrate A, Zang M, Ares LP. 455 Pegasus Lung, a platform study of SAR444245 (THOR-707, a pegylated recombinant non-alpha IL-2) with anti-cancer agents in patients with non-small cell lung cancer (NSCLC) and mesothelioma. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundSAR444245 (THOR-707) is a recombinant human IL-2 molecule that includes a PEG moiety irreversibly bound to a novel amino acid via click chemistry to block the alpha-binding domain while retaining near-native affinity for the beta/gamma subunits. In animal models, SAR444245 showed anti-tumor benefits, but with no severe side effects, both as single agent and when combined with anti-PD1 comparing with historical data from aldesleukin. The HAMMER trial, which is the FIH study shows preliminary encouraging clinical results: initial efficacy and safety profile with SAR444245 monotherapy and in combination with pembrolizumab support a non-alpha preferential activity, validating preclinical models. The Pegasus Lung Ph2 study will evaluate the clinical benefit of SAR444245 in combination with other anticancer therapies for the treatment of patients with lung cancer or pleural mesotheliomaMethodsThe Pegasus Lung (NCT04914897) will enroll approximately 354 patients in 6 separate cohorts concurrently or sequentially. In cohorts A1 & A2, patients with first line (L) NSCLC will receive SAR444245 + pembrolizumab. In cohort A3, patients with 1L non-squamous NSCLC will receive SAR444245 + pembrolizumab + pemetrexed + carboplatin/cisplatin. In cohort B1 & B2 patients with 2/3L NSCLC who have progressed on a checkpoint inhibitor (CPI)-based therapy will receive SAR444245 + pembrolizumab, or SAR444245 + pembrolizumab + nab-paclitaxel. In cohort C patients with 2/3L CPI naïve mesothelioma will receive SAR444245 + pembrolizumab. SAR444245 is administered IV at a dose of 24 ug/kg Q3W in an outpatient setting until disease progression or completion of 35 cycles. Pembrolizumab is administered at a dose of 200 mg Q3W until PD or completion of 35 cycles. The study primary objective is to determine the antitumor activity of SAR444245 in combination with other anticancer therapies. Secondary objectives include confirmation of dose and safety profile, assess other indicators of antitumor activity, and assess the pharmacokinetic profile and immunogenicity of SAR444245. The study will be conducted in the US, Australia, France, Italy, Japan, Poland, South Korea, Spain, and Taiwan.AcknowledgementsThe Pegasus Lung study is sponsored by Sanofi.Trial RegistrationNCT04914897Ethics ApprovalThis study has been approved by applicable ethics committees or institutional review boards. All participants gave informed consent before taking part.ConsentWritten informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Collapse
|
11
|
Rossi S, Damiano P, Toschi L, Finocchiaro G, Giordano L, Marinello A, Bria E, D'Argento E, Santoro A. Uncommon single and compound EGFR mutations: clinical outcomes of a heterogeneous subgroup of NSCLC. Curr Probl Cancer 2021; 46:100787. [PMID: 34489119 DOI: 10.1016/j.currproblcancer.2021.100787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/03/2022]
Abstract
Molecular characterization of non-small-cell lung cancer (NSCLC) is essential to define the correct therapeutic algorithm in metastatic disease. Approximately 90% of epidermal growth factor receptor (EGFR) mutations are usually associated with sensitivity to EGFR tyrosine kinase inhibitors (TKIs). The remaining 10% defines a small, extremely heterogeneous subgroup of mutations, with a varied profile of sensitivity and response to target therapies.This retrospective observational study includes 47 patients affected by metastatic NSCLC harboring uncommon EGFR mutations (single or compound mutation). Patients were treated with EGFR-targeting TKIs or platinum-based chemotherapy as first-line treatment.Median OS resulted longer in the compound mutation group when compared to single rare mutations (33.6 vs 12 months; P = 0.473); a similar result was observed for PFS (16 vs 7.6 months; P = 0.281), although statistical significance was not reached. ORR, PFS and OS resulted similar for patients treated with first-line EGFR TKIs or chemotherapy. No difference in terms of PFS and OS was found according to the TKI administered.Compound mutations seem to be a good prognostic indicator for OS; they are also predictive of response to 1st and 2nd generation EGFR TKIs, as well as exon 19 insertions and mutations in codon 719 of exon 18. For mutations in exon 18 (not in codon 719) and exon 20 insertions, chemotherapy seems the most effective available option. The addition of immunotherapy to chemotherapy could change this approach in the next future.
Collapse
Affiliation(s)
- Sabrina Rossi
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy.
| | - Paola Damiano
- U.O.C. Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Toschi
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Giovanna Finocchiaro
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Laura Giordano
- Biostatistic Unit, IRCSS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Arianna Marinello
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Emilio Bria
- U.O.C. Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ettore D'Argento
- U.O.C. Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Armando Santoro
- IRCCS Humanitas Clinical and Research Center - Humanitas Cancer Center, Rozzano, Milan, Italy; Humanitas University, Department of Biomedical Sciences, Milan, Italy
| |
Collapse
|
12
|
Gregorc V, Mazzarella L, Lazzari C, Graziano P, Vigneri P, Genova C, Toschi L, Ciliberto G, Bonanno L, Delmonte A, Bucci G, Rossi A, Motta G, Coco S, Marinello A, Buglioni S, Cangi MG, Di Micco C, Bandiera A, Bonfiglio S, Pecciarini L, Guida A, Ceol A, Frige' G, De Maria R, Pelicci PG. Prospective Validation of the Italian Alliance Against Cancer Lung Panel in Patients With Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2021; 22:e637-e641. [PMID: 33642178 DOI: 10.1016/j.cllc.2020.12.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/25/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The deeper knowledge of non-small-cell lung cancer (NSCLC) biology and the discovery of driver molecular alterations have opened the era of precision medicine in lung oncology, thus significantly revolutionizing the diagnostic and therapeutic approach to NSCLC. In Italy, however, molecular assessment remains heterogeneous across the country, and numbers of patients accessing personalized treatments remain relatively low. Nationwide programs have demonstrated that the creation of consortia represent a successful strategy to increase the number of patients with a molecular classification. PATIENTS AND METHODS The Alliance Against Cancer (ACC), a network of 25 Italian Research Institutes, has developed a targeted sequencing panel for the detection of genomic alterations in 182 genes in patients with a diagnosis of NSCLC (ACC lung panel). One thousand metastatic NSCLC patients will be enrolled onto a prospective trial designed to measure the sensitivity and specificity of the ACC lung panel as a tool for molecular screening compared to standard methods. RESULTS AND CONCLUSION The ongoing trial is part of a nationwide strategy of ACC to develop infrastructures and improve competences to make the Italian research institutes independent for genomic profiling of cancer patients.
Collapse
Affiliation(s)
- Vanesa Gregorc
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milano.
| | | | - Chiara Lazzari
- Department of Oncology, IRCCS San Raffaele Scientific Institute, Milano
| | - Paolo Graziano
- Unit of Pathology, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
| | - Paolo Vigneri
- A.O.U. Policlinico "G. Rodolico - S. Marco", Catania
| | - Carlo Genova
- UOC Clinica di Oncologia Medica; IRCCS Ospedale Policlinico San Martino, Genova; Dipartimento di Medicina Interna e Specialità Mediche (DiMI); Università degli Studi di Genova
| | - Luca Toschi
- Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Milano
| | - Gennaro Ciliberto
- Direzione Scientifica, IRCCS Istituto Nazionale Tumori Regina Elena, Roma
| | - Laura Bonanno
- Oncologia Medica 2, IstitutoOncologico Veneto IOV IRCCS, Padova
| | - Angelo Delmonte
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola
| | - Gabriele Bucci
- Center for Omics Sciences (COSR), IRCCS San Raffaele Scientific Institute, Milano
| | - Antonio Rossi
- Medical Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
| | | | - Simona Coco
- UOS Tumori Polmonari; IRCCS Ospedale Policlinico San Martino, Genova
| | - Arianna Marinello
- Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Milano
| | | | - Maria Giulia Cangi
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milano
| | - Concetta Di Micco
- Medical Oncology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (Foggia)
| | - Alessandro Bandiera
- Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milano
| | - Silvia Bonfiglio
- Center for Omics Sciences (COSR), IRCCS San Raffaele Scientific Institute, Milano
| | - Lorenza Pecciarini
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milano
| | | | - Arnaud Ceol
- IRCCS European Institute of Oncology, Milano
| | - Gianmaria Frige'
- Department of Experimental Oncology, European Institute of Oncology IRCCS, Milano
| | - Ruggero De Maria
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, RomeFondazione Policlinico A. Gemelli IRCCS, Roma; Universitá Cattolica del Sacro Cuore, Roma
| | - Pier Giuseppe Pelicci
- IRCCS European Institute of Oncology, Milano; Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano
| |
Collapse
|
13
|
Castello A, Rossi S, Toschi L, Lopci E. Impact of Antibiotic Therapy and Metabolic Parameters in Non-Small Cell Lung Cancer Patients Receiving Checkpoint Inhibitors. J Clin Med 2021; 10:jcm10061251. [PMID: 33803006 PMCID: PMC8002619 DOI: 10.3390/jcm10061251] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction: In the current study, we aimed to assess the impact of antibiotics (ATB) and metabolic parameters on clinical outcome of non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI). Methods: Data from fifty NSCLC patients referred for ICI between December 2015 and May 2019 were analyzed. All patients underwent 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT) and contrast-enhanced CT at baseline and for response assessment after 6–8 weeks. Patients who received ATB within 1 month before or after the first dose of ICI were compared with those who did not. Response assessment according to iRECIST and EORTC was evaluated, as well as progression-free survival (PFS) and overall survival (OS). For semi-quantitative parameters, we computed metabolic tumor volume (MTV), total lesion glycolysis (TLG) and their variations (∆). Results: Twenty NSCLC cases of 50 (40%) had received ATB. Patients receiving ATB had a higher number of metastases (p = 0.046), and were associated with an elevated tumor burden, expressed by TLG (687 vs. 235.3, p = 0.007) and MTV (125.6 vs. 40.6, p = 0.002), compared to no-ATB patients. According to iRECIST, progressive disease rate was significantly higher for ATB group (64.7% vs. 27.6%, p = 0.029). Likewise, PFS was shorter for ATB compared to no-ATB (median 4.1 vs. 12.4 months, p = 0.004), while no difference for OS was detected. On multivariate analysis, the effect of ATB remained significant for poor PFS along with performance status (ECOG ≥ 1), and ∆SUVmax. Conclusions: ATB therapy seems to be associated with a worse treatment response, PFS, and higher metabolic tumor burden in NSCLC patients treated with ICI.
