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Welsch E, Holzer B, Schuster E, Fabikan H, Weinlinger C, Hauptmann-Repitz E, Illini O, Hochmair MJ, Fischer MB, Weiss E, Zeillinger R, Obermayr E. Prognostic significance of circulating tumor cells and tumor related transcripts in small cell lung cancer: A step further to clinical implementation. Int J Cancer 2024; 154:2189-2199. [PMID: 38353516 DOI: 10.1002/ijc.34886] [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: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 04/14/2024]
Abstract
Small-cell lung cancer (SCLC) is a fatal disease with limited treatment options. Circulating tumor cells (CTCs) in liquid biopsy samples may serve as predictive and prognostic biomarkers; but the analysis of CTCs is still challenging. By using microfluidic or density gradient CTC enrichment in combination with immunofluorescent (IF) staining or qPCR of CTC-related transcripts, we achieved a 60.8% to 88.0% positivity in SCLC blood samples. Epithelial and neuroendocrine transcripts including the druggable target DLL3 were associated with shorter overall survival (OS), indicating the clinical value of these markers in terms of differential diagnosis and treatment decisions. High CTC counts and the presence of CTC duplets detected by IF staining were prognostic for OS, and thus may serve as indicators of disease progression or therapy failure. In patient samples with high CTC load detected by IF staining, a concordance of the transcripts positivity in circulating free plasma RNA and CTCs was observed. Our data emphasize the role of CTCs and CTC-related transcripts and underline the clinical value of liquid biopsy analysis in SCLC.
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Affiliation(s)
- Eva Welsch
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Barbara Holzer
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Eva Schuster
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hannah Fabikan
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Christoph Weinlinger
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Elisabeth Hauptmann-Repitz
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Oliver Illini
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Michael B Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Esther Weiss
- OncoLab Diagnostics GmbH, Wiener Neustadt, Austria
| | - Robert Zeillinger
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- OncoLab Diagnostics GmbH, Wiener Neustadt, Austria
| | - Eva Obermayr
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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2
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Illini O, Saalfeld FC, Christopoulos P, Duruisseaux M, Vikström A, Peled N, Demedts I, Dudnik E, Eisert A, Hashemi SMS, Janzic U, Kian W, Mohorcic K, Mohammed S, Silvoniemi M, Rothschild SI, Schulz C, Wesseler C, Addeo A, Armster K, Itchins M, Ivanović M, Kauffmann-Guerrero D, Koivunen J, Kuon J, Pavlakis N, Piet B, Sebastian M, Velthaus-Rusik JL, Wannesson L, Wiesweg M, Wurm R, Albers-Leischner C, Aust DE, Janning M, Fabikan H, Herold S, Klimova A, Loges S, Sharapova Y, Schütz M, Weinlinger C, Valipour A, Overbeck TR, Griesinger F, Jakopovic M, Hochmair MJ, Wermke M. Mobocertinib in Patients with EGFR Exon 20 Insertion-Positive Non-Small Cell Lung Cancer (MOON): An International Real-World Safety and Efficacy Analysis. Int J Mol Sci 2024; 25:3992. [PMID: 38612799 PMCID: PMC11012872 DOI: 10.3390/ijms25073992] [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: 02/26/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
EGFR exon 20 (EGFR Ex20) insertion mutations in non-small cell lung cancer (NSCLC) are insensitive to traditional EGFR tyrosine kinase inhibitors (TKIs). Mobocertinib is the only approved TKI specifically designed to target EGFR Ex20. We performed an international, real-world safety and efficacy analysis on patients with EGFR Ex20-positive NSCLC enrolled in a mobocertinib early access program. We explored the mechanisms of resistance by analyzing postprogression biopsies, as well as cross-resistance to amivantamab. Data from 86 patients with a median age of 67 years and a median of two prior lines of treatment were analyzed. Treatment-related adverse events (TRAEs) occurred in 95% of patients. Grade ≥3 TRAEs were reported in 38% of patients and included diarrhea (22%) and rash (8%). In 17% of patients, therapy was permanently discontinued, and two patients died due to TRAEs. Women were seven times more likely to discontinue treatment than men. In the overall cohort, the objective response rate to mobocertinib was 34% (95% CI, 24-45). The response rate in treatment-naïve patients was 27% (95% CI, 8-58). The median progression-free and overall survival was 5 months (95% CI, 3.5-6.5) and 12 months (95% CI, 6.8-17.2), respectively. The intracranial response rate was limited (13%), and one-third of disease progression cases involved the brain. Mobocertinib also showed antitumor activity following EGFR Ex20-specific therapy and vice versa. Potential mechanisms of resistance to mobocertinib included amplifications in MET, PIK3CA, and NRAS. Mobocertinib demonstrated meaningful efficacy in a real-world setting but was associated with considerable gastrointestinal and cutaneous toxicity.
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Affiliation(s)
- Oliver Illini
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Bruenner Straße 68, A-1210 Vienna, Austria (M.J.H.)
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Felix Carl Saalfeld
- Clinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany; (F.C.S.); (M.W.)
- National Center for Tumor Diseases, 01307 Dresden, Germany
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
| | - Petros Christopoulos
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Thoraxklinik and Translational Lung Research Center (TLRC), member of the German Center for Lung Research (DZL), Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Michaël Duruisseaux
- Respiratory Department and Early Phase, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, 69002 Lyon, France
- Oncopharmacology Laboratory, Cancer Research Center of Lyon, Unité Mixte de Recherche (UMR), Institut National de la Santé et de la Recherche Médicale (INSERM), 1052 Centre National de la Recherche Scientifique (CNRS), 5286 Lyon, France
- Université Claude Bernard, Université de Lyon, 69622 Villeurbanne cedex, France
| | - Anders Vikström
- Department of Pulmonary Medicine, University Hospital Linköping, 58185 Linköping, Sweden
| | - Nir Peled
- The Hemsely Cancer Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Ingel Demedts
- Department of Pulmonary Diseases, AZ Delta, Deltalaan 1, 8800 Roeselare, Belgium;
| | - Elizabeth Dudnik
- Head, Thoracic Oncology Service, Assuta Medical Centers, Tel-Aviv 6329302, Israel
- Faculty of Health Sciences, Ben-Gurion Unversity of the Negev, Be’er Sheva 84105, Israel
| | - Anna Eisert
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Sayed M. S. Hashemi
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, 1081 Amsterdam, The Netherlands
| | - Urska Janzic
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (U.J.)
- Medical Oncology Unit, University Clinic Golnik, 4204 Golnik, Slovenia
| | - Waleed Kian
- The Hemsely Cancer Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Institute of Oncology, Assuta Ashdod University Hospital, Ashdod 7747629, Israel
| | - Katja Mohorcic
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (U.J.)
| | - Saara Mohammed
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent TN24QJ, UK
| | - Maria Silvoniemi
- Department of Pulmonary Diseases, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Sacha I. Rothschild
- Center for Oncology & Hematology and Comprehensive Cancer Center, Cantonal Hospital Baden, 5404 Baden, Switzerland
| | - Christian Schulz
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Internal Medicine II, University Hospital, 93053 Regensburg, Germany
| | - Claas Wesseler
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Pneumology, Asklepios Tumorzentrum Hamburg, Klinikum Harburg, 21075 Hamburg, Germany
| | - Alfredo Addeo
- Oncology Department, University Hospital Geneva, 1205 Geneva, Switzerland
| | - Karin Armster
- Department of Pneumology, Universitätsklinikum Krems, 3500 Krems an der Donau, Austria
| | - Malinda Itchins
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW 2065, Australia
| | - Marija Ivanović
- Department of Oncology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Diego Kauffmann-Guerrero
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Thoracic Oncology Center Munich, University Hospital, University of Munich (LMU), 81377 Munich, Germany
| | - Jussi Koivunen
- Department of Oncology and Radiotherapy, Oulu University Hospital, 90014 Oulu, Finland
- Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
- Medical Research Center Oulu, 90014 Oulu, Finland
| | - Jonas Kuon
- Department Thoracic Oncology, SLK Fachklinik Löwenstein, 74245 Löwenstein, Germany
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW 2065, Australia
| | - Berber Piet
- Department of Respiratory Medicine, Radboudumc, 6225 GA Nijmegen, The Netherlands
| | - Martin Sebastian
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Medicine, Hematology/Oncology, University Hospital, University of Frankfurt, 60596 Frankfurt am Main, Germany
| | - Janna-Lisa Velthaus-Rusik
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Luciano Wannesson
- Istituto Oncologico della Svizzera Italiana, 6500 Bellinzona, Switzerland
| | - Marcel Wiesweg
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- West German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, 45147 Essen, Germany
| | - Robert Wurm
- Division of Pulmonology, Department of Internal Medicine, LKH-Universitätsklinikum, Medical University of Graz, 8036 Graz, Austria
| | - Corinna Albers-Leischner
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Daniela E. Aust
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department for Pathology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Melanie Janning
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, 68167 Mannheim, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Hannah Fabikan
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Sylvia Herold
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department for Pathology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Anna Klimova
- Core Unit for Data Management and Analytics, National Center for Tumor Diseases, 01307 Dresden, Germany
| | - Sonja Loges
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, 68167 Mannheim, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Yana Sharapova
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, 68167 Mannheim, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Maret Schütz
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department for Pathology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Christoph Weinlinger
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Bruenner Straße 68, A-1210 Vienna, Austria (M.J.H.)
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Tobias Raphael Overbeck
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen University, 37075 Göttingen, Germany
| | - Frank Griesinger
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Hematology and Oncology, Pius University Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany
| | - Marko Jakopovic
- Department for Respiratory Diseases Jordanovac, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Bruenner Straße 68, A-1210 Vienna, Austria (M.J.H.)
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Martin Wermke
- Clinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany; (F.C.S.); (M.W.)
- National Center for Tumor Diseases, 01307 Dresden, Germany
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
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3
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de Jager VD, Timens W, Bayle A, Botling J, Brcic L, Büttner R, Fernandes MGO, Havel L, Hochmair MJ, Hofman P, Janssens A, Johansson M, van Kempen L, Kern I, Lopez-Rios F, Lüchtenborg M, Machado JC, Mohorcic K, Paz-Ares L, Popat S, Ryška A, Taniere P, Wolf J, Schuuring E, van der Wekken AJ. Developments in predictive biomarker testing and targeted therapy in advanced stage non-small cell lung cancer and their application across European countries. Lancet Reg Health Eur 2024; 38:100838. [PMID: 38476742 PMCID: PMC10928289 DOI: 10.1016/j.lanepe.2024.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/16/2023] [Accepted: 01/08/2024] [Indexed: 03/14/2024]
Abstract
In the past two decades, the treatment of metastatic non-small cell lung cancer (NSCLC), has undergone significant changes due to the introduction of targeted therapies and immunotherapy. These advancements have led to the need for predictive molecular tests to identify patients eligible for targeted therapy. This review provides an overview of the development and current application of targeted therapies and predictive biomarker testing in European patients with advanced stage NSCLC. Using data from eleven European countries, we conclude that recommendations for predictive testing are incorporated in national guidelines across Europe, although there are differences in their comprehensiveness. Moreover, the availability of recently EMA-approved targeted therapies varies between European countries. Unfortunately, routine assessment of national/regional molecular testing rates is limited. As a result, it remains uncertain which proportion of patients with metastatic NSCLC in Europe receive adequate predictive biomarker testing. Lastly, Molecular Tumor Boards (MTBs) for discussion of molecular test results are widely implemented, but national guidelines for their composition and functioning are lacking. The establishment of MTB guidelines can provide a framework for interpreting rare or complex mutations, facilitating appropriate treatment decision-making, and ensuring quality control.
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Affiliation(s)
- Vincent D. de Jager
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wim Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arnaud Bayle
- Oncostat U1018, Inserm, Paris-Saclay University, Gustave Roussy, Villejuif, France
| | - Johan Botling
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy of University of Gothenburg, Gothenburg, Sweden
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Reinhard Büttner
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | | | - Libor Havel
- Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Maximilian J. Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Paul Hofman
- IHU RespirERA, FHU OncoAge, Nice University Hospital, Côte d’Azur University, Nice, France
| | - Annelies Janssens
- Department of Oncology, University Hospital Antwerp, University of Antwerp, Edegem, Belgium
| | - Mikael Johansson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Léon van Kempen
- Department of Pathology, University Hospital Antwerp, University of Antwerp, Edegem, Belgium
| | - Izidor Kern
- Laboratory for Cytology and Pathology, University Clinic Golnik, Golnik, Slovenia
| | - Fernando Lopez-Rios
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Research Institute Hospital 12 de Octubre (i+12), Ciberonc, Madrid, Spain
| | - Margreet Lüchtenborg
- National Disease Registration Service, NHS England, London, United Kingdom
- Centre for Cancer, Society & Public Health, King’s College London, London, United Kingdom
| | - José Carlos Machado
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Faculty of Medicine of the University of Porto, Institute for Research and Innovation in Health (i3S), Porto, Portugal
| | - Katja Mohorcic
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, H12O-CNIO Lung Cancer Clinical Research Unit, Research Institute Hospital 12 de Octubre (i+12)/Spanish National Cancer Research Center (CNIO), Ciberonc, Madrid, Spain
| | - Sanjay Popat
- Lung Unit, Royal Marsden NHS Trust, London, United Kingdom
| | - Aleš Ryška
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, Czech Republic
| | - Phillipe Taniere
- Department of Histopathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Ed Schuuring
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Anthonie J. van der Wekken
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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4
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Besse B, Pons-Tostivint E, Park K, Hartl S, Forde PM, Hochmair MJ, Awad MM, Thomas M, Goss G, Wheatley-Price P, Shepherd FA, Florescu M, Cheema P, Chu QSC, Kim SW, Morgensztern D, Johnson ML, Cousin S, Kim DW, Moskovitz MT, Vicente D, Aronson B, Hobson R, Ambrose HJ, Khosla S, Reddy A, Russell DL, Keddar MR, Conway JP, Barrett JC, Dean E, Kumar R, Dressman M, Jewsbury PJ, Iyer S, Barry ST, Cosaert J, Heymach JV. Biomarker-directed targeted therapy plus durvalumab in advanced non-small-cell lung cancer: a phase 2 umbrella trial. Nat Med 2024; 30:716-729. [PMID: 38351187 PMCID: PMC10957481 DOI: 10.1038/s41591-024-02808-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/09/2024] [Indexed: 03/23/2024]
Abstract
For patients with non-small-cell lung cancer (NSCLC) tumors without currently targetable molecular alterations, standard-of-care treatment is immunotherapy with anti-PD-(L)1 checkpoint inhibitors, alone or with platinum-doublet therapy. However, not all patients derive durable benefit and resistance to immune checkpoint blockade is common. Understanding mechanisms of resistance-which can include defects in DNA damage response and repair pathways, alterations or functional mutations in STK11/LKB1, alterations in antigen-presentation pathways, and immunosuppressive cellular subsets within the tumor microenvironment-and developing effective therapies to overcome them, remains an unmet need. Here the phase 2 umbrella HUDSON study evaluated rational combination regimens for advanced NSCLC following failure of anti-PD-(L)1-containing immunotherapy and platinum-doublet therapy. A total of 268 patients received durvalumab (anti-PD-L1 monoclonal antibody)-ceralasertib (ATR kinase inhibitor), durvalumab-olaparib (PARP inhibitor), durvalumab-danvatirsen (STAT3 antisense oligonucleotide) or durvalumab-oleclumab (anti-CD73 monoclonal antibody). Greatest clinical benefit was observed with durvalumab-ceralasertib; objective response rate (primary outcome) was 13.9% (11/79) versus 2.6% (5/189) with other regimens, pooled, median progression-free survival (secondary outcome) was 5.8 (80% confidence interval 4.6-7.4) versus 2.7 (1.8-2.8) months, and median overall survival (secondary outcome) was 17.4 (14.1-20.3) versus 9.4 (7.5-10.6) months. Benefit with durvalumab-ceralasertib was consistent across known immunotherapy-refractory subgroups. In ATM-altered patients hypothesized to harbor vulnerability to ATR inhibition, objective response rate was 26.1% (6/23) and median progression-free survival/median overall survival were 8.4/22.8 months. Durvalumab-ceralasertib safety/tolerability profile was manageable. Biomarker analyses suggested that anti-PD-L1/ATR inhibition induced immune changes that reinvigorated antitumor immunity. Durvalumab-ceralasertib is under further investigation in immunotherapy-refractory NSCLC.ClinicalTrials.gov identifier: NCT03334617.
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Affiliation(s)
- Benjamin Besse
- Institut Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Elvire Pons-Tostivint
- Medical Oncology, Centre Hospitalier Universitaire Nantes, Nantes University, Nantes, France
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- MD Anderson Cancer Center, Houston, TX, USA
| | - Sylvia Hartl
- Ludwig Boltzmann Institute for Lung Health, Clinic Penzing, Vienna, Austria
- Sigmund Freud University, Vienna, Austria
| | - Patrick M Forde
- Bloomberg-Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Mark M Awad
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Glenwood Goss
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Wheatley-Price
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Frances A Shepherd
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Marie Florescu
- Division of Hematology Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Parneet Cheema
- William Osler Health System, University of Toronto, Toronto, Ontario, Canada
| | | | - Sang-We Kim
- Department of Oncology, Asan Medical Center, Seoul, Republic of Korea
| | - Daniel Morgensztern
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa L Johnson
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN, USA
| | - Sophie Cousin
- Department of Medical Oncology, Institut Bergonié, Regional Comprehensive Cancer Center, Bordeaux, France
| | - Dong-Wan Kim
- Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Mor T Moskovitz
- Institute of Oncology, Rambam Medical Center, Haifa, Israel
- Thoracic Cancer Service, Rabin Medical Center Davidoff Cancer Centre, Beilinson Campus, Petah Tikva, Israel
| | - David Vicente
- Department of Medical Oncology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Boaz Aronson
- Oncology Early Global Development, AstraZeneca, Gaithersburg, MD, USA
| | | | - Helen J Ambrose
- Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Sajan Khosla
- Real-World Evidence, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Avinash Reddy
- Oncology Data Science, Oncology R&D, AstraZeneca, Boston, MA, USA
| | - Deanna L Russell
- Translational Medicine, Oncology R&D, AstraZeneca, Boston, MA, USA
| | - Mohamed Reda Keddar
- Oncology Data Science, Research and Early Development, Oncology R&D, AstraZeneca, Cambridge, UK
| | - James P Conway
- Oncology Data Science, Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | - J Carl Barrett
- Translational Medicine, Oncology R&D, AstraZeneca, Boston, MA, USA
| | - Emma Dean
- Oncology R&D, AstraZeneca, Cambridge, UK
| | - Rakesh Kumar
- Oncology R&D, AstraZeneca, Gaithersburg, MD, USA
| | | | | | - Sonia Iyer
- Translational Medicine, Oncology R&D, AstraZeneca, Boston, MA, USA
| | | | | | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
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Paz-Ares L, Garassino MC, Chen Y, Reinmuth N, Hotta K, Poltoratskiy A, Trukhin D, Hochmair MJ, Özgüroğlu M, Ji JH, Statsenko G, Conev N, Bondarenko I, Havel L, Losonczy G, Xie M, Lai Z, Godin-Heymann N, Mann H, Jiang H, Shrestha Y, Goldman JW. Durvalumab ± Tremelimumab + Platinum-Etoposide in Extensive-Stage Small Cell Lung Cancer (CASPIAN): Outcomes by PD-L1 Expression and Tissue Tumor Mutational Burden. Clin Cancer Res 2024; 30:824-835. [PMID: 37801329 PMCID: PMC10870117 DOI: 10.1158/1078-0432.ccr-23-1689] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/17/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE In the CASPIAN trial, first-line durvalumab plus platinum-etoposide (EP) significantly improved overall survival (OS) versus EP alone in extensive-stage small cell lung cancer (ES-SCLC). We report exploratory analyses of CASPIAN outcomes by programmed cell death ligand-1 (PD-L1) expression and tissue tumor mutational burden (tTMB). EXPERIMENTAL DESIGN Patients were randomized (1:1:1) to durvalumab (1,500 mg) plus EP, durvalumab plus tremelimumab (75 mg) plus EP, or EP alone. Treatment effects in PD-L1 and tTMB subgroups were estimated using an unstratified Cox proportional hazards model. RESULTS The PD-L1 and tTMB biomarker-evaluable populations (BEP) comprised 54.4% (438/805) and 35.2% (283/805) of the intention-to-treat population, respectively. PD-L1 prevalence was low: 5.7%, 25.8%, and 28.3% had PD-L1 expression on ≥1% tumor cells (TC), ≥1% immune cells (IC), and ≥1% TCs or ICs, respectively. OS benefit with durvalumab plus EP versus EP was similar across PD-L1 subgroups, with HRs all falling within the 95% confidence interval (CI) for the PD-L1 BEP (0.47‒0.79). OS benefit with durvalumab plus tremelimumab plus EP versus EP was greater in PD-L1 ≥1% versus <1% subgroups, although CIs overlapped. There was no evidence of an interaction between tTMB and treatment effect on OS (durvalumab plus EP vs. EP, P = 0.916; durvalumab plus tremelimumab plus EP vs. EP, P = 0.672). CONCLUSIONS OS benefit with first-line durvalumab plus EP in patients with ES-SCLC was observed regardless of PD-L1 or tTMB status. PD-L1 expression may prove to be a useful biomarker for combined treatment with PD-(L)1 and CTLA-4 inhibition, although this requires confirmation with an independent dataset. See related commentary by Rolfo and Russo, p. 652.