Collapse
Affiliation(s)
- Angelo Castello
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy;
| | - Sabrina Rossi
- Department of Oncology and Hematology, IRCCS-Humanitas Research Center, 20089 Rozzano, Italy; (S.R.); (L.T.)
| | - Luca Toschi
- Department of Oncology and Hematology, IRCCS-Humanitas Research Center, 20089 Rozzano, Italy; (S.R.); (L.T.)
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy;
- Correspondence: ; Tel.: +39-02-82247542; Fax: +39-02-82246693
| |
Collapse
|
14
|
Franceschini D, Rossi S, Loi M, Chiola I, Piccoli F, Lutman FR, Finocchiaro G, Toschi L, Santoro A, Scorsetti M. Lung cancer management: monitoring and treating resistance development in third-generation EGFR TKIs. Expert Rev Anticancer Ther 2020; 20:743-753. [PMID: 32755244 DOI: 10.1080/14737140.2020.1806716] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Patients treated with third-generation EGFR TKIs will develop resistance to treatment at a certain point. Early detection of resistance occurrence could allow more options for treatment. AREAS COVERED We discuss the development of third-generation EGFR TKIs, focusing on osimertinib and discuss the most common resistance mechanisms under evaluation. We also debate how this resistance can be detected; particularly we review the possible application of liquid biopsy in this scenario. Lastly we discuss available treatment options when resistance occurs, with an eye on ongoing trials and possible future developments. EXPERT OPINION As resistance will ultimately develop, a strict instrumental follow-up as per international guidelines is required with the aim of detecting this resistance in an early phase. Detecting an oligoprogression could allow the integration of local ablative therapies while further delaying the need for a systemic therapy change. By exploiting the increasing potentiality of liquid biopsy, in the near future, physicians could be able to understand why a patient develops resistance and therefore can choose the best possible individualized treatment option.
Collapse
Affiliation(s)
- D Franceschini
- Radiotherapy and Radiosurgery Department- Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy
| | - S Rossi
- Medical Oncology Department, Humanitas Clinical and Research Center - IRCCS , Rozzano, Italy
| | - M Loi
- Radiotherapy and Radiosurgery Department- Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy
| | - I Chiola
- Radiotherapy and Radiosurgery Department- Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy
| | - F Piccoli
- Radiology Department, Humanitas University , Pieve Emanuele, Italy
| | - F R Lutman
- Radiology Department, Humanitas Clinical and Research Center - IRCCS , Rozzano, Italy
| | - G Finocchiaro
- Medical Oncology Department, Humanitas Clinical and Research Center - IRCCS , Rozzano, Italy
| | - L Toschi
- Medical Oncology Department, Humanitas Clinical and Research Center - IRCCS , Rozzano, Italy
| | - A Santoro
- Medical Oncology Department, Humanitas Clinical and Research Center - IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
| | - M Scorsetti
- Radiotherapy and Radiosurgery Department- Humanitas Clinical and Research Center, IRCCS , Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Italy
| |
Collapse
|
15
|
Castello A, Rossi S, Toschi L, Lopci E. Comparison of Metabolic and Morphological Response Criteria for Early Prediction of Response and Survival in NSCLC Patients Treated With Anti-PD-1/PD-L1. Front Oncol 2020; 10:1090. [PMID: 32850315 PMCID: PMC7412129 DOI: 10.3389/fonc.2020.01090] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction/Aim: Immunotherapy with immune checkpoint inhibitors (ICIs) has positively changed the history of several malignant tumors. In parallel, new challenges have emerged in the evaluation of treatment response as a result of their peculiar anticancer effect. In the current study, we aimed to compare different response criteria, both morphological and metabolic, for assessing response and outcome in patients with advanced non-small cell lung cancer (NSCLC) treated with ICI. Materials and Methods: Overall, 52 patients with advanced NSCLC candidate to ICI were prospectively evaluated. Inclusion criteria comprised whole-body contrast-enhanced CT and 18F-FDG PET/CT at baseline and at the first response evaluation 3 or 4 cycles after ICI. Response assessment on CT was performed according to RECIST 1.1 and imRECIST criteria, whereas metabolic response on PET was computed by EORTC, PERCIST, imPERCIST, and PERCIMT criteria. The concordance between the different tumor response criteria and the performance of each criterion to predict progression-free survival (PFS) and overall survival (OS) were calculated. Results: Inclusion criteria were fulfilled in 35 out of 52 patients. We observed a low agreement between imRECIST and imPERCIST (κ = 0.143) with discordant response in 20 patients, particularly regarding stable disease and progressive disease groups. Fair agreement between imRECIST and EORTC (κ = 0.340), and PERCIST (κ = 0.342), and moderate for PERCIMT (κ = 0.413) were detected. All criteria were significantly associated with PFS, while only PERCIMT and imPERCIST were associated with OS. Of note, in patients classified as immune stable disease (iSD), imPERCIST, and PERCIMT well-differentiated those with longer PFS (p < 0.001, p = 0.009) and OS (p = 0.001, p = 0.002). In the multivariate analysis, performance status [hazard ratio (HR) = 0.278, p = 0.015], imRECIST (HR = 3.799, p = 0.026), and imPERCIST (HR = 4.064, p = 0.014) were predictive factors for PFS, while only performance status (HR = 0.327, p = 0.035) and imPERCIST (HR = 3.247, p = 0.007) were predictive for OS. Conclusions: At the first evaluation during treatment with ICI, imPERCIST criteria correctly evaluated treatment response and appeared able to predict survival. Moreover, in patients with iSD on CT, imPERCIST were able to discriminate those with longer survival. This advantage might allow for earlier therapy modification based on metabolic response.
Collapse
Affiliation(s)
- Angelo Castello
- Department of Nuclear Medicine, Humanitas Clinical and Research Hospital—IRCCS, Milan, Italy
| | - Sabrina Rossi
- Medical Oncology, Humanitas Clinical and Research Hospital—IRCCS, Milan, Italy
| | - Luca Toschi
- Medical Oncology, Humanitas Clinical and Research Hospital—IRCCS, Milan, Italy
| | - Egesta Lopci
- Department of Nuclear Medicine, Humanitas Clinical and Research Hospital—IRCCS, Milan, Italy
| |
Collapse
|
16
|
Rossi S, Toschi L, Finocchiaro G, Santoro A. Neutrophil and lymphocyte blood count as potential predictive indicators of nivolumab efficacy in metastatic non-small-cell lung cancer. Immunotherapy 2020; 12:715-724. [PMID: 32522052 DOI: 10.2217/imt-2019-0154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: We retrospectively evaluated the role of neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) as prognostic factors in metastatic non-small-cell lung cancer patients treated with nivolumab. Materials & methods: Medical records of 65 patients were reviewed. NLR and LMR were calculated at baseline (t0) and at first radiological tumor assessment (t1). Results: At univariate analysis, low NLR or high LMR values at t0 were associated with longer overall survival (p = 0.0001). At multivariate analysis including NLR and LMR at t0 and t1 and their trend, only NLR at t1 (p < 0.0001) and NLR trend (p < 0.0001) were significantly associated with overall survival outcomes. Conclusion: Our study suggests that NLR value at first tumor assessment or NLR trend could be used as prognostic indicators during nivolumab treatment in metastatic non-small-cell lung cancer.
Collapse
Affiliation(s)
- Sabrina Rossi
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Luca Toschi
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Giovanna Finocchiaro
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center - IRCCS -, via Manzoni 56, 20089 Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| |
Collapse
|
17
|
Castello A, Rossi S, Toschi L, Mansi L, Lopci E. Soluble PD-L1 in NSCLC Patients Treated with Checkpoint Inhibitors and Its Correlation with Metabolic Parameters. Cancers (Basel) 2020; 12:cancers12061373. [PMID: 32471030 PMCID: PMC7352887 DOI: 10.3390/cancers12061373] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022] Open
Abstract
We investigated the role of soluble PD-L1 (sPD-L1) in non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI) and analyzed its association with clinical outcomes and metabolic parameters by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT). Between July 2017 and May 2019, we enrolled 20 candidate patients of ICI therapy who had serum frozen samples and 18F-FDG PET/CT available, both at baseline and at the first response evaluation. This analysis is embedded into a larger prospective study (NCT03563482). Twelve out of 20 patients received nivolumab, one patient received combination of nivolumab and ipilimumab, whereas the others received pembrolizumab. Median sPD-L1 level at baseline was 27.22 pg/mL. We found a significant association between patients with elevated sPD-L1, above the median value, and high metabolic tumor burden, expressed by metabolic tumor volume (MTV, 115.3 vs. 35.5, p = 0.034) and total lesion glycolysis (TLG, 687 vs. 210.1, p = 0.049). At the first restaging after 7–8 weeks, median sPD-L1 levels significantly increased as compared to baseline median value (43.9 pg/mL, p = 0.017). No significant differences in response rates were detected, according to both morphological and metabolic response criteria. Likewise, no difference in survival outcomes were observed between low sPD-L1 and high sPD-L1 patients. The increase of sPD-L1 concentrations during ICI treatment may reflect the expansion of tumor volume and the tumor lysis. Moreover, it is supposed that sPD-L1 has its own biological action, either by reducing membrane PD-1 sites available for nivolumab or by inducing lymphocytes exhaustion after binding their membrane PD-1. Further, larger studies are needed to confirm our preliminary results on the role of sPD-L1 during ICI therapy.