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Affiliation(s)
- Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Lung Cancer Unit CNIO-H120, Complutense University and Ciberonc, Madrid, Spain
| | - Marina Chiara Garassino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Medicine, Section of Hematology/Oncology, Thoracic Oncology Unit, University of Chicago, Chicago, Illinois
| | - Yuanbin Chen
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, Michigan
| | - Niels Reinmuth
- Asklepios Lung Clinic, Member of the German Center for Lung Research (DZL), Munich-Gauting, Germany
| | | | - Artem Poltoratskiy
- Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | | | - Maximilian J. Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Mustafa Özgüroğlu
- Istanbul University−Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Jun Ho Ji
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of South Korea
| | | | - Nikolay Conev
- Clinic of Medical Oncology, UMHAT St Marina, Varna, Bulgaria
| | | | - Libor Havel
- Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
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6
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Rath B, Stickler S, Hochmair MJ, Hamilton G. Expression of cytokines in pleural effusions and corresponding cell lines of small cell lung cancer. Transl Lung Cancer Res 2024; 13:5-15. [PMID: 38405004 PMCID: PMC10891412 DOI: 10.21037/tlcr-23-569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/29/2023] [Indexed: 02/27/2024]
Abstract
Background Small cell lung cancer (SCLC) is a neuroendocrine aggressive tumor with a dismal prognosis due to the lack of curative therapeutic modalities. Approximately 11% of these patients show a malignant pleural effusion (MPE) that increase in frequency with progression of the disease. In MPE, fluid accumulates due to leaky vessels and mesothelial surfaces as well as impaired removal of fluid due to impaired drainage. Methods For this investigation, three SCLC MPE samples and supernatants of the corresponding isolated cell lines were analyzed for the content of 105 cytokines, chemokines, and growth factors. Overexpressed pathways including these cytokines were identified using Reactome analysis tools. Results A large range of cytokines, including vascular endothelial growth factor A (VEGFA), were found to be expressed in the MPEs and conditioned media of the corresponding cell line. These mediators are involved in pathways such as interleukin (IL) signaling, growth factor stimulation, modulation of cell adhesion molecules and proliferative cell signaling. Cytokine expression by the corresponding SCLC cell lines revealed the specific contributions of the tumor cells and included high expression of VEGFA, tumor-promoting factors and mediators exerting immunosuppressive and protumor effects. MPEs used here showed marked stimulation of the proliferation of four permanent SCLC cell lines. Conclusions MPEs comprise a large number of cytokines with mixed activities on tumor cells and the invading SCLC cells release a number of protumor mediators and induce an immunosuppressive pleural environment.
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Affiliation(s)
- Barbara Rath
- Institute of Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Sandra Stickler
- Institute of Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Maximilian J. Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Gerhard Hamilton
- Institute of Pharmacology, Medical University of Vienna, Vienna, Austria
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7
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Hochmair MJ, Unk M, Spasic J, Cerić T, Konsoulova A, Dediu M, Bogos K, Hegmane A, Oselin K, Stojiljkovic M, Roblek T, Jakopovic M. Unmet needs in EGFR exon 20 insertion mutations in Central and Eastern Europe: reimbursement, diagnostic procedures, and treatment availability. BMC Proc 2024; 18:2. [PMID: 38233854 PMCID: PMC10795200 DOI: 10.1186/s12919-023-00287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Lung cancer remains the leading cause of cancer-related deaths in Europe, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of cases. NSCLC is a heterogeneous disease encompassing various oncogenic alterations. Among them, EGFR exon 20 insertion mutations, constituting 0.3-2.2% of NSCLC cases, rank as the third most common EGFR alteration after exon 19 deletions and the L858R point mutation in exon 21, also known as "typical" EGFR alterations. Recent advancements in understanding the molecular pathogenesis of NSCLC have led to significant breakthroughs in targeted therapies, revolutionizing treatment options for patients with specific genetic alterations.This article presents the outcomes of a Virtual Meeting conducted on the online platform (provided Within3©) from September 19 to October 30, 2022. The meeting focused on addressing the challenges in the diagnosis and treatment of NSCLC patients with EGFR exon 20 insertion mutations. The participants consisted of healthcare professionals from ten Central and Eastern European countries who shared their experiences and opinions on various aspects, including epidemiology, treatment options, and diagnostic approaches employed in their respective healthcare institutions. The discussions were facilitated through open-ended and multiple-choice questions.The primary objective of this article is to provide an overview of the identified challenges associated with the diagnosis and treatment of this heterogeneous disease, based on the assessments of the meeting participants. Among the major emerging challenges discussed, the reimbursement issues concerning next-generation sequencing (NGS), a recommended method in NSCLC molecular diagnosis, and the availability of approved targeted treatments to enhance patient outcomes were of paramount importance. Furthermore, fostering community awareness of lung cancer and promoting harmonized lung cancer care were identified as areas deserving greater attention. Notably, the rapidly evolving treatment landscape, particularly with NGS for NSCLC patients with genomic alterations like EGFR, ALK, RET, MET, NTRK, and ROS1, necessitates prioritizing the development of new drugs, even for the relatively smaller subgroup with exon 20 insertion mutations.
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Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Mojca Unk
- Institute of Oncology Ljubljana, Zaloška Cesta 2, Ljubljana, Slovenia
| | - Jelena Spasic
- Institute for Oncology and Radiology of Serbia, Pasterova 14, Belgrade, Serbia
| | - Timur Cerić
- University Clinical Center Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
| | - Assia Konsoulova
- National Oncology Hospital, "Plovdivsko Pole" 6, Sofia, 1756, Bulgaria
| | - Mircea Dediu
- Sanador Oncology Center Bucharest, Strada Sevastopol 5, Bucharest, Romania
| | - Krisztina Bogos
- National Koranyi Institute for Pulmonology, Korányi Frigyes út 1, Budapest, Hungary
| | - Alinta Hegmane
- Riga East University Hospital, Oncology Center of Latvia, Hipokrāta iela 4, Rīga, Latvia
| | - Kersti Oselin
- North Estonia Medical Centre, J. Sütiste tee 19, Tallinn, Estonia
| | | | - Tina Roblek
- Takeda Pharmaceuticals d.o.o., Bleiweisova cesta 30, Ljubljana, Slovenia
| | - Marko Jakopovic
- Zagreb Medical School, University Clinical Hospital Center Zagreb, Jordanovac 104, Zagreb, Croatia.
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8
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Liu SV, Mok TSK, Nabet BY, Mansfield AS, De Boer R, Losonczy G, Sugawara S, Dziadziuszko R, Krzakowski M, Smolin A, Hochmair MJ, Garassino MC, Gay CM, Heymach JV, Byers LA, Lam S, Cardona A, Morris S, Adler L, Shames DS, Reck M. Clinical and molecular characterization of long-term survivors with extensive-stage small cell lung cancer treated with first-line atezolizumab plus carboplatin and etoposide. Lung Cancer 2023; 186:107418. [PMID: 37931445 DOI: 10.1016/j.lungcan.2023.107418] [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: 06/27/2023] [Revised: 10/06/2023] [Accepted: 10/29/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES In the Phase I/III IMpower133 study, first-line atezolizumab plus carboplatin and etoposide (CP/ET) treatment for extensive-stage small cell lung cancer (ES-SCLC) significantly improved overall survival (OS) and progression-free survival versus placebo plus CP/ET. We explored patient and disease characteristics associated with long-term survival in IMpower133, and associations of differential gene expression and SCLC-A (ASCL1-driven), SCLC-N (NEUROD1-driven), SCLC-P (POU2F3-driven), and SCLC-inflamed (SCLC-I) transcriptional subtypes with long-term survival. MATERIALS AND METHODS Patients with previously untreated ES-SCLC were randomized 1:1 to four 21-day cycles of CP/ET with atezolizumab or placebo. Long-term survivors (LTS) were defined as patients who lived ≥ 18 months post randomization. A generalized linear model was used to evaluate the odds of living ≥ 18 months. Differential gene expression was analyzed using RNA-sequencing data in LTS and non-LTS. OS was assessed by T-effector and B-cell gene signature expression. Distribution of SCLC transcriptional subtypes was assessed in LTS and non-LTS. RESULTS More LTS were in the atezolizumab arm (34%) than in the placebo arm (20%). The odds ratio for living ≥ 18 months in the atezolizumab arm versus the placebo arm was 2.1 (P < 0.03). Enhanced immune-related signaling was seen in LTS in both arms. Exploratory OS analyses showed atezolizumab treatment benefit versus placebo across T-effector and B-cell gene signature expression subgroups. A higher proportion of LTS than non-LTS in both arms had the SCLC-I subtype; this difference was particularly pronounced in the atezolizumab arm. CONCLUSION These exploratory analyses suggest that long-term survival is more likely with atezolizumab than placebo in ES-SCLC, confirming the treatment benefit of the IMpower133 regimen. CLINICALTRIAL gov Identifier: NCT02763579.
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Affiliation(s)
- Stephen V Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - Tony S K Mok
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | - György Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy and Early Phase Clinical Trials Center, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej Krzakowski
- Maria Sklodowska Curie National Research Institute of Oncology, Warsaw, Poland
| | - Alexey Smolin
- Burdenko Main Military Clinical Hospital, Moscow, Russia
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna North Hospital Klinik Floridsdorf, Vienna, Austria
| | - Marina C Garassino
- The University of Chicago Department of Hematology/Oncology, Chicago, IL, USA
| | - Carl M Gay
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John V Heymach
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren A Byers
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Leah Adler
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | | | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
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9
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Kifjak D, Hochmair MJ, Krenbek D, Milos RI, Heidinger BH, Prayer F, Röhrich S, Watzenboeck ML, Oberndorfer F, Klikovits T, Aigner C, Sinn K, Hoda MA, Hoetzenecker K, Haug AR, Prosch H, Beer L. Neoadjuvant immune-checkpoint inhibitors in lung cancer - a primer for radiologists. Eur J Radiol 2023; 161:110732. [PMID: 36804313 DOI: 10.1016/j.ejrad.2023.110732] [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: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
The introduction of neoadjuvant immune checkpoint inhibitors plus platinum-based chemotherapy has changed treatment regimens of patient's early-stage lung cancer. This treatment combination induces high rates of complete pathologic response and improves clinical endpoints. Imaging plays a fundamental role in assessment of treatment response, monitoring of (immune-related) adverse events and enables both the surgeon and pathologist optimal treatment and diagnostic workup of the resected tumor samples. Knowledge of the strengths and weaknesses of diagnostic imaging in this setting are essential for radiologists to provide valuable input in multidisciplinary team decisions.
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Affiliation(s)
- Daria Kifjak
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria; Department of Radiology, UMass Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria; Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Dagmar Krenbek
- Department of Pathology, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria
| | - Benedikt H Heidinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria
| | - Florian Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria
| | - Sebastian Röhrich
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria
| | - Martin L Watzenboeck
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Klikovits
- Department of Thoracic Surgery, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Clemens Aigner
- Department of Thoracic Surgery, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Katharina Sinn
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander R Haug
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria
| | - Lucian Beer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Machine Learning Driven Precision Imaging, Medical University of Vienna, Vienna, Austria.
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10
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Garassino MC, Gadgeel S, Speranza G, Felip E, Esteban E, Dómine M, Hochmair MJ, Powell SF, Bischoff HG, Peled N, Grossi F, Jennens RR, Reck M, Hui R, Garon EB, Kurata T, Gray JE, Schwarzenberger P, Jensen E, Pietanza MC, Rodríguez-Abreu D. Pembrolizumab Plus Pemetrexed and Platinum in Nonsquamous Non-Small-Cell Lung Cancer: 5-Year Outcomes From the Phase 3 KEYNOTE-189 Study. J Clin Oncol 2023; 41:1992-1998. [PMID: 36809080 PMCID: PMC10082311 DOI: 10.1200/jco.22.01989] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically on the based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We present 5-year outcomes from the phase 3 KEYNOTE-189 study (ClinicalTrials.gov identifier: NCT02578680). Eligible patients with previously untreated metastatic nonsquamous non-small-cell lung cancer without EGFR/ALK alterations were randomly assigned 2:1 to pembrolizumab 200 mg or placebo once every 3 weeks for up to 35 cycles with pemetrexed and investigator's choice of carboplatin/cisplatin for four cycles, followed by maintenance pemetrexed until disease progression or unacceptable toxicity. Primary end points were overall survival (OS) and progression-free survival (PFS). Among 616 randomly assigned patients (n = 410, pembrolizumab plus pemetrexed-platinum; n = 206, placebo plus pemetrexed-platinum), median time from random assignment to data cutoff (March 8, 2022) was 64.6 (range, 60.1-72.4) months. Hazard ratio (95% CI) for OS was 0.60 (0.50 to 0.72) and PFS was 0.50 (0.42 to 0.60) for pembrolizumab plus platinum-pemetrexed versus placebo plus platinum-pemetrexed. 5-year OS rates were 19.4% versus 11.3%. Toxicity was manageable. Among 57 patients who completed 35 cycles of pembrolizumab, objective response rate was 86.0% and 3-year OS rate after completing 35 cycles (approximately 5 years after random assignment) was 71.9%. Pembrolizumab plus pemetrexed-platinum maintained OS and PFS benefits versus placebo plus pemetrexed-platinum, regardless of programmed cell death ligand-1 expression. These data continue to support pembrolizumab plus pemetrexed-platinum as a standard of care in previously untreated metastatic non-small-cell lung cancer without EGFR/ALK alterations.
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Affiliation(s)
- Marina C Garassino
- Knapp Center for Biomedical Discovery, University of Chicago Medicine & Biological Sciences, Chicago, IL.,Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Giovanna Speranza
- Centre Integré de Cancérologie de la Montérégie, Hôpital Charles-Le Moyne, Greenfield Park, QC, Canada
| | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Emilio Esteban
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Manuel Dómine
- Department of Oncology, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Steven F Powell
- Hematology and Oncology, Sanford Cancer Center, Sioux Falls, SD
| | | | - Nir Peled
- Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Francesco Grossi
- Medical Oncology Division, University of Insubria, Varese, Italy
| | - Ross R Jennens
- Department of Medical Oncology, Epworth Healthcare, Richmond, VIC, Australia
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Rina Hui
- Department of Medical Oncology, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Edward B Garon
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Takayasu Kurata
- Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan
| | - Jhanelle E Gray
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL
| | | | | | | | - Delvys Rodríguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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11
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Obermayr E, Koppensteiner N, Heinzl N, Schuster E, Holzer B, Fabikan H, Weinlinger C, Illini O, Hochmair MJ, Zeillinger R. Effect of short-term storage of blood samples on gene expression in lung cancer patients. Clin Chem Lab Med 2023; 61:294-301. [PMID: 36395488 DOI: 10.1515/cclm-2022-0738] [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: 07/29/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The stability of gene transcripts associated with the presence of circulating tumor cells (CTCs) has been predominantly studied in cultured cancer cell lines added to blood samples under artificial conditions. In the present study the effect of storage on CTC-related transcripts was assessed in blood samples taken from patients with non-small lung cancer (n=58). METHODS The blood samples were split in two equal parts to compare the gene expression with and without storage for 24 h at ambient temperature without preservative added. After enrichment using the microfluidic Parsortix® technology, the expression levels of selected genes were assessed using quantitative PCR following a gene-specific pre-amplification. The prognostic relevance of each gene in fresh and stored blood samples was evaluated using the R-package Survminer. RESULTS Some genes were either not affected (TWIST1, CDH5, CK19) or upregulated upon storage (NANOG, MET, UCHL1) but still associated with poor prognosis. In contrast, ERBB3, PTHLH, EpCAM, and TERT were no longer associated with the overall survival of the patients. CONCLUSIONS The study demonstrates the surprising stability of CTC-related transcripts, which makes overnight shipping of native blood samples possible. Careful verification is required when using model systems - such as normal blood spiked with tumor cells - or other CTC-related markers, as individual transcripts may respond differently to storage.
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Affiliation(s)
- Eva Obermayr
- Department of Obstetrics and Gynecology, Molecular Oncology Group, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Nina Koppensteiner
- Department of Obstetrics and Gynecology, Molecular Oncology Group, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Nicole Heinzl
- Department of Obstetrics and Gynecology, Molecular Oncology Group, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Eva Schuster
- Department of Obstetrics and Gynecology, Molecular Oncology Group, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Barbara Holzer
- Department of Obstetrics and Gynecology, Molecular Oncology Group, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hannah Fabikan
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Christoph Weinlinger
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Oliver Illini
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Robert Zeillinger
- Department of Obstetrics and Gynecology, Molecular Oncology Group, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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12
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Ahn MJ, Kim HR, Yang JCH, Han JY, Li JYC, Hochmair MJ, Chang GC, Delmonte A, Lee KH, Campelo RG, Gridelli C, Spira AI, Califano R, Griesinger F, Ghosh S, Felip E, Kim DW, Liu Y, Zhang P, Popat S, Camidge DR. Efficacy and Safety of Brigatinib Compared With Crizotinib in Asian vs. Non-Asian Patients With Locally Advanced or Metastatic ALK-Inhibitor-Naive ALK+ Non-Small Cell Lung Cancer: Final Results From the Phase III ALTA-1L Study. Clin Lung Cancer 2022; 23:720-730. [PMID: 36038416 DOI: 10.1016/j.cllc.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Brigatinib is a next-generation anaplastic lymphoma kinase (ALK) inhibitor with demonstrated efficacy in locally advanced and metastatic non-small cell lung cancer (NSCLC) in crizotinib-refractory and ALK inhibitor-naive settings. This analysis assessed brigatinib in Asian vs. non-Asian patients from the first-line ALTA-1L trial. PATIENTS AND METHODS This was a subgroup analysis from the phase III ALTA-1L trial of brigatinib vs. crizotinib in ALK inhibitor-naive ALK+ NSCLC. The primary endpoint was progression-free survival (PFS) as assessed by blinded independent review committee (BIRC). Secondary endpoints included confirmed objective response rate (ORR) and overall survival (OS) in the overall population and BIRC-assessed intracranial ORR and PFS in patients with brain metastases. RESULTS Of the 275 randomized patients, 108 were Asian. Brigatinib showed consistent superiority in BIRC-assessed PFS vs. crizotinib in Asian (hazard ratio [HR]: 0.35 [95% CI: 0.20-0.59]; log-rank P = .0001; median 24.0 vs. 11.1 months) and non-Asian (HR: 0.56 [95% CI: 0.38-0.84]; log-rank P = .0041; median 24.7 vs. 9.4 months) patients. Results were consistent with investigator-assessed PFS and BIRC-assessed intracranial PFS. Brigatinib was well tolerated. Toxicity profiles and dose modification rates were similar between Asian and non-Asian patients. CONCLUSION Efficacy with brigatinib was consistently better than with crizotinib in Asian and non-Asian patients with locally advanced or metastatic ALK inhibitor-naive ALK-+ NSCLC. There were no clinically notable differences in overall safety in Asian vs. non-Asian patients.