Collapse
Affiliation(s)
- Angelo Castello
- Nuclear Medicine, Humanitas Clinical and Research Hospital—IRCCS, 20089 Rozzano (MI), Italy;
| | - Sabrina Rossi
- Medical Oncology, Humanitas Clinical and Research Hospital—IRCCS, 20089 Rozzano (MI), Italy; (S.R.); (L.T.)
| | - Luca Toschi
- Medical Oncology, Humanitas Clinical and Research Hospital—IRCCS, 20089 Rozzano (MI), Italy; (S.R.); (L.T.)
| | - Luigi Mansi
- Section Health and Development, Interuniversity Research Center for Sustainability (CIRPS), 80100 Naples, Italy;
| | - Egesta Lopci
- Nuclear Medicine, Humanitas Clinical and Research Hospital—IRCCS, 20089 Rozzano (MI), Italy;
- Correspondence: or ; Tel.: +39-0282247542; Fax: +39-0282246693
| |
Collapse
|
18
|
Veronesi G, Navone N, Novellis P, Dieci E, Toschi L, Velutti L, Solinas M, Vanni E, Alloisio M, Ghislandi S. Favorable incremental cost-effectiveness ratio for lung cancer screening in Italy. Lung Cancer 2020; 143:73-79. [PMID: 32234647 DOI: 10.1016/j.lungcan.2020.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Lung cancer detection by low-dose computed tomographic screening reduces mortality. However, it is essential to assess cost-effectiveness. We present a cost-effectiveness analysis of screening in Italians at high risk of lung cancer, from the point of view of the Italian tax-payer. MATERIALS AND METHODS We used a decision model to estimate the cost-effectiveness of annual screening for 5 years in smokers (≥30 pack-years) of 55-79 years. Patients diagnosed in the COSMOS study were the screening arm; patients diagnosed and treated for lung cancer in the Lombardy Region, Italy, constituted the usual care arm. Treatment costs were extracted from our hospital database. Lung cancer survival in screened patients was adjusted for 2-year lead-time bias. Life-years and quality-adjusted life-years were estimated by stage at diagnosis, from which incremental cost-effectiveness ratios per life-year and quality-adjusted life-year gained were estimated. RESULTS Base-case incremental cost-effectiveness ratios were 3297 and 2944 euro per quality-adjusted life-year and life-year gained, respectively. Deterministic sensitivity analysis indicated that these values were particularly sensitive to lung cancer prevalence, screening sensitivity and specificity, screening cost, and treatment costs for stage I and IV disease. From the probabilistic sensitivity analysis incremental cost-effectiveness ratios had a 98 % probability of being <25,000 euro (widely-accepted threshold) and a 55 % probability of being <5000 euro. CONCLUSIONS Low-dose computed tomographic screening is associated with an incremental cost of 2944 euro per life-year gained in high risk population, implying that screening can be introduced in Italy at contained cost, saving the lives of many lung cancer patients.
Collapse
Affiliation(s)
- Giulia Veronesi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano (Milan), Italy.
| | - Niccolò Navone
- CERGAS and Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisa Dieci
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Toschi
- Department of Oncology & Hematology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - Laura Velutti
- Department of Oncology & Hematology, Humanitas Clinical and Research Center, Rozzano (Milan), Italy
| | - Michela Solinas
- Thoracic Surgery Unit, New Hospital of Legnano, ASST Ovest (Milan), Italy
| | - Elena Vanni
- Business Operating Officer, Humanitas Clinical and Research Center, Rozzano (Milan), Italy; Department of Biomedical Science, Humanitas University, Rozzano (Milan), Italy
| | - Marco Alloisio
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano (Milan), Italy; Department of Biomedical Science, Humanitas University, Rozzano (Milan), Italy
| | - Simone Ghislandi
- CERGAS and Department of Social and Political Sciences, Bocconi University, Milan, Italy
| |
Collapse
|
19
|
Castello A, Toschi L, Rossi S, Mazziotti E, Lopci E. The immune-metabolic-prognostic index and clinical outcomes in patients with non-small cell lung carcinoma under checkpoint inhibitors. J Cancer Res Clin Oncol 2020; 146:1235-1243. [PMID: 32048008 DOI: 10.1007/s00432-020-03150-9] [Citation(s) in RCA: 27] [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: 10/03/2019] [Accepted: 02/05/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This prospective study evaluated whether peripheral blood biomarkers and metabolic parameters on F-18 fludeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) could be associated with clinical outcome in non-small cell lung carcinoma (NSCLC) patients treated with immune checkpoint inhibitors (ICI). METHODS Data from 33 patients with NSCLC and treated with ICI were collected. Complete blood cell counts before and at the first restaging were measured. All patients underwent F-18 FDG PET/CT at baseline, while 25 patients at the first restaging. Progression-free survival (PFS) and overall survival (OS) were determined and compared using the Kaplan-Meier and the log-rank test. The median follow-up was 11.3 months (range 1-17 months). RESULTS Multivariate analyses demonstrated that low neutrophil-to-lymphocyte ratio (NLR < 4.9) and low total lesion glycolysis (TLG < 541.5 ml) at the first restaging were significantly associated with PFS (both p = 0.019) and OS (p = 0.001 and p = 0.048, respectively). An immune-metabolic-prognostic index (IMPI), based on post-NLR and post-TLG was developed, categorizing 3 groups: high risk, 2 factors; intermediate risk, 1 factor; low risk, 0 factors. Median PFS for low, intermediate and high risk was 7.8 months (95% CI 4.6-11.0), 5.6 months (95% CI 3.8-7.4), and 1.8 months (95% CI 1.6-2.0) (p < 0.001) respectively. Likewise, median OS was 15.2 months (95% CI 10.9-19.6), 13.2 months (95% CI 5.9-20.3), and 2.8 months (95% CI 1.4-4.2) (p < 0.001), respectively. CONCLUSION IMPI at the first restaging, combining both inflammatory and metabolic biomarkers, was correlated with PFS and OS. IMPI can be a potentially valuable tool for identifying NSCLC patients who are likely to benefit from ICI.
Collapse
Affiliation(s)
- Angelo Castello
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, CAP, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Luca Toschi
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy
| | - Sabrina Rossi
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy
| | - Emanuela Mazziotti
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, CAP, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Egesta Lopci
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, CAP, Via Manzoni 56, 20089, Rozzano, MI, Italy.
| |
Collapse
|
20
|
Franceschini D, De Rose F, Cozzi S, Franzese C, Rossi S, Finocchiaro G, Toschi L, Santoro A, Scorsetti M. The use of radiation therapy for oligoprogressive/oligopersistent oncogene-driven non small cell lung cancer: State of the art. Crit Rev Oncol Hematol 2020; 148:102894. [PMID: 32062314 DOI: 10.1016/j.critrevonc.2020.102894] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/14/2020] [Accepted: 01/29/2020] [Indexed: 01/14/2023] Open
Abstract
Oncogene-driven non small cell lung cancer (NSCLC) is a distinct entity in thoracic oncology. The availability of effective target therapies, like EGFR inhibitors or ALK inhibitors, have revolutionized the prognosis of these patients. However, despite an initial response in the majority of patients, drug resistance ultimately occurs. In some cases, this resistance develops in few clonal cells (oligoprogression), so that a local ablation of these resistant deposits could allow to maintain the same systemic therapy and possibly to prolong patients' survival. For these purposes, stereotactic body radiation therapy (SBRT) is an ideal local ablative treatment, because it is effective, non invasive and with limited side effects. In this review, we aim to analyze available clinical data to verify whether SBRT can allow these patients to continue with existing target therapy longer, delay the switch to other systemic therapies and improve their outcome modifying the natural history of the disease.
Collapse
Affiliation(s)
- D Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy.
| | - F De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - S Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - C Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - S Rossi
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - G Finocchiaro
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - L Toschi
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - A Santoro
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - M Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| |
Collapse
|
21
|
Castello A, Rossi S, Mazziotti E, Toschi L, Lopci E. Hyperprogressive Disease in Patients with Non-Small Cell Lung Cancer Treated with Checkpoint Inhibitors: The Role of 18F-FDG PET/CT. J Nucl Med 2019; 61:821-826. [PMID: 31862803 DOI: 10.2967/jnumed.119.237768] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/04/2019] [Indexed: 12/31/2022] Open
Abstract
A new pattern of response, so-called hyperprogressive disease (HPD), is emerging during treatment with immune checkpoint inhibitors (ICIs). Our aim was to investigate the prevalence of such a phenomenon and to assess its association with clinical variables and metabolic parameters by 18F-FDG PET/CT. Methods: Data from 50 patients (34 men and 16 women; median age, 73 y) with non-small cell lung carcinoma treated with ICIs were prospectively collected. All patients underwent contrast-enhanced CT, 18F-FDG PET/CT, and complete peripheral blood sampling at baseline before ICI treatment. HPD was defined according to clinical and radiologic criteria. Because of rapid disease progression or worsening of clinical condition, radiologic response assessment was available for only 46 of the 50 patients. Overall survival (OS) was analyzed using the Kaplan-Meier method and the log-rank test. A Cox proportional hazards regression analysis was used to evaluate factors independently associated with OS. Median follow-up was 12.4 mo (range, 9.7-15.2 mo). Results: We identified the following response categories: 10 cases as complete or partial response, 17 cases as stable disease, 5 cases as progressive disease, and 14 cases as HPD. Among metabolic parameters, we observed a statistically significant association between HPD status and tumor burden, expressed by both TLG (756.1 cm3 for HPD vs. 475.6 cm3 for non-HPD, P = 0.042) and MTV (287.3 for HPD vs. 62.1 for non-HPD, P = 0.011). Among clinical variables, 12 of 14 patients (85.7%) within the HPD group, compared with 8 of 32 patients (25%) in the non-HPD group, had more than 2 metastatic sites (P < 0.001). In addition, the derived neutrophil-to-lymphocyte ratio and platelet count were significantly associated with HPD status (P = 0.038 and P = 0.025, respectively). Survival analysis showed a median OS of 4 mo for the HPD group, compared with 15 mo for the non-HPD group (P = 0.003). Likewise, median OS was significantly different when we considered all the response categories: complete or partial response, stable disease, progressive disease, and HPD (P = 0.001). Finally, multivariate analysis identified metabolic tumor volume and derived neutrophil-to-lymphocyte ratio as independent predictors for OS. Conclusion: Our results suggest that the use of ICIs might represent a concern in patients with high metabolic tumor burden and inflammatory indices at baseline. However, additional studies are needed.