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Affiliation(s)
- Myung J Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hye R Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - James C H Yang
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, and Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ji-Yu Han
- Center for Lung Cancer, National Cancer Center, Goyang, South Korea
| | - Jacky Yu-Chung Li
- Department of Clinical Oncology, Hong Kong United Oncology Centre, Kowloon, Hong Kong
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Gee-Chen Chang
- School of Medicine, and Institute of Medicine, Chung Shan Medical University, Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, and Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Angelo Delmonte
- Medical Oncology, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), IRCCS, Meldola, Italy
| | - Ki H Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Rosario G Campelo
- Medical Oncology Department, Thoracic Tumors Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Cesare Gridelli
- Division of Medical Oncology, A.O.S.G. Moscati, Avellino, Italy
| | - Alexander I Spira
- Medical Oncology, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, and Division of Cancer Sciences, The University of Manchester, Manchester, England, UK
| | - Frank Griesinger
- University Department of Internal Medicine-Oncology, Pius-Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Sharmistha Ghosh
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Yuyin Liu
- Oncology Statistics, Takeda Development Center Americas, Inc., Lexington, MA
| | - Pingkuan Zhang
- Clinical Science, Takeda Development Center Americas, Inc., Lexington, MA
| | - Sanjay Popat
- Lung Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, England, UK
| | - D Ross Camidge
- Department of Medicine, Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO
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13
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Gettinger SN, Huber RM, Kim DW, Bazhenova L, Hansen KH, Tiseo M, Langer CJ, Paz-Ares Rodríguez LG, West HL, Reckamp KL, Weiss GJ, Smit EF, Hochmair MJ, Kim SW, Ahn MJ, Kim ES, Groen HJ, Pye J, Liu Y, Zhang P, Vranceanu F, Camidge DR. Long-Term Efficacy and Safety of Brigatinib in Crizotinib-Refractory ALK+ NSCLC: Final Results of the Phase 1/2 and Randomized Phase 2 (ALTA) Trials. JTO Clin Res Rep 2022; 3:100385. [PMID: 36065449 PMCID: PMC9440305 DOI: 10.1016/j.jtocrr.2022.100385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 10/27/2022] Open
Abstract
Introduction We report brigatinib long-term efficacy and safety from phase 1/2 and phase 2 (ALTA) trials in ALK-rearrangement positive (ALK+) NSCLC. Methods The phase 1/2 study evaluated brigatinib 30 to 300 mg/d in patients with advanced malignancies. ALTA randomized patients with crizotinib-refractory ALK+ NSCLC to brigatinib 90 mg once daily (arm A) or 180 mg once daily (7-d lead-in at 90 mg; arm B). Results In the phase 1/2 study, 79 of 137 brigatinib-treated patients had ALK+ NSCLC; 71 were crizotinib pretreated. ALTA randomized 222 patients (n = 112 in arm A; n = 110 in arm B). Median follow-up at phase 1/2 study end (≈5.6 y after last patient enrolled) was 27.7 months; at ALTA study end (≈4.4 y after last patient enrolled), 19.6 months (A) and 28.3 months (B). Among patients with ALK+ NSCLC in the phase 1/2 study, median investigator-assessed progression-free survival (PFS) was 14.5 months (95% confidence interval [CI]: 10.8-21.2); median overall survival was 47.6 months (28.6-not reached). In ALTA, median investigator-assessed PFS was 9.2 months (7.4-11.1) in arm A and 15.6 months (11.1-18.5) in arm B; median independent review committee (IRC)-assessed PFS was 9.9 (7.4-12.8) and 16.7 (11.6-21.4) months, respectively; median overall survival was 25.9 (18.2-45.8) and 40.6 (32.5-not reached) months, respectively. Median intracranial PFS for patients with any brain metastases was 12.8 (9.2-18.4) months in arm A and 18.4 (12.6-23.9) months in arm B. No new safety signals were identified versus previous analyses. Conclusions Brigatinib exhibited sustained long-term activity and PFS with manageable safety in patients with crizotinib-refractory ALK+ NSCLC.
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Affiliation(s)
- Scott N. Gettinger
- Yale Cancer Center, Yale-New Haven Hospital, New Haven, Connecticut
- Corresponding author. Address for correspondence: Scott N. Gettinger, MD, Yale Cancer Center, Yale-New Haven Hospital, 333 Cedar Street, FMP 127, New Haven, CT 06520-8028.
| | - Rudolf M. Huber
- Thoracic Oncology Centre Munich, University Hospital of Munich, member of the German Center for Lung Research (DZL, CPC-M), Munich, Germany
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Lyudmila Bazhenova
- University of California San Diego Moores Cancer Center, La Jolla, California
| | | | - Marcello Tiseo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Corey J. Langer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | | | - Howard L. West
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Karen L. Reckamp
- City of Hope Comprehensive Cancer Center, Duarte, California
- Current Affiliation: Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Egbert F. Smit
- Thoracic Oncology Service, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maximilian J. Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna, Austria
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Edward S. Kim
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Harry J.M. Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Joanna Pye
- Oncology Statistics, Takeda Development Center Americas, Inc., Lexington, Massachusetts
| | - Yuyin Liu
- Oncology Statistics, Takeda Development Center Americas, Inc., Lexington, Massachusetts
| | - Pingkuan Zhang
- Clinical Science, Takeda Development Center Americas, Inc., Lexington, Massachusetts
- Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
| | - Florin Vranceanu
- Oncology Statistics, Takeda Development Center Americas, Inc., Lexington, Massachusetts
- Clinical Science, Takeda Development Center Americas, Inc., Lexington, Massachusetts
| | - D. Ross Camidge
- Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
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14
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Miura S, Jung HA, Lee SY, Lee SH, Lee MK, Lee YC, Hochmair MJ, Yang CT, Märten A, Yang JCH, Popat S. Sequential Afatinib and Osimertinib in Asian Patients with EGFR Mutation-Positive Non-Small Cell Lung Cancer and Acquired T790M: Combined Analysis of Two Global Non-Interventional Studies. Onco Targets Ther 2022; 15:873-882. [PMID: 36033903 PMCID: PMC9416460 DOI: 10.2147/ott.s362535] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/12/2022] [Indexed: 12/17/2022] Open
Abstract
Objective Two recent non-interventional trials, GioTag and UpSwinG, demonstrated encouraging time-to-treatment failure (TTF) and overall survival (OS) in patients with epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC) (Del19 or L858R) who received sequential afatinib/osimertinib, especially in Asians. Here, we have undertaken a combined analysis of Asian patients from both studies. Materials and Methods Existing medical/electronic records were identified for consecutive EGFR-tyrosine kinase inhibitor (TKI)-naïve patients who received first-line afatinib/second-line osimertinib in “real-world” practice (all T790M-positive). Patients with active brain metastases were excluded. The primary objective was TTF. OS was a key secondary objective. Results One hundred and sixty-eight patients were analyzed. Most patients were recruited from South Korea or Japan (52/21%). At the start of afatinib, median age (range) was 61.5 years (35–88), 58% were female, Eastern Cooperative Oncology Group Performance Status (ECOG PS) (0/1/≥2) was 29/62/9%, 17% had brain metastases, and EGFR mutation status (Del19/L858R) was 65/35%. At the start of osimertinib, ECOG PS (0/1/≥2) was 22/61/17% and 14% had brain metastases. Median TTF and OS were 30.0 months (95% CI: 24.5–32.5) and 45.2 months (95% CI: 41.7–71.1), respectively. Median OS was 63.5 months in patients with a Del19 mutation. Median OS in patients with brain metastases or ECOG PS ≥2 was 26.4 and 33.1 months, respectively. Conclusion Sequential afatinib/osimertinib showed encouraging activity in Asian patients with EGFR mutation-positive NSCLC and T790M-mediated acquired resistance, especially those with Del19-positive disease. Activity was observed across “real-world” patients including those with poor ECOG PS and/or brain metastases. ECOG PS and incidence of brain metastases remained stable prior to, and after, afatinib.
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Affiliation(s)
- Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Shin Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung Hyeun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea
| | - Yong Chul Lee
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Maximilian J Hochmair
- Department of Respiratory & Critical Care Medicine, Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Vienna, Austria
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Angela Märten
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - James Chih-Hsin Yang
- Department of Medical Oncology, National Taiwan University Cancer Center and Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Sanjay Popat
- Lung Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom.,The Institute of Cancer Research, London, United Kingdom
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15
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Miura S, Jung HA, Lee SY, Lee SH, Lee MK, Lee YC, Hochmair MJ, Yang CT, Märten A, Chih-Hsin Yang J, Popat S. MO29-4 Sequential afatinib and osimertinib in Asians with EGFRm+ NSCLC: combined analysis of two non-interventional studies. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.177] [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: 11/26/2022] Open
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16
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Illini O, Fabikan H, Swalduz A, Vikström A, Krenbek D, Schumacher M, Dudnik E, Studnicka M, Öhman R, Wurm R, Wannesson L, Peled N, Kian W, Bar J, Daher S, Addeo A, Rotem O, Pall G, Zer A, Saad A, Cufer T, Sorotsky HG, Hashemi SMS, Mohorcic K, Stoff R, Rovitsky Y, Keren-Rosenberg S, Winder T, Weinlinger C, Valipour A, Hochmair MJ. Real-world experience with capmatinib in MET exon 14-mutated non-small cell lung cancer (RECAP): a retrospective analysis from an early access program. Ther Adv Med Oncol 2022; 14:17588359221103206. [PMID: 35720834 PMCID: PMC9201318 DOI: 10.1177/17588359221103206] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/16/2022] [Accepted: 05/08/2022] [Indexed: 12/25/2022] Open
Abstract
Background Patients with non-small cell lung cancer (NSCLC) presenting with mesenchymal-epithelial transition (MET) exon 14 skipping mutation have an unfavorable prognosis with standard treatments. Capmatinib is a selective MET inhibitor, which showed promising efficacy in this patient population in early trials. Methods We performed a retrospective, international, multicenter efficacy and safety analysis in patients with NSCLC treated with capmatinib in an early access program between March 2019 and December 2021. Results Data from 81 patients with advanced MET exon 14 mutated NSCLC treated with capmatinib in first- or later-line therapy were analyzed. Median age was 77 years (range, 48-91), 56% were women, 86% had stage IV disease, and 27% had brain metastases. For all patients, the objective response rate (ORR) to capmatinib was 58% (95% CI, 47-69), whereas it was 68% (95% CI, 50-82) in treatment-naïve and 50% (95% CI, 35-65) in pretreated patients. The median progression-free survival was 9.5 months (95% CI, 4.7-14.3), whereas it was 10.6 months (95% CI, 5.5-15.7) in first-line and 9.1 months (95% CI, 3.1-15.1) in pretreated patients. After a median follow-up of 11.0 months, the median overall survival was 18.2 months (95% CI, 13.2-23.1). In patients with measurable brain metastases (n = 11), the intracranial ORR was 46% (95% CI, 17-77). Capmatinib showed a manageable safety profile. Grade ⩾ 3 treatment-related adverse events included peripheral edema (13%), elevated creatinine (4%), and elevated liver enzymes (3%). Conclusion In patients with MET exon 14 skipping mutation, capmatinib showed durable systemic and intracranial efficacy and a manageable safety profile. This analysis confirms previously reported phase II data in a real-world setting.