Collapse
Affiliation(s)
- Angelo Castello
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy; and
| | - Sabrina Rossi
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Emanuela Mazziotti
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy; and
| | - Luca Toschi
- Department of Oncology and Hematology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Egesta Lopci
- Department of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy; and
| |
Collapse
|
22
|
Monterisi S, Castello A, Toschi L, Federico D, Rossi S, Veronesi G, Lopci E. Preliminary data on circulating tumor cells in metastatic NSCLC patients candidate to immunotherapy. Am J Nucl Med Mol Imaging 2019; 9:282-295. [PMID: 31976158 PMCID: PMC6971481] [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] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
In the current paper, we aimed to investigate circulating tumor cells (CTCs) in non-small cell lung carcinoma (NSCLC) candidates to immunotherapy and correlate findings with clinical and metabolic parameters. Seventeen metastatic NSCLC patients (12 males, 5 females), were prospectively enrolled. All patients underwent 18F-Fluorodeoxyglucose (FDG) PET/CT and CTCs detection before treatment. CTCs isolation by size was carried out with the ISET method. CTCs were characterized based on cytopathological features and were compared with smoking status, histological subtype, pre-immunotherapy treatment, PDL-1 expression, performance status, and semi-quantitative parameters on PET, including SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG). We found CTCs in 10 out of 17 patients (59%). Mean number of CTCs was 3 (range 1-7). Only one cell with 3 malignant features was detected in the blood of a healthy control out of 7 (16%). A significantly lower number of CTCs was found in patients previously treated with chemotherapy (P=0.041). No correlation between CTCs and other clinical pathologic characteristics was observed. Patients with an extensive tumor burden, i.e. MTV and TLG, were associated with a higher number of CTCs (P=0.004 and P=0.028, respectively). Likewise, patients with a higher metabolism determined with SUVmean resulted having a higher CTCs count (P=0.048). The presence of CTCs was associated with tumor uptake and metabolic burden on PET/CT, while results were influenced by previous chemotherapy. Whether confirmed in larger series, the combination of the presence of CTCs and FDG PET metabolic parameters might improve prognostic stratification and allow more personalized treatment paradigm.
Collapse
Affiliation(s)
- Simona Monterisi
- Immunology and Inflammation, Humanitas Clinical and Research Hospital-IRCCSVia Manzoni 56, Rozzano (MI) 20089, Italy
| | - Angelo Castello
- Nuclear Medicine, Humanitas Clinical and Research Hospital-IRCCSVia Manzoni 56, Rozzano (MI) 20089, Italy
| | - Luca Toschi
- Oncology, Humanitas Clinical and Research Hospital-IRCCSVia Manzoni 56, Rozzano (MI) 20089, Italy
| | - Davide Federico
- Thoracic Surgery, Humanitas Clinical and Research Hospital-IRCCSVia Manzoni 56, Rozzano (MI) 20089, Italy
| | - Sabrina Rossi
- Oncology, Humanitas Clinical and Research Hospital-IRCCSVia Manzoni 56, Rozzano (MI) 20089, Italy
| | - Giulia Veronesi
- Thoracic Surgery, Humanitas Clinical and Research Hospital-IRCCSVia Manzoni 56, Rozzano (MI) 20089, Italy
| | - Egesta Lopci
- Nuclear Medicine, Humanitas Clinical and Research Hospital-IRCCSVia Manzoni 56, Rozzano (MI) 20089, Italy
| |
Collapse
|
23
|
Grossi F, Genova C, Crinò L, Delmonte A, Turci D, Signorelli D, Passaro A, Soto Parra H, Catino A, Landi L, Gelsomino F, Tiseo M, Puppo G, Roila F, Ricciardi S, Tonini G, Cognetti F, Toschi L, Tassinari D, Scoppola A, Giannarelli D, Cortesi E. Real-life results from the overall population and key subgroups within the Italian cohort of nivolumab expanded access program in non-squamous non–small cell lung cancer. Eur J Cancer 2019; 123:72-80. [DOI: 10.1016/j.ejca.2019.09.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/22/2019] [Accepted: 09/06/2019] [Indexed: 01/12/2023]
|
24
|
Landi L, D'Incà F, Gelibter A, Chiari R, Grossi F, Delmonte A, Passaro A, Signorelli D, Gelsomino F, Galetta D, Giannarelli D, Soto Parra H, Minuti G, Tiseo M, Migliorino MR, Cognetti F, Toschi L, Bidoli P, Piantedosi F, Calabro' L, Cappuzzo F. Bone metastases and immunotherapy in patients with advanced non-small-cell lung cancer. J Immunother Cancer 2019; 7:316. [PMID: 31752994 PMCID: PMC6868703 DOI: 10.1186/s40425-019-0793-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/30/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bone metastases (BoM) are a negative prognostic factor in non-small-cell lung cancer (NSCLC). Beyond its supportive role, bone is a hematopoietic organ actively regulating immune system. We hypothesized that BoM may influence sensitivity to immunotherapy. METHODS Pretreated non-squamous (cohort A) and squamous (cohort B) NSCLCs included in the Italian Expanded Access Program were evaluated for nivolumab efficacy according to BoM. RESULTS Cohort A accounted for 1588 patients with non-squamous NSCLC, including 626 (39%) with (BoM+) and 962 (61%) without BoM (BoM-). Cohort B accounted for 371 patients with squamous histology including 120 BoM+ (32%) and 251 (68%) BoM- cases. BoM+ had lower overall response rate (ORR; Cohort A: 12% versus 23%, p < 0.0001; Cohort B: 13% versus 22%, p = 0.04), shorter progression free survival (PFS; Cohort A: 3.0 versus 4.0 months, p < 0.0001; Cohort B: 2.7 versus 5.2 months, p < 0.0001) and overall survival (OS; Cohort A: 7.4 versus 15.3 months, p < 0.0001; Cohort B: 5.0 versus 10.9 months, p < 0.0001). Moreover, BoM negatively affected outcome irrespective of performance status (PS; OS in both cohorts: p < 0.0001) and liver metastases (OS cohort A: p < 0.0001; OS Cohort B: p = 0.48). At multivariate analysis, BoM independently associated with higher risk of death (cohort A: HR 1.50; cohort B: HR 1.78). CONCLUSIONS BoM impairs immunotherapy efficacy. Accurate bone staging should be included in clinical trials with immunotherapy.
Collapse
Affiliation(s)
- Lorenza Landi
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy
| | | | | | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Grossi
- Division of Medical Oncology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Domenico Galetta
- Oncologia Medica Toracica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | | | - Gabriele Minuti
- UO Oncologia Medica, Azienda Usl Toscana Nord Ovest, Livorno, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital, Parma, Italy
| | | | | | - Luca Toschi
- Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Paolo Bidoli
- Oncology Unit, ASST, Ospedale S. Gerardo, Monza, Italy
| | | | - Luana Calabro'
- Medical Oncology and Immunotherapy, Center for Immuno-Oncology, University Hospital of Siena, Siena, Italy
| | - Federico Cappuzzo
- Department of Oncology and Hematology, AUSL Romagna, Ravenna, Italy.
| |
Collapse
|
25
|
Rossi S, Finocchiaro G, Noia VD, Bonomi M, Cerchiaro E, Rose FD, Franceschini D, Navarria P, Ceresoli GL, Beretta GD, D'Argento E, Scorsetti M, Santoro A, Toschi L. Survival outcome of tyrosine kinase inhibitors beyond progression in association to radiotherapy in oligoprogressive EGFR-mutant non-small-cell lung cancer. Future Oncol 2019; 15:3775-3782. [PMID: 31709807 DOI: 10.2217/fon-2019-0349] [Citation(s) in RCA: 5] [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] [Indexed: 12/17/2022] Open
Abstract
Aim: The association of tyrosine kinase inhibitors (TKIs) and local radiotherapy in EGFR-mutated non-small-cell lung cancer patients experiencing disease progression under TKIs could be a valid an option. Patients & methods: We included 131 patients experiencing disease progression during first-line TKI. In group A, patients received TKI beyond progression and site(s) of progression were irradiated; in group B, patients remained on TKI alone beyond progression; and group C stopped TKI at first disease progression. Results: Median overall survival resulted longer in group A versus B and C (p < 0.0001). Group A had a trend toward a longer second progression-free survival (measured from the time of first progression until second progression) versus group B (p = 0.06). Conclusion: TKI beyond progression in association with local ablative treatment is a valid treatment option in oligoprogressive patients.