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Affiliation(s)
- Oliver Illini
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna Healthcare Group, Brünner Strasse 68, Vienna 1210, Austria
| | - Hannah Fabikan
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Aurélie Swalduz
- Univ Lyon, Claude Bernard Lyon 1/ University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Anders Vikström
- Department of Pulmonary Medicine, University Hospital Linköping, Linköping, Sweden
| | - Dagmar Krenbek
- Department of Pathology and Bacteriology, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | | | - Elizabeth Dudnik
- Head of the Lung Cancer Service, Assuta Medical Centers, Tel-Aviv, Israel
| | - Michael Studnicka
- Department of Pneumology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Ronny Öhman
- Department of Pulmonary Medicine, University Hospital of Skane/Lund, Lund, Sweden
| | - Robert Wurm
- Division of Pulmonology, Department of Internal Medicine, LKH Universitätsklinik/Medizinische Universität Graz, Graz, Austria
| | - Luciano Wannesson
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Nir Peled
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Waleed Kian
- The Oncology Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Jair Bar
- Institute of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, IsraelSchool of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sameh Daher
- Department of Medical Oncology, Cancer Centre Haim Sheba MC Tel Hashomer, Ramat Gan, Israel
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Ofer Rotem
- Davidoff Center - Institute of Oncology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Georg Pall
- Department of Internal Medicine V - Hematology/Oncology, University Hospital Innsbruck, Innsbruck, Austria
| | - Alona Zer
- Department of Medical Oncology, Rambam Health Campus, Haifa, Israel
| | - Akram Saad
- Department of Oncology, Sheba Medical Center, Tel Hashomer, IsraelSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanja Cufer
- University Clinic Golnik, Golnik, SloveniaMedical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Hadas Gantz Sorotsky
- Department of Medical Oncology, Cancer Centre Haim Sheba MC Tel Hashomer, Ramat Gan, Israel
| | - Sayed M S Hashemi
- Department of Pulmonary Diseases, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Katja Mohorcic
- Medical Oncology Unit, University Clinic Golnik, Golnik, Slovenia
| | - Ronen Stoff
- Ella Institute for Immuno-Oncology, Cancer Center, Sheba Medical Center, Ramat Gan, Israel
| | - Yulia Rovitsky
- Lin Medical Centre affiliated to Carmel Hospital, Haifa, Israel
| | | | - Thomas Winder
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Christoph Weinlinger
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
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17
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Lin SH, Ahn MJ, Nagar SP, Affi R, Agulnik J, Shih JY, Hochmair MJ, Tufman A, Debieuvre D, Jimenez M, Davis K, Kahangire DA, Servidio LA, Veluswamy R. Treatment patterns and outcomes in resectable early stage NSCLC: Interim analysis of a global real-world study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18803] [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
e18803 Background: Complete surgical resection is the preferred treatment for early stage NSCLC, with adjuvant chemotherapy as the standard of care in resected stage II/III and select stage IB NSCLC. Osimertinib, an epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), is approved as adjuvant therapy in patients (pts) with resected stage IB–IIIA EGFR mutation-positive (EGFRm) NSCLC following results from the Phase III ADAURA trial. Understanding real-world clinical outcomes in early stage NSCLC, including EGFRm prevalence, will help inform unmet needs and further development of new treatment strategies in this population. We report interim results from a global non-interventional retrospective study of pts with resectable NSCLC using clinical data from medical records. Methods: Eligible pts (aged ≥18 yrs) had completely resected stage IA–IIIA NSCLC diagnosed between Jan 1, 2014 and Dec 31, 2017 with EGFR test results available and were followed to at least Dec 31, 2020. Primary endpoints included EGFRm prevalence, treatment patterns, and overall survival (OS); disease-free survival (DFS) was an exploratory endpoint estimated by Kaplan-Meier at predefined landmark timepoints. Results: Of 463 pts from 6 countries (31% from Taiwan, 21% Canada, 17% US, 13% Austria, 10% South Korea, 9% France), median age was 66 yrs (range: 33–86); 172 pts (37%) had stage IA NSCLC at initial diagnosis and 291 (63%) had stage IB–IIIA (22% IB, 13% IIA, 10% IIB, 18% IIIA). 213/463 pts (46%) were EGFRm (43% stage IA, 61% IB, 43% IIA, 26% IIB, 47% IIIA), of who 46% were from Taiwan, 21% South Korea, 14% Austria, 8% Canada, 7% US, and 4% France. In pts with EGFRm vs EGFR wild-type (wt) NSCLC, 84/213 (39%) and 83/250 (33%), respectively, received (neo)adjuvant therapy, of who 156/167 pts (93%) had stage IB–IIIA NSCLC. 106/156 pts (68%) had disease recurrence or death from time of surgery; recurrence rates were similar in pts with EGFRm vs EGFRwt NSCLC, though median DFS was longer in the EGFRm group (Table). Recurrence rates were high in both EGFRm and EGFTwt groups, with landmark DFS probability of 72% vs 77% at 12 mo and 29% vs 32% at 60 mo, respectively. Conclusions: In this real-world global study of surgically resected stage IA–IIIA NSCLC in pts who received an EGFR test, nearly half of the study cohort were EGFRm positive, of who 70% were treated in Taiwan/South Korea. The high rate of recurrence in pts with stage IB–IIIA NSCLC despite receiving (neo)adjuvant therapy reinforces the need for early diagnosis and EGFR testing to identify pts who might benefit from EGFR-targeted therapy, helping optimize clinical outcomes.[Table: see text]
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Affiliation(s)
- Steven H. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Myung-Ju Ahn
- Department of Hematology & Oncology, Samsung Medical Center, Seoul, South Korea
| | | | - Raafet Affi
- Hôpital Laennec, CHU de Nantes, Nantes, France
| | - Jason Agulnik
- Jewish General Hospital, McGill University, Montréal, QC, Canada
| | | | - Maximilian J. Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Amanda Tufman
- Ludwig-Maximilians-University of Munich and Thoracic Oncology Centre, Munich, Germany
| | - Didier Debieuvre
- Groupe Hospitalier de la Région Mulhouse Sud-Alsace, Hôpital Emile Muller, GHRMSA - Mulhouse, Mulhouse, France
| | | | - Keith Davis
- RTI Health Solutions, Research Triangle Park, NC
| | - Doreen A. Kahangire
- AstraZeneca, Oncology Business Unit, Medical Affairs, Cambridge, United Kingdom
| | - Leslie Ann Servidio
- AstraZeneca, Oncology Business Unit, Global Medical Affairs, Gaithersburg, MD
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18
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Holzknecht A, Illini O, Hochmair MJ, Krenbek D, Setinek U, Huemer F, Bitterlich E, Kaindl C, Getman V, Akan A, Weber M, Leobacher G, Valipour A, Mueller MR, Watzka SB. Multimodal Treatment of Malignant Pleural Mesothelioma: Real-World Experience with 112 Patients. Cancers (Basel) 2022; 14:cancers14092245. [PMID: 35565374 PMCID: PMC9104590 DOI: 10.3390/cancers14092245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare pleural cancer associated with asbestos exposure. According to current evidence, the combination of chemotherapy, surgery and radiotherapy improves patients’ survival. However, the optimal sequence and weighting of the respective treatment modalities is unclear. In anticipation of the upcoming results of the MARS-2 trial, we sought to determine the relative impact of the respective treatment modalities on complications and overall survival in our own consecutive institutional series of 112 patients. Fifty-seven patients (51%) underwent multimodality therapy with curative intent, while 55 patients (49%) were treated with palliative intent. The median overall survival (OS) of the entire cohort was 16.9 months (95% CI: 13.4−20.4) after diagnosis; 5-year survival was 29% for patients who underwent lung-preserving surgery. In univariate analysis, surgical treatment (p < 0.001), multimodality therapy (p < 0.001), epithelioid subtype (p < 0.001), early tumor stage (p = 0.02) and the absence of arterial hypertension (p = 0.034) were found to be prognostic factors for OS. In multivariate analysis, epithelioid subtype was associated with a survival benefit, whereas the occurrence of complications was associated with worse OS. Multimodality therapy including surgery significantly prolonged the OS of MPM patients compared with multimodal therapy without surgery.
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Affiliation(s)
- Arnulf Holzknecht
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Oliver Illini
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, 1210 Vienna, Austria; (O.I.); (M.J.H.); (A.V.)
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, 1210 Vienna, Austria; (O.I.); (M.J.H.); (A.V.)
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Dagmar Krenbek
- Institute for Pathology, Klinik Floridsdorf, 1210 Vienna, Austria;
| | - Ulrike Setinek
- Institute for Pathology and Microbiology, Klinik Ottakring, 1160 Vienna, Austria;
| | - Florian Huemer
- Division of Pulmonology, Klinik Penzing, 1140 Vienna, Austria;
| | - Erwin Bitterlich
- Division of Pulmonology, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria;
| | - Christoph Kaindl
- Division of Surgery, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria;
| | - Vladyslav Getman
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Ahmet Akan
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Michael Weber
- Department of Medical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Gunther Leobacher
- Institute of Mathematics and Scientific Computing, University of Graz, 8010 Graz, Austria;
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, 1210 Vienna, Austria; (O.I.); (M.J.H.); (A.V.)
- Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
| | - Michael R. Mueller
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
- Division of Thoracic Surgery, Sigmund Freud University, 1020 Vienna, Austria
| | - Stefan B. Watzka
- Karl Landsteiner Institute for Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria; (A.H.); (V.G.); (A.A.); (M.R.M.)
- Division of Thoracic Surgery, Karl Landsteiner Institute of Thoracic Oncology, Klinik Floridsdorf, 1210 Vienna, Austria
- Division of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +431-27700-74213
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Chen Y, Paz-Ares L, Reinmuth N, Garassino MC, Statsenko G, Hochmair MJ, Özgüroğlu M, Verderame F, Havel L, Losonczy G, Conev NV, Hotta K, Ji JH, Spencer S, Dalvi T, Jiang H, Goldman JW. Brief report: Impact of brain metastases on treatment patterns and outcomes with first-line durvalumab plus platinum-etoposide in extensive-stage SCLC (CASPIAN). JTO Clin Res Rep 2022; 3:100330. [PMID: 35719865 PMCID: PMC9204731 DOI: 10.1016/j.jtocrr.2022.100330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction In the phase 3 study involving the use of durvalumab with or without tremelimumab in combination with platinum-based chemotherapy in untreated extensive-stage SCLC (CASPIAN study), first-line durvalumab plus platinum-etoposide (EP) significantly improved overall survival (OS) versus EP alone (p = 0.0047). We report exploratory subgroup analyses of treatment patterns and outcomes according to the presence of baseline brain or central nervous system metastases. Methods Patients (WHO performance status 0 or 1), including those with asymptomatic or treated-and-stable brain metastases, were randomized to four cycles of durvalumab plus EP followed by maintenance durvalumab until progression or up to six cycles of EP and optional prophylactic cranial irradiation. Prespecified analyses of OS and progression-free survival (PFS) in subgroups with or without brain metastases used unstratified-Cox proportional hazards models. The data cutoff was on January 27, 2020. Results At baseline, 28 out of 268 patients (10.4%) in the durvalumab plus EP arm and 27 out of 269 patients (10.0%) in the EP arm had known brain metastases, of whom 3 of 28 (10.7%) and 4 of 27 (14.8%) had previous brain radiotherapy, respectively. Durvalumab plus EP (versus EP alone) prolonged OS (hazard ratio, 95% confidence interval) in patients with (0.79, 0.44–1.41) or without (0.76, 0.62–0.92) brain metastases, with similar PFS results (0.73, 0.42–1.29 and 0.80, 0.66–0.97, respectively). Among patients without brain metastases, similar proportions in each arm developed new brain lesions as part of their first progression (8.8% and 9.5%), although 8.3% in the EP arm received prophylactic cranial irradiation. Similar proportions in each arm received subsequent brain radiotherapy (20.5% and 21.2%), although more common in patients with than without baseline brain metastases (45.5% and 18.0%). Conclusions The OS and PFS benefit with first-line durvalumab plus EP were maintained irrespective of the presence of brain metastases, further supporting its standard-of-care use.
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Cho A, Hennenberg J, Untersteiner H, Hirschmann D, Gatterbauer B, Zöchbauer-Müller S, Hochmair MJ, Preusser M, Rössler K, Dorfer C, Frischer JM, Furtner J. Influence of temporal muscle thickness on the outcome of radiosurgically treated patients with brain metastases from non-small cell lung cancer. J Neurosurg 2022; 137:1-7. [PMID: 35120324 DOI: 10.3171/2021.12.jns212193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of temporal muscle thickness (TMT), a surrogate marker for sarcopenia, in radiosurgically treated patients with brain metastases (BMs) from non-small cell lung cancer (NSCLC). METHODS For 566 patients with BMs from NSCLC in the period between June 2012 and December 2019, TMT values were retrospectively measured on the planning brain magnetic resonance imaging (MRI) studies that had been obtained before their first Gamma Knife radiosurgery treatment (GKRS1). Predefined sex-specific TMT cutoff values were used to stratify the study cohort into patients at risk for sarcopenia and patients with normal muscle status. Cox regression models adjusted for other prognostic parameters were used to evaluate sarcopenia as an independent prognostic factor. RESULTS In sarcopenia patients with a TMT below the sex-specific cutoff values, the risk of death was significantly increased (HR 1.908, 95% CI 1.550-2.349, p < 0.001). In addition, sarcopenia was revealed as an independent prognostic factor even after adjusting for age groups, sex, number of BMs, presence of extracranial metastases, NSCLC subtypes, Karnofsky Performance Status groups, recursive partitioning analysis classes, and concomitant immunotherapy or targeted therapy (HR 1.680, 95% CI 1.347-2.095, p < 0.001). However, patients at risk for sarcopenia showed no significant differences in the estimated mean time until local BM progression after GKRS1, compared to patients with normal muscle status (p = 0.639). CONCLUSIONS TMT obtained from planning MRI studies is an independent prognostic marker in radiosurgically treated patients with BMs from NSCLC and may aid patient stratification in future clinical trials.
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Affiliation(s)
| | - Juliane Hennenberg
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
| | | | | | | | | | - Maximilian J Hochmair
- 4Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Matthias Preusser
- 3Department of Internal Medicine I, Division of Oncology, Medical University of Vienna; and
| | | | | | | | - Julia Furtner
- 2Biomedical Imaging and Image-guided Therapy, Medical University of Vienna
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21
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Ansari J, Eltigani Mohmmed Y, Ghazal-Aswad S, Ansari H, Akhter SMJ, Hassoun Hadid O, Rizwan S, Almazrouei R, Dawoud E, Azribi F, Elhasin H, Kumar P, Al Sumaida AR, Al-Qawasmeh K, Glaholm J, Hochmair MJ, Hussain S, Balaraj K. Rare case of chemotherapy-refractory metastatic vaginal squamous cell carcinoma with complete response to concurrent pembrolizumab and radiotherapy- case report and literature review. Gynecol Oncol Rep 2021; 38:100878. [PMID: 34926759 PMCID: PMC8651786 DOI: 10.1016/j.gore.2021.100878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/11/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Metastatic vaginal cancer, rare cancer with limited treatment options. Pembrolizumab and radiotherapy led to complete response in a patient with metastatic vaginal cancer. Wall-eyed bilateral internuclear ophthalmoplegia, a new immune related adverse event.
Primary vaginal cancer is a rare malignancy with a lack of international guidelines and supporting clinical trial evidence to guide decision making. Historical results have shown poor outcomes with chemotherapy for stage IVB vaginal squamous cell carcinoma (SCC). The evolving role of checkpoint inhibitors in rare gynaecological cancers prompted us to investigate the role of pembrolizumab in this setting. The efficacy of pembrolizumab in vaginal SCC has never been investigated in any clinical trial. There is established data to support the use of concurrent chemoradiotherapy in gynaecological cancers, however, the data for concurrent use of immunotherapy and radiotherapy is still lacking but is the subject of several clinical trials. We herein present the first reported case of chemotherapy refractory vaginal SCC with complete response to pembrolizumab and concurrent pelvic radiotherapy. We also present wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) as a rare but new immune related adverse event.
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Affiliation(s)
- Jawaher Ansari
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Saad Ghazal-Aswad
- Department of Gynaecology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hidayath Ansari
- Department of Radiology and Nuclear Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Syed M J Akhter
- Department of Pathology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Omar Hassoun Hadid
- Department of Ophthalmology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Syed Rizwan
- Department of Radiology and Nuclear Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Raya Almazrouei
- Department of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Emad Dawoud
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Fathi Azribi
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Heba Elhasin
- Department of Neurology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Pawan Kumar
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Khaled Al-Qawasmeh
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - John Glaholm
- Institute of Cancer Research, London SM2 5NG, United Kingdom
| | - M J Hochmair
- Department of Respiratory & Critical Care Medicine, Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Krankenhaus Nord, 3500 Vienna, Austria
| | - Syed Hussain
- Department of oncology and metabolism, Room 228, 2nd Floor, Broomcross Building, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, United Kingdom
| | - Khalid Balaraj
- Department of Radiation Oncology, Tawam Hospital, Al Ain, United Arab Emirates
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Popat S, Jung HA, Lee SY, Hochmair MJ, Lee SH, Escriu C, Lee MK, Migliorino MR, Lee YC, Girard N, Daoud H, Märten A, Miura S. Sequential afatinib and osimertinib in patients with EGFR mutation-positive NSCLC and acquired T790M: A global non-interventional study (UpSwinG). Lung Cancer 2021; 162:9-15. [PMID: 34649106 DOI: 10.1016/j.lungcan.2021.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are standard of care for EGFR mutation-positive non-small cell lung cancer (NSCLC). However, optimal sequence of treatment has yet to be defined. Overall survival (OS) is influenced by the availability/use of subsequent therapy after first-line treatment. Emergence of T790M is the main mechanism of resistance to afatinib and second-line osimertinib could be a treatment option in this instance. METHODS In this non-interventional, global study (NCT04179890), existing medical/electronic records were identified for consecutive EGFR TKI-naïve patients with EGFR mutation-positive NSCLC (Del19 or L858R) treated with first-line afatinib and second-line osimertinib in regular clinical practice (n = 191; all T790M-positive). The primary objective was time to treatment failure (TTF). Key secondary objectives were OS and objective response rate (ORR). RESULTS At the start of afatinib treatment, median age (range) was 62 years (34-88). Fifty-five percent of patients were female and 67% were Asian. ECOG PS (0/1/≥2) was 31%/57%/12%. Fourteen percent of patients had brain metastases. At the start of osimertinib treatment, ECOG PS (0/1/≥2) was 25%/61%/14% and 14% had brain metastases (rising to 29% at the end of osimertinib treatment). The source of biopsy material (solid/liquid) was 86%/3% at the start of afatinib and 54%/33% at start of osimertinib. Mutations were mainly detected with PCR methods. Overall, median TTF was 27.7 months (95% CI: 24.0-30.2) and median OS was 36.5 months (95% CI: 32.9-41.8). ORR with afatinib and osimertinib was 74% and 45%. TTF, OS and ORR were generally consistent across subgroups. CONCLUSION Sequential afatinib and osimertinib demonstrated encouraging activity in patients with EGFR mutation-positive NSCLC and acquired T790M. Activity was observed across all subgroups, including patients with poor ECOG PS or brain metastases. ECOG PS and incidence of brain metastases remained stable prior to, and after, afatinib treatment.
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Affiliation(s)
- Sanjay Popat
- Lung Unit, Royal Marsden National Health Service Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom.
| | - Hyun Ae Jung
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Shin Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
| | - Maximilian J Hochmair
- Department of Respiratory & Critical Care Medicine, Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria.
| | - Seung Hyeun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Dongdaemun-gu, Seoul, South Korea.
| | - Carles Escriu
- The Clatterbridge Cancer Centre, Bebington, Wirral, United Kingdom.
| | - Min Ki Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea.
| | | | - Yong Chul Lee
- Department of Internal Medicine, Research Center for Pulmonary Disease, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, South Korea.
| | - Nicolas Girard
- Institut Curie, Institut du Thorax Curie-Montsouris, Paris, France and UVSQ, Paris Saclay, Saint Aubin, France.
| | - Hasan Daoud
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.
| | - Angela Märten
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany.
| | - Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan.