Collapse
Affiliation(s)
- Sabrina Rossi
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | - Giovanna Finocchiaro
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | - Vincenzo Di Noia
- Department of Medical Oncology, Agostino Gemelli University Hospital, Catholic University, Rome, Italy
| | - Maria Bonomi
- Medical Oncology Department, Humanitas Gavazzeni Clinic, Bergamo, Italy
| | | | - Fiorenza De Rose
- Department of Radiotherapy, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | - Davide Franceschini
- Department of Radiotherapy, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | | | | | - Ettore D'Argento
- Department of Medical Oncology, Agostino Gemelli University Hospital, Catholic University, Rome, Italy
| | - Marta Scorsetti
- Department of Radiotherapy, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | - Armando Santoro
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| | - Luca Toschi
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano, Milan, Italy
| |
Collapse
|
26
|
Grizzi F, Castello A, Qehajaj D, Toschi L, Rossi S, Pistillo D, Paleari V, Veronesi G, Novellis P, Monterisi S, Mineri R, Rahal D, Lopci E. Independent expression of circulating and tissue levels of PD-L1: correlation of clusters with tumor metabolism and outcome in patients with non-small cell lung cancer. Cancer Immunol Immunother 2019; 68:1537-1545. [PMID: 31482306 DOI: 10.1007/s00262-019-02387-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 08/27/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the clinical-pathological and prognostic significance of the circulating PD-L1 level in patients with surgically treated NSCLC, by combining data for PD-L1 expression with other immune-related markers and tumor metabolism. METHODS Overall, 40 patients with resected NSCLC (stage Ia-IIIa) who had preoperative blood storage and underwent staging PET/CT were enrolled for the study. In all cases, we determined plasma levels of PD-L1 (pg/ml), immune-reactive areas (IRA %) covered by CD3, CD68, CD20, CD8, PD-1, and PD-L1 in the tumor specimen, and metabolic parameters on PET, i.e., SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Variables were statistically analyzed to establish their association with disease-free survival (DFS). RESULTS The circulating levels of PD-L1 in the bloodstream could be determined in 38/40 (95%) samples. The mean and median expression levels were 34.86 pg/ml and 24.83 pg/ml, respectively. We did not find any statistically significant correlation between circulating PD-L1 and tissue expression of PD-L1/PD-1. Some mild degree of positive correlation was determined between tissue PD-L1 and SUVmax (ρ = 0.390; p = 0.0148). Hierarchical clustering combining circulating, tissue, and metabolic parameters identified clusters with high metabolic tumor burden or high expression of plasma PD-L1 levels (Z score ≥ 2) as having a poor DFS (p = 0.033). The multivariate analysis detected stage and metabolism (i.e., SUVmax and SUVpeak) as independent prognostic factors for DFS. CONCLUSION Plasma levels of PD-L1 are independent of the expression of PD-1/PD-L1 in NSCLC tumor tissue and, when combined with other clinical-pathological parameters, allow for the identification of clusters with different outcomes.
Collapse
Affiliation(s)
- Fabio Grizzi
- Immunology and Inflammation, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Angelo Castello
- Nuclear Medicine Department, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Dorina Qehajaj
- Immunology and Inflammation, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Luca Toschi
- Medical Oncology, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Sabrina Rossi
- Medical Oncology, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, MI, Italy
| | - Daniela Pistillo
- Biobank, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Valentina Paleari
- Biobank, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giulia Veronesi
- Thoracic Surgery, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Pierluigi Novellis
- Thoracic Surgery, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Simona Monterisi
- Thoracic Surgery, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Rossana Mineri
- Molecular Biology Section, Clinical Investigation Laboratory, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Daoud Rahal
- Pathology, Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy
| | - Egesta Lopci
- Nuclear Medicine Department, Humanitas Clinical and Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Italy.
| |
Collapse
|
27
|
Castello A, Toschi L, Rossi S, Finocchiaro G, Grizzi F, Mazziotti E, Qehajaj D, Rahal D, Lopci E. Predictive and Prognostic Role of Metabolic Response in Patients With Stage III NSCLC Treated With Neoadjuvant Chemotherapy. Clin Lung Cancer 2019; 21:28-36. [PMID: 31409523 DOI: 10.1016/j.cllc.2019.07.004] [Citation(s) in RCA: 5] [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: 03/06/2019] [Revised: 07/10/2019] [Accepted: 07/14/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The purpose of this study was to assess the predictive and prognostic role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in candidates with stage III non-small-cell lung cancer (NSCLC) to neoadjuvant chemotherapy. PATIENTS AND METHODS Sixty-six patients with stage III NSCLC treated with induction chemotherapy from March 2013 to December 2017 were retrospectively identified. Response assessment were evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and European Organisation for Research and Treatment of Cancer (EORTC) criteria. 18F-FDG PET/CT metabolic parameters were analyzed as absolute values as well as percentage changes (Δ) between 2 consecutive scans, for primary tumor (T) and for regional lymph nodes (N). All clinical variables and metabolic parameters were compared with treatment response and correlated with progression-free survival (PFS) and overall survival (OS), based on a median follow-up of 9.4 months. RESULTS Post-induction therapy standardized uptake value (SUV)max_T, SUVmean_T, metabolic tumor volume (MTV_T), and total lesion glycolysis of the tumor (TLG_T) varied significantly between responders and non-responders (6.6 vs. 13.8; P = .001; 4.2 vs. 8.1; P < .001; 6 vs. 17.9; P = .002; and 24.1 vs. 136.3; P < .001, respectively). Likewise, percentage changes (Δ_T) were significantly different between the 2 groups (P < .001). Along with primary tumor, also post-SUVmax_N, post-SUVmean_N, and post-TLG_N (P = .024, P = .015, and P = .024, respectively), as well as all percentage changes (Δ_N) were different between responders and non-responders. RECIST 1.1 and EORTC response classifications were discordant in 27 patients (40.9%; κ = 0.265; P = .003). On multivariate analysis, post-TLG_N was an independent predictor for both PFS and OS, whereas RECIST 1.1 was a predictor only for OS. CONCLUSIONS Several metabolic parameters may differentiate responders from non-responders following neoadjuvant chemotherapy in stage III NSCLC. As compared with RECIST 1.1, EORTC seems to be more appropriate for evaluation therapeutic response. Finally, post-TLG_N has significant prognostic information.
Collapse
Affiliation(s)
- Angelo Castello
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Luca Toschi
- Department of Oncology, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Sabrina Rossi
- Department of Oncology, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Giovanna Finocchiaro
- Department of Oncology, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Fabio Grizzi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Emanuela Mazziotti
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Dorina Qehajaj
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Daoud Rahal
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy
| | - Egesta Lopci
- Department of Nuclear Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy.
| |
Collapse
|
28
|
Rossi S, Finocchiaro G, Toschi L, Santoro A. Nivolumab in disadvantaged subgroups of metastatic non-small-cell lung cancer patients: a single-institution experience. Immunotherapy 2019; 11:945-952. [PMID: 31199183 DOI: 10.2217/imt-2019-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: Immunotherapy opened new frontiers in metastatic non-small-cell lung cancer treatment, but not all patients benefit from it. Methods: We retrospectively evaluated 65 metastatic non-small-cell lung cancer patients, treated with nivolumab, considering as disadvantaged subgroups those with poor performance status, elderly, patients with brain metastases at baseline, with high disease burden and refractory to platinum. Results: No differences in overall survival or time to treatment failure were found according to performance status, age, presence of brain metastases at baseline or high disease burden. Conversely, patients refractory to platinum had a statistically significant shorter overall survival and time to treatment failure. At multivariate analysis only platinum resistance was confirmed as an independent predictive factor. Conclusion: Our study suggests that only refractoriness to platinum salts influence the efficacy of nivolumab.
Collapse
Affiliation(s)
- Sabrina Rossi
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| | - Giovanna Finocchiaro
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| | - Luca Toschi
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| | - Armando Santoro
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| |
Collapse
|
29
|
Rossi S, Disconzi L, Toschi L, Finocchiaro G, Giordano L, Lanza E, Lutman RF, Santoro A. Clinical and prognostic implications of sarcopenia in patients affected by locally advanced NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e20046] [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
e20046 Background: Sarcopenia is a loss of skeletal muscle mass that has been studied as prognostic factor in several cancers. Retrospective studies have suggested that sarcopenia is associated with poorer survival outcomes and with an increase of major chemotherapy toxicities resulting in dose reduction and delay. This study examined the value of sarcopenia in patients with stage III non-small cell lung cancer (NSCLC). Methods: This retrospective analysis includes 68 patients affected by stage III NSCLC treated with induction chemotherapy followed by surgery or radical radiation therapy in our cancer center. Weight and height were obtained from medical records at diagnosis. Skeletal muscle index (SMI) was measured by the analysis of electronically stored computed tomography images obtained before the start of chemotherapy; sarcopenia was defined by international consensus as a SMI≤39 cm2/m2 for women and ≤55 cm2/m2 for men. Kaplan-Meier method and Log-Rank test were used to determine the impact of sarcopenia on overall survival (OS) and progression-free survival (PFS). Exact Fisher test and Chi-squared test were used to establish the association between the presence of sarcopenia and other variables. Results: A total of 68 patients (stage 3A = 39; stage 3B = 29) with performance status 0-1 and median age 67 yrs were analyzed. Forty-five patients (66%) were sarcopenic: 100% of underweight patients (BMI ≤18.5), 83% of patients with normal weight (BMI 18.5-24.9), 56% of overweight patients (BMI 25-29.9) and 30% of obese (BMI≥30). Sarcopenia was not associated with age≥70 yrs (p = 0.67), Charlson Comorbidity Index (p = 1.00), stage (p = 0.53), response rate to chemotherapy (p = 0.78) or toxicities of grade≥3 (p = 0.83). Median OS in sarcopenic patients was 18.2 months compared with 33.2 months in nonsarcopenic patients (p = 0.03); the difference in terms of PFS was not statistically significant (10.7 vs 14.9 months; p = 0.19). Conclusions: Sarcopenia is associated with shorter OS in patients with locally advanced NSCLC but it seems not related with worse response to induction chemotherapy or higher toxicities. These data should be validated in larger prospective clinical studies.
Collapse
Affiliation(s)
| | | | - Luca Toschi
- Humanitas Research Hospital, Rozzano (MI), Italy
| | | | - Laura Giordano
- Department of Oncology, Humanitas Research Hospital - Humanitas Cancer Center, Rozzano, Italy
| | - Ezio Lanza
- Humanitas Research Hospital, Rozzano (MI), Italy
| | | | | |
Collapse
|
30
|
Rossi S, Finocchiaro G, Marchetti S, Toschi L, Santoro A. Checkpoint inhibitors: 'raising the bar' also in brain metastases from non-small-cell lung cancer? Immunotherapy 2019; 10:403-410. [PMID: 29473467 DOI: 10.2217/imt-2017-0151] [Citation(s) in RCA: 5] [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] [Indexed: 01/16/2023] Open
Abstract
Despite efforts, brain metastases (BM) remain a critical issue in the management of patients affected by non-small-cell lung cancer (NSCLC). To date, radiotherapy is still considered the gold standard treatment; on the other hand, systemic chemotherapeutical agents are not so often an effective therapy for BM, whereas targeted agents in oncogene-addicted disease have shown a good activity also on BM. Anti-programmed death-1/programmed death ligand-1 agents represent a new valid therapeutic strategy for NSCLC as well as for several tumor types, but their efficacy on patients with BM is still unclear mainly due to the strict selection criteria adopted in clinical trials. The aim of the present article is to discuss the potential activity of checkpoint inhibitors in patients with BM from NSCLC.
Collapse
Affiliation(s)
- Sabrina Rossi
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| | - Giovanna Finocchiaro
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| | - Silvia Marchetti
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| | - Luca Toschi
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| | - Armando Santoro
- Department of Oncology & Hematology, Humanitas Clinical & Research Center, Rozzano (MI), Italy
| |
Collapse
|
31
|
Rossi S, Toschi L, Finocchiaro G, Di Noia V, Bonomi M, Cerchiaro E, Ceresoli GL, Beretta GD, D’Argento E, Santoro A. Impact of Exon 19 Deletion Subtypes in EGFR-Mutant Metastatic Non–Small-Cell Lung Cancer Treated With First-Line Tyrosine Kinase Inhibitors. Clin Lung Cancer 2019; 20:82-87. [DOI: 10.1016/j.cllc.2018.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/06/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
|
32
|
Abbate MI, Cortinovis DL, Tiseo M, Vavalà T, Cerea G, Toschi L, Canova S, Colonese F, Bidoli P. Peritoneal carcinomatosis in non-small-cell lung cancer: retrospective multicentric analysis and literature review. Future Oncol 2019; 15:989-994. [DOI: 10.2217/fon-2018-0469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We investigated outcomes in patients with advanced non-small-cell lung cancer (NSCLC) and peritoneal involvement. Patients & methods: NSCLC patients with peritoneal carcinomatosis (PC) were included. We evaluated mOS1 (overall survival [OS] from NSCLC diagnosis) and mOS2 (OS from diagnosis of PC). Results: In total, 60 NSCLC patients were diagnosed with PC, 12 (20%) patients had a diagnosis of NSCLC and synchronous PC with a median OS of 9 months. Smokers had a shorter mOS1 and mOS2 compared with never-smokers; EGFR-mutated patients on tyrosine kinase inhibitors had longer mOS1 and mOS2 than EGFR wild-type patients. Conclusion: Metachronous PC is correlated to a short survival, irrespective of treatment line. Never-smokers and EGFR-mutated patients had improved mOS1 and mOS2 when compared with smokers and EGFR wild-type population.
Collapse
Affiliation(s)
| | | | - Marcello Tiseo
- Azienda Ospedaliero-Sanitaria San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, Italy
| | - Tiziana Vavalà
- Azienda Ospedaliero-Sanitaria San Luigi Gonzaga, Regione Gonzole 10, Orbassano, TO, Italy
- Presidio Ospedaliero Saluzzo-Savigliano, Via Ospedali, 14, Savigliano, CN, Italy
| | - Giulio Cerea
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, Milano, Italy
| | - Luca Toschi
- Istituto Clinico Humanitas, Via Alessandro Manzoni 56, Milano, Italy
| | - Stefania Canova
- Ospedale San Gerardo, Via GB Pergolesi 33, 20052 Monza, Italy
| | | | - Paolo Bidoli
- Ospedale San Gerardo, Via GB Pergolesi 33, 20052 Monza, Italy
| |
Collapse
|
33
|
Passaro A, Prelaj A, Bonanno L, Tiseo M, Tuzi A, Proto C, Chiari R, Rocco D, Genova C, Sini C, Cortinovis D, Pilotto S, Landi L, Bennati C, Camerini A, Toschi L, Putzu C, Cerea G, Spitaleri G, Cappuzzo F, de Marinis F. Activity of EGFR TKIs in Caucasian Patients With NSCLC Harboring Potentially Sensitive Uncommon EGFR Mutations. Clin Lung Cancer 2018; 20:e186-e194. [PMID: 30563752 DOI: 10.1016/j.cllc.2018.11.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/30/2018] [Accepted: 11/11/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND Molecular characterization of non-small-cell lung cancer (NSCLC), defined predictive and druggable mutations that greatly modified patient prognoses. The most frequent driver mutations detected in NSCLC are epidermal growth factor receptor (EGFR) mutations, accounting for approximately 90% of exon 19 deletions and exon 21 point mutations. The other EGFR mutations are classified as uncommon or nonclassical and include exon 18 point mutations, exon 20 insertions, and combined mutations, which present different sensitivity to tyrosine kinase inhibitor (TKI) targeting. PATIENTS AND METHODS We collected data from EGFR TKI-naive patients with metastatic NSCLC, harboring EGFR exon 18 mutations and EGFR combined mutations treated with first- or second-generation EGFR TKIs. Efficacy end points were evaluated considering the activity of EGFR TKIs in exon 18 versus double-mutation EGFR groups. RESULTS Eighty-eight patients harboring uncommon EGFR mutations were evaluated in our analysis, and subdivided into 2 group: complex mutations (cohort A = 46 patients) and double mutations in exon 18 (cohort B = 42 patients). The results showed a median progression-free survival of 8.3 versus 12.3 months (hazard ratio [HR], 0.65; P = .06) and a median overall survival of 17.0 versus 31.0 months (HR, 0.62, P = .04) favoring the EGFR combination group. Within the combination group, no detrimental effect was associated with exon 20 mutations. CONCLUSION Our study confirmed that EGFR exon 18 and combination mutations might be considered potentially sensitive uncommon mutations, with a similar survival compared with the well known common EGFR mutations. Comparative analysis showed that patients with complex mutations achieved longer survival compared with the exon 18 group, without correlation with the presence of exon 20 mutations.
Collapse
Affiliation(s)
- Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Arsela Prelaj
- Division of Thoracic Oncology, IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Laura Bonanno
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | | | - Claudia Proto
- Division of Thoracic Oncology, IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Rita Chiari
- Medical Oncology, Santa Maria della Misericordia Hospital, AOU di Perugia, Perugia, Italy
| | - Danilo Rocco
- Department of Oncology, AORN Vincenzo Monaldi, Naples, Italy
| | - Carlo Genova
- Lung Cancer Unit, IRCCS AOU San Martino-IST, Genova, Italy
| | | | | | - Sara Pilotto
- Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Lorenza Landi
- Onco-Hematology Department, AUSL Romagna, Ravenna, Italy
| | - Chiara Bennati
- Onco-Hematology Department, AUSL Romagna, Ravenna, Italy
| | - Andrea Camerini
- Medical Oncology, Versilia Hospital and Istituto Toscano Tumori, Lido di Camaiore, Italy
| | - Luca Toschi
- Medical Oncology, Humanitas Research Hospital, Rozzano, Italy
| | - Carlo Putzu
- Oncology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Giulio Cerea
- Department of Oncology and Hemato-Oncology, Niguarda Cancer Center, Milan, Italy
| | - Gianluca Spitaleri
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Filippo de Marinis
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
34
|
Veronesi G, Ghislandi S, Vanni E, Dieci E, Toschi L, Velutti L, Solinas M, Novellis P, Alloisio M, Riboli E, Navone N. P3.11-25 Analysis Indicates Low Incremental Cost-Effectiveness Ratio for Implementation of Lung Cancer Screening in Italy. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Luciani A, Toschi L, Fava S, Cortinovis D, Filipazzi V, Tuzi A, Marra A, Rossi S, Rossi A, Blasi M, Violati M, Sala L, Agustoni F, Bidoli P, Zonato S, Ferrari D. Immunotherapy in elderly patients (≥ 75 yrs) with advanced non-small cell lung cancer (NSCLC): A multicenter Italian experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Navarria P, Clerici E, Pessina F, Franzese C, Bello L, Riva M, Toschi L, Masci G, Comito T, Scorsetti M. P05.75 Surgery followed by fractionated radiosurgery on the tumor bed in patients with single large brain metastases from solid tumor: preliminary results of a phase II study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - E Clerici
- Humanitas Cancer Center, Rozzano, Italy
| | - F Pessina
- Humanitas Cancer Center, Rozzano, Italy
| | | | - L Bello
- Humanitas Cancer Center, Rozzano, Italy
| | - M Riva
- Humanitas Cancer Center, Rozzano, Italy
| | - L Toschi
- Humanitas Cancer Center, Rozzano, Italy
| | - G Masci
- Humanitas Cancer Center, Rozzano, Italy
| | - T Comito
- Humanitas Cancer Center, Rozzano, Italy
| | - M Scorsetti
- Humanitas Cancer Center, Rozzano, Italy
- humanitas university, Rozzano, milano, Italy
| |
Collapse
|
37
|
Rossi S, Castello A, Toschi L, Lopci E. Immunotherapy in non-small-cell lung cancer: potential predictors of response and new strategies to assess activity. Immunotherapy 2018; 10:797-805. [DOI: 10.2217/imt-2017-0187] [Citation(s) in RCA: 18] [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: 11/21/2022] Open
Abstract
The treatment algorithm of advanced non-small-cell lung cancer is rapidly evolving. This result is mostly related to the availability in clinical practice of checkpoint inhibitors targeting the programmed death-1 (PD-1) and its ligands (PD-Ls) immunosuppressive pathway. Although patient's selection in the first-line setting relies essentially on high levels of PD-L1 tumor expression, treatment choice in pretreated patients is more challenging and, although clinical and biological characteristics might be of help, there is an urgent need for novel tools to better identify sensitive and resistant patients. In this context, the integration of molecular markers and immune-PET imaging might represent a potentially effective strategy to refine patient selection.
Collapse
Affiliation(s)
- Sabrina Rossi
- Medical Oncology, Humanitas Clinical & Research Hospital, Rozzano, Italy
| | - Angelo Castello
- Nuclear Medicine – Humanitas Cancer Center, Humanitas Clinical & Research Hospital, Via Manzoni 56, 20089 – Rozzano, Italy
| | - Luca Toschi
- Medical Oncology, Humanitas Clinical & Research Hospital, Rozzano, Italy
| | - Egesta Lopci
- Nuclear Medicine – Humanitas Cancer Center, Humanitas Clinical & Research Hospital, Via Manzoni 56, 20089 – Rozzano, Italy
| |
Collapse
|
38
|
Rossi S, Finocchiaro G, Toschi L, Santoro A. Disadvantaged subgroups of metastatic non-small cell lung cancer (mNSCLC) patients treated with nivolumab. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Luca Toschi
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy
| |
Collapse
|
39
|
Rossi S, Toschi L, Finocchiaro G, Santoro A. Neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR) as predictive indicators of nivolumab efficacy in metastatic non-small cell lung cancer (mNSCLC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Luca Toschi
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Armando Santoro
- Humanitas Clinical and Research Center and Humanitas University, Rozzano (MI), Italy
| |
Collapse
|
40
|
Cappuzzo F, Toschi L, Finocchiaro G, Ligorio C, Santoro A. Surrogate Predictive Biomarkers for Response to Anti-EGFR Agents: State of the Art and Challenges. Int J Biol Markers 2018; 22:10-23. [DOI: 10.1177/17246008070221s403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The epidermal growth factor receptor (EGFR) plays a key role in cancer development and progression in several human malignancies including non-small cell lung cancer (NSCLC). Several strategies aimed at inhibiting the EGFR have been investigated in the last years, including the use of small tyrosine kinase inhibitors (TKIs) directed against the intracellular domain of the receptor and monoclonal antibodies targeting its extracellular portion. Subgroups of patients who are more likely to respond to TKIs have been identified based on both clincal and biological features. Never-smoking history has emerged as the most relevant clinical characteristic predictive of response to TKIs in NSCLC, while presence of drug-sensitive EGFR mutations and EGFR gene gain represent critical biological variables associated with an improved outcome for patients exposed to these agents. Recent studies have highlighted the existence of biological factors involved in intrinsic and acquired resistance to TKIs, including k-ras, HER-2 and EGFR exon 20 mutations. Increasing knowledge of EGFR biology and drug-receptor interactions will allow to identify individuals who are likely to derive a clinical benefit from the proposed targeted therapy, sparing refractory patients expensive and potentially toxic treatment.
Collapse
Affiliation(s)
- F. Cappuzzo
- Department of Oncology-Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan - Italy
| | - L. Toschi
- Department of Oncology-Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan - Italy
| | - G. Finocchiaro
- Department of Oncology-Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan - Italy
| | - C. Ligorio
- Department of Oncology-Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan - Italy
| | - A. Santoro
- Department of Oncology-Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Milan - Italy
| |
Collapse
|
41
|
Toschi L, Rossi S, Finocchiaro G, Santoro A. Non-small cell lung cancer treatment (r)evolution: ten years of advances and more to come. Ecancermedicalscience 2017; 11:787. [PMID: 29225694 PMCID: PMC5718252 DOI: 10.3332/ecancer.2017.787] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Indexed: 12/13/2022] Open
Abstract
Diagnostic and treatment algorithms in non-small cell lung cancer (NSCLC) are evolving at a never-before-seen pace. Histological subtyping to maximise treatment efficacy and avoid toxicity has marked the beginning of the revolution, opening the way to molecular characterisation to guide genomically driven treatments with targeted agents, led by Epidermal Growth Factor Receptor (EGFR) and Anaplastic Lymphoma Kinase (ALK) inhibitors. More recently, agents against the Program Death 1 receptor (PD-1) and ligand 1 (PD-L1) have entered the clinical arena, offering new hope to NSCLC patients, although several uncertainties remain to be elucidated. Here, we review the most clinically relevant advances in the diagnosis and treatment of NSCLC in the past decade.
Collapse
Affiliation(s)
- Luca Toschi
- Humanitas Research Hospital, Medical Oncology, Via Manzoni 56, 20089 Rozzano, Italy
| | - Sabrina Rossi
- Humanitas Research Hospital, Medical Oncology, Via Manzoni 56, 20089 Rozzano, Italy
| | - Giovanna Finocchiaro
- Humanitas Research Hospital, Medical Oncology, Via Manzoni 56, 20089 Rozzano, Italy
| | - Armando Santoro
- Humanitas Research Hospital, Medical Oncology, Via Manzoni 56, 20089 Rozzano, Italy
| |
Collapse
|
42
|
Ardizzoni A, Bidoli P, Chiari R, Bonomi L, Turci D, Landi L, Toschi L, De Tursi M, Francini G, Giordano M, Alabiso O, De Censi A, Livi L, Berruti A, Minelli M, Ricevuto E, Illiano A, Puppo G, Delmonte A, Galetta D. MA 02.05 Nivolumab in Advanced Non-Squamous NSCLC Patients with KRAS Mutations: Results from the Italian Expanded Access Program (EAP). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Rossi S, Toschi L, Castello A, Grizzi F, Mansi L, Lopci E. Clinical characteristics of patient selection and imaging predictors of outcome in solid tumors treated with checkpoint-inhibitors. Eur J Nucl Med Mol Imaging 2017; 44:2310-2325. [PMID: 28815334 DOI: 10.1007/s00259-017-3802-5] [Citation(s) in RCA: 37] [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: 06/19/2017] [Accepted: 08/04/2017] [Indexed: 12/13/2022]
Abstract
The rapidly evolving knowledge on tumor immunology and the continuous implementation of immunotherapy in cancer have recently led to the FDA and EMA approval of several checkpoint inhibitors as immunotherapic agents in clinical practice. Anti-CTLA-4, anti-PD-1, and anti-PDL-1 antibodies are becoming standard of care in advanced melanoma, as well as in relapsed or metastatic lung and kidney cancer, demonstrating higher and longer response compared to standard chemotherapy. These encouraging results have fostered the evaluation of these antibodies either alone or in combination with other therapies in several dozen clinical trials for the treatment of multiple tumor types. However, not all patients respond to immune checkpoint inhibitors, hence, specific biomarkers are necessary to guide and monitor therapy. The utility of PD-L1 expression as a biomarker has varied in different clinical trials, but, to date, no consensus has been reached on whether PD-L1 expression is an ideal marker for response and patient selection; approximately 20-25% of patients will respond to immunotherapy with checkpoint inhibitors despite a negative PD-L1 staining. On the other hand, major issues concern the evaluation of objective response in patients treated with immunotherapy. Pure morphological criteria as commonly used in solid tumors (i.e. RECIST) are not sufficient because change in size is not an early and reliable marker of tumor response to biological therapies. Thus, the scientific community has required a continuous adaptation of immune-related response criteria (irRC) to overcome the problem. In this context, metabolic information and antibody-based imaging with positron emission tomography (PET) have been investigated, providing a powerful approach for an optimal stratification of patients at staging and during the evaluation of the response to therapy. In the present review we provide an overview on the clinical characteristics of patient selection when using imaging predictors of outcome in solid tumors treated with checkpoint-inhibitors.
Collapse
Affiliation(s)
- Sabrina Rossi
- Medical Oncology, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Luca Toschi
- Medical Oncology, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Angelo Castello
- Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Fabio Grizzi
- Immunology and Inflammation, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Luigi Mansi
- Nuclear Medicine, Seconda Università di Napoli, Naples, Italy
| | - Egesta Lopci
- Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano, Italy.
- Nuclear Medicine, Humanitas Cancer Center, Humanitas Clinical and Research Hospital, Via Manzoni 56, 20089, Rozzano, MI, Italy.
| |
Collapse
|
44
|
Rossi S, Toschi L, Finocchiaro G, D'Argento E, Di Noia VP, Cassano A, Bonomi M, Cerchiaro E, Ceresoli GL, Beretta GD, Barone C, Santoro A. Predictive impact of different exon 19 deletions in EGFR-mutant NSCLC treated with first-line TKIs. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20608] [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
e20608 Background: Common Epidermal Growth Factor Receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) predict sensitivity to EGFR tyrosine-kinase inhibitors (TKIs), with exon 19 deletions being associated with better outcome when compared to L858R mutations. We aimed to investigate the impact of different exon 19 deletions on patient outcome in EGFR-mutant NSCLC treated with first-line TKIs. Methods: In this retrospective analysis we included 98 patients with metastatic NSCLC and EGFR exon 19 deletions, treated with first-line EGFR TKIs (gefitinib or afatinib) in 3 Italian centers between 2011 and 2016. The primary endpoint was overall survival (OS), the secondary endpoint progression free survival (PFS). Analyses were performed by grouping exon 19 deletions according to two different models: type of deletion (delE746-A750 vs other) and starting codon of deletion (E746 vs L747). Kaplan-Meier method, the log-rank test and multivariate Cox regression models were used to estimate survival outcomes. Median follow-up time was 40 months. Results: All groups resulted well balanced in terms of patients’ characteristics but the percentage of patients treated with gefitinib was significantly superior in E746 group compared to L747 (p = 0.02). In the whole cohort median OS was 24.6 months [95%CI 21.9 – 33.1] while median PFS was 13.7 months [95%CI 11.6 – 15.9]. When delE746-A750 (n = 60) was compared to the other deletions in exon 19 (n = 38), no differences were evidenced either in terms of OS (24.1 vs 26.0 months; HR 0.80 [95%CI 0.5 – 1.4]; p = 0.42) or PFS (13.9 vs. 12.8 months; HR 0.99 [95%CI 0.6 – 1.6]; p = 0.97). Similarly, no difference in OS or PFS emerged comparing E746 (n = 73) versus L747 group (n = 25) (OS:24.6 and 26.0 months, respectively, HR 0.79 [95%CI 0.4 – 1.4; p = 0.45; PFS 13.9 vs 12.9 months, respectively (HR 0.87 [95%CI 0.5 – 1.4] p = 0.57). On multivariate analysis including age, sex, smoking history, deletions (delE746-A750 vs others or E746 vs L747), presence of brain metastases at diagnosis or during TKI treatment, no variable resulted associated with longer OS or PFS. Conclusions: Different exon 19 deletions are equally sensitive to first-line EGFR TKIs in EGFR-mutant NSCLC.
Collapse
Affiliation(s)
| | - Luca Toschi
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Ettore D'Argento
- Medical Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | | | | - Carlo Barone
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| |
Collapse
|
45
|
Rossi S, Finocchiaro G, D'Argento E, Di Noia VP, Cassano A, Bonomi M, Cerchiaro E, Ceresoli GL, Beretta GD, Barone C, Santoro A, Toschi L. Clinical outcome of EGFR-mutant NSCLC patients continuing TKIs beyond progression in combination with local ablative radiotherapy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20662] [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
e20662 Background: Continuation of EGFR TKIs with or without local ablative treatments in patients with metastatic EGFR-mutant NSCLC experiencing disease progression under TKIs is feasible and may be associated with improved outcomes. Methods: The retrospective analysis includes 130 patients with advanced EGFR-mutant NSCLC experiencing RECIST disease progression under first-line gefitinib or afatinib, treated in 3 Italian centers between 2011 and 2016. In group 1 (n = 99, 76.2%) patients stopped TKI treatment at first RECIST-confirmed progression while in group 2 (n = 31, 23.8%) TKIs were continued and sites of progression were irradiated. The primary endpoint was overall survival (OS). Progression-free survival (PFS) and time to treatment failure (TTF) were calculated from the start of first-line TKIs. Kaplan-Meier method, the log-rank test and multivariate Cox regression models were used to estimate outcome endpoints. Median follow-up time was 40 months. Results: Median OS, PFS and TTF in the whole cohort were 22.4, 11.1 and 13.0 months, respectively. The two groups resulted well balanced in terms of patients’ characteristics and TKI administered. Median OS was significantly longer in group 2 (37.3 vs 15.6 months; HR 0.33; 95%CI 0.22-0.50; p < 0.0001), as well as median PFS (13.8 vs 8.9 months; HR 0.60; 95%CI 0.42-0.86; p = 0.01) and median TTF (29.3 vs 10.4 months; HR 0.30; 95%CI 0.21-0.44; p < 0.0001). Ten out of 31 (32.3%) patients underwent radiotherapy in ≥2 sites of progressive disease; the most frequently irradiated site was bone (n = 16), followed by brain (n = 9), lung (n = 8) and lymph nodes (n = 6). On multivariate analysis including age, sex, smoking history, mutant exon, presence of brain metastases, TKI administered and treatment strategy at progression, only TKI continuation with radiotherapy was independently associated with all outcome endpoints (OS: p = 0.0007, PFS: p = 0.004; TTF: p < 0.0001). Conclusions: In EGFR-mutant NSCLC progressing under first-line TKIs continuation of TKI in association with local ablative radiotherapy is associated with prolonged OS, PFS and TTF. Whether the improved outcome is a result of treatment strategy or more indolent disease remains unclear.
Collapse
Affiliation(s)
| | | | - Ettore D'Argento
- Medical Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | | | | - Carlo Barone
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Armando Santoro
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Luca Toschi
- Humanitas Cancer Center, Humanitas Clinical and Research Center, Rozzano, Italy
| |
Collapse
|
46
|
Navarria P, Pessina F, Toschi L, Santoro A, Ascolese A, Clerici E, Franceschini D, Bello L, Scorsetti M. P14.17 What is the optimal therapeutic strategy for limited brain metastases (BMs) from non small cell lung cancer (NSCLC)? Prognostic factors conditioning brain control and patients outcome. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.403] [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
|
47
|
Pessina F, Navarria P, Cozzi L, Tomatis S, Ascolese AM, Franzese C, Toschi L, Santoro A, De Rose F, Franceschini D, Bello L, Scorsetti M. Outcome appraisal of patients with limited brain metastases (BMs) from non small cell lung cancer (NSCLC) treated with different local therapeutic strategies: a single institute evaluation. Br J Radiol 2017; 90:20170022. [PMID: 28256924 DOI: 10.1259/bjr.20170022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the outcome of patients with non-small-cell lung cancer (NSCLC) with limited brain metastases (BMs) treated with local approaches omitting whole-brain radiation therapy (WBRT). METHODS Surgery was performed in case of a single, large BM, controlled extracranial disease and Karnofsky Performance Status (KPS) 90-100; stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiosurgery (HSRS) was performed in all other cases. The prescribed dose was 24 Gy/1 fraction for lesions <2.5 cm, and a median of 30 Gy (24-40 Gy) in 3-5 fractions for lesions >2.5 cm. RESULTS 156 patients treated for 228 BMs were retrospectively evaluated. The median age was 62 years. The majority of patients had a KPS 90-100, recursive partitioning analysis Class II, diagnosis-specific graded prognostic assessment score 2.5-3 and 1-2 BMs. Surgical resection was performed in 18 cases, and SRS/HSRS was performed in 210 cases. The 1-2-year local control was 87.2 ± 3.0% and 72.8 ± 5.0%; the 1.2-year brain distant failure was 30.8 ± 4.0% and 58.1 ± 6.0%; the 1-2-year overall survival was 60.9 ± 3.9% and 31.4 ± 4.0%. On univariate and multivariate analysis, the following factors influenced survival: age (p = 0.01), the presence of lymph node involvement (p = 0.03), KPS (p << 0.01), the presence of extracranial metastases at the time of BM treatment (p < 0.01), the number of BMs (p = 0.02) and the treatment performed (p < 0.01). CONCLUSION The choice of an adequate local treatment can impact on survival in patients with limited BMs from NSCLC. A careful evaluation of prognostic and predictive factors is a pivotal additional aid. Advances in knowledge: Radiosurgery or surgery followed by radiosurgery on the tumour bed in place of WBRT proved to be an effective treatment influencing outcome. Surgical resection followed by SRS on the tumour bed has to be considered for lesions ≥15 mm, in patients with good KPS, age ≤70 years, adenocarcinoma histology and oligometastatic disease.
Collapse
Affiliation(s)
- Federico Pessina
- 1 Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Pierina Navarria
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Luca Cozzi
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.,4 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Stefano Tomatis
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Anna M Ascolese
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Ciro Franzese
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Luca Toschi
- 3 Haematology and Oncology, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Armando Santoro
- 3 Haematology and Oncology, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.,4 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Fiorenza De Rose
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Davide Franceschini
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Lorenzo Bello
- 1 Neurooncological Surgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy
| | - Marta Scorsetti
- 2 Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Italy.,4 Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| |
Collapse
|
48
|
Paz-Arez L, Serwatowski P, Szczęsna A, Von Pawel J, Toschi L, Tibor C, Morabito A, Zhang L, Shuster D, Chen S, Copigneaux C, Akerley W. P3.02b-045 Patritumab plus Erlotinib in EGFR Wild-Type Advanced Non–Small Cell Lung Cancer (NSCLC): Part a Results of HER3-Lung Study. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
49
|
Grossi F, Crinò L, Misino A, Bidoli P, Delmonte A, Gelsomino F, Proto C, Mancini M, Landi L, Turci D, Quadrini S, Antonelli P, Marchetti P, Toschi L, Giusti S, Di Costanzo F, Rastelli F, Sandri P, Scotti V, de Marinis F. Efficacy and safety of nivolumab in elderly patients (pts) with advanced squamous non small cell lung cancer (Sq-NSCLC) participating in the expanded access programme (EAP) in Italy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw378.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
50
|
Toschi L, Lopci E, Marchesi F, Grizzi F, Rahal D, Olivari L, Castino G, Marchetti S, Cortese N, Qehajaj D, Pistillo D, Alloisio M, Roncalli M, Allavena P, Santoro A, Chiti A. Correlation of metabolic information on 18F-FDG PET with the tissue expression of immune markers in patients with non-small cell lung cancer (NSCLC) candidate to upfront surgery. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw332.17] [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: 11/15/2022] Open
|