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Camidge DR, Kim HR, Ahn MJ, Yang JCH, Han JY, Hochmair MJ, Lee KH, Delmonte A, Garcia Campelo MR, Kim DW, Griesinger F, Felip E, Califano R, Spira AI, Gettinger SN, Tiseo M, Lin HM, Liu Y, Vranceanu F, Niu H, Zhang P, Popat S. Brigatinib Versus Crizotinib in ALK Inhibitor-Naive Advanced ALK-Positive NSCLC: Final Results of Phase 3 ALTA-1L Trial. J Thorac Oncol 2021; 16:2091-2108. [PMID: 34537440 DOI: 10.1016/j.jtho.2021.07.035] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [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: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In the phase 3 study entitled ALK in Lung cancer Trial of brigAtinib in 1st Line (ALTA-1L), which is a study of brigatinib in ALK inhibitor-naive advanced ALK-positive NSCLC, brigatinib exhibited superior progression-free survival (PFS) versus crizotinib in the two planned interim analyses. Here, we report the final efficacy, safety, and exploratory results. METHODS Patients were randomized to brigatinib 180 mg once daily (7-d lead-in at 90 mg once daily) or crizotinib 250 mg twice daily. The primary end point was a blinded independent review committee-assessed PFS. Genetic alterations in plasma cell-free DNA were assessed in relation to clinical efficacy. RESULTS A total of 275 patients were enrolled (brigatinib, n = 137; crizotinib, n = 138). At study end, (brigatinib median follow-up = 40.4 mo), the 3-year PFS by blinded independent review committee was 43% (brigatinib) versus 19% (crizotinib; median = 24.0 versus 11.1 mo, hazard ratio [HR] = 0.48, 95% confidence interval [CI]: 0.35-0.66). The median overall survival was not reached in either group (HR = 0.81, 95% CI: 0.53-1.22). Posthoc analyses suggested an overall survival benefit for brigatinib in patients with baseline brain metastases (HR = 0.43, 95% CI: 0.21-0.89). Detectable baseline EML4-ALK fusion variant 3 and TP53 mutation in plasma were associated with poor PFS. Brigatinib exhibited superior efficacy compared with crizotinib regardless of EML4-ALK variant and TP53 mutation. Emerging secondary ALK mutations were rare in patients progressing on brigatinib. No new safety signals were observed. CONCLUSIONS In the ALTA-1L final analysis, with longer follow-up, brigatinib continued to exhibit superior efficacy and tolerability versus crizotinib in patients with or without poor prognostic biomarkers. The suggested survival benefit with brigatinib in patients with brain metastases warrants future study.
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Affiliation(s)
- D Ross Camidge
- Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado.
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Seoul, South Korea
| | - James C H Yang
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ji-Youn Han
- Department of Precision Medicine, National Cancer Center, Gyeonggi, South Korea
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Ki Hyeong Lee
- Internal Medicine Department, Chungbuk National University Hospital, Chungbuk, South Korea
| | - Angelo Delmonte
- Department of Medical Oncology, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Meldola, Italy
| | - Maria Rosario Garcia Campelo
- Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña (CHUAC), University Hospital A Coruña, A Coruña, Spain
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Enriqueta Felip
- Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Medical Oncology, Division of Cancer Sciences, The University of Manchester, Manchester, England, United Kingdom
| | - Alexander I Spira
- Department of Medical Oncology, Virginia Cancer Specialists, US Oncology Research, Fairfax, Virginia
| | - Scott N Gettinger
- Department of Medical Oncology, Yale Cancer Center, New Haven, Connecticut
| | - Marcello Tiseo
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Huamao M Lin
- Global Evidence and Outcome, Millennium Pharmaceuticals, Inc., a wholly-owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Yuyin Liu
- Oncology Statistics, Millennium Pharmaceuticals, Inc., a wholly-owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Florin Vranceanu
- Clinical Science, Millennium Pharmaceuticals, Inc., a wholly-owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Huifeng Niu
- Oncology Translational Sciences, Millennium Pharmaceuticals, Inc., a wholly-owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Pingkuan Zhang
- Oncology Clinical Research, Millennium Pharmaceuticals, Inc., a wholly-owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
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Saito H, Goldman JW, Garassino MC, Chen Y, Reinmuth N, Hotta K, Poltoratskiy A, Trukhin D, Hochmair MJ, Özgüroğlu M, Ji JH, Statsenko G, Voitko O, Conev NV, Bondarenko I, Spencer S, Xie M, Jones S, Franks A, Shrestha Y, Paz-Ares L. O11-5 Durvalumab(D) ± tremelimumab(T) + platinum-etoposide(EP) in 1L ES-SCLC: Characterization of long-term benefit in CASPIAN. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
The GioTag study assessed how drugs called afatinib and osimertinib affected people with non-small cell lung cancer (NSCLC) who had mutations in the epidermal growth factor receptor (EGFR) gene. Resistance mutations in our genes can lead to resistance to specific treatments, meaning that drugs no longer work. Patients in the current study all initially received afatinib treatment before they developed a certain resistance mutation in the EGFR gene, called T790M. Patients then started osimertinib treatment. The study aimed to identify for how long patients received treatment and for how long patients survived after their first dose of afatinib. Overall, 204 patients were included. Median overall time on treatment (afatinib and osimertinib) was 27.7 months. Median overall survival was 37.6 months. This study showed that afatinib followed by osimertinib treatment was effective in patients with NSCLC with EGFR mutations developing T790M resistance mutations on initial afatinib treatment. To read the full Plain Language Summary of this article, click on the View Article button above and download the PDF.
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Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory & Critical Care Medicine, Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria
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26
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Buder A, Heitzer E, Waldispühl-Geigl J, Weber S, Moser T, Hochmair MJ, Hackner K, Errhalt P, Setinek U, Filipits M. Somatic Copy-Number Alterations in Plasma Circulating Tumor DNA from Advanced EGFR-Mutated Lung Adenocarcinoma Patients. Biomolecules 2021; 11:biom11050618. [PMID: 33919291 PMCID: PMC8143372 DOI: 10.3390/biom11050618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/08/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background: To assess the clinical relevance of genome-wide somatic copy-number alterations (SCNAs) in plasma circulating tumor DNA (ctDNA) from advanced epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma patients. Methods: We included 43 patients with advanced EGFR T790M-positive lung adenocarcinoma who were treated with osimertinib after progression under previous EGFR-TKI therapy. We performed genomic profiling of ctDNA in plasma samples from each patient obtained pre-osimertinib and after patients developed resistance to osimertinib. SCNAs were detected by shallow whole-genome plasma sequencing and EGFR mutations were assessed by droplet digital PCR. Results: SCNAs in resistance-related genes (rrSCNAs) were detected in 10 out of 31 (32%) evaluable patients before start of osimertinib. The presence of rrSCNAs in plasma before the initiation of osimertinib therapy was associated with a lower response rate to osimertinib (50% versus 81%, p = 0.08) and was an independent predictor for shorter progression-free survival (adjusted HR 3.33, 95% CI 1.37–8.10, p = 0.008) and overall survival (adjusted HR 2.54, 95% CI 1.09–5.92, p = 0.03). Conclusions: Genomic profiling of plasma ctDNA is clinically relevant and affects the efficacy and clinical outcome of osimertinib. Our approach enables the comprehensive assessment of SCNAs in plasma samples of lung adenocarcinoma patients and may help to guide genotype-specific therapeutic strategies in the future.
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Affiliation(s)
- Anna Buder
- Comprehensive Cancer Center, Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Ellen Heitzer
- Diagnostic and Research Center for Molecular BioMedicine, Institute of Human Genetics, Medical University of Graz, 8036 Graz, Austria; (E.H.); (J.W.-G.); (S.W.); (T.M.)
- Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, 8036 Graz, Austria
| | - Julie Waldispühl-Geigl
- Diagnostic and Research Center for Molecular BioMedicine, Institute of Human Genetics, Medical University of Graz, 8036 Graz, Austria; (E.H.); (J.W.-G.); (S.W.); (T.M.)
| | - Sabrina Weber
- Diagnostic and Research Center for Molecular BioMedicine, Institute of Human Genetics, Medical University of Graz, 8036 Graz, Austria; (E.H.); (J.W.-G.); (S.W.); (T.M.)
- Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, 8036 Graz, Austria
| | - Tina Moser
- Diagnostic and Research Center for Molecular BioMedicine, Institute of Human Genetics, Medical University of Graz, 8036 Graz, Austria; (E.H.); (J.W.-G.); (S.W.); (T.M.)
- Christian Doppler Laboratory for Liquid Biopsies for Early Detection of Cancer, 8036 Graz, Austria
| | - Maximilian J. Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Department of Respiratory and Critical Care Medicine, Hospital North, 1210 Vienna, Austria;
| | - Klaus Hackner
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria; (K.H.); (P.E.)
| | - Peter Errhalt
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria; (K.H.); (P.E.)
| | - Ulrike Setinek
- Department of Pathology and Bacteriology, Otto Wagner Hospital, 1140 Vienna, Austria;
| | - Martin Filipits
- Comprehensive Cancer Center, Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40160-57528
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Cho A, Kranawetter B, Untersteiner H, Khalaveh F, Dorfer C, Rössler K, Zöchbauer-Müller S, Gatterbauer B, Hochmair MJ, Frischer JM. Neutrophil-to-Lymphocyte Ratio Is Superior to Other Leukocyte-Based Ratios as a Prognostic Predictor in Non-Small Cell Lung Cancer Patients with Radiosurgically Treated Brain Metastases Under Immunotherapy or Targeted Therapy. World Neurosurg 2021; 151:e324-e331. [PMID: 33878466 DOI: 10.1016/j.wneu.2021.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate predictive value of preradiosurgery leukocyte-based prognostic ratios in a selected cohort of non-small cell lung cancer (NSCLC) patients with radiosurgery-treated brain metastases (BM) and concomitant immunotherapy (IT) or targeted therapy (TT). METHODS We performed a retrospective analysis of 166 patients with NSCLC BM treated with Gamma Knife radiosurgery. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio were assessed within 14 days before radiosurgery. RESULTS In radiosurgically treated patients with NSCLC BM with concomitant IT or TT, estimated median survival after first Gamma Knife radiosurgery treatment was significantly longer in patients with NLR cutoff value <5 (P = 0.038). Consequently, the Cox regression model for NLR cutoff value groups revealed a significant hazard ratio of 1.519 (95% confidence interval 1.020-2.265, P = 0.040). In addition, each increase in NLR of 1 equaled an increase of 5.4% in risk of death (hazard ratio 1.054, 95% confidence interval 1.024-1.085, P < 0.001). After adjusting for sex, age, Karnofsky performance scale, and presence of extracranial metastases, NLR remained a significant and independent predictor for survival (hazard ratio 1.047, 95% confidence interval 1.017-1.078, P = 0.002). In contrast, platelet-to-lymphocyte ratio and lymphocyte-to-monocyte ratio did not exhibit the same predictive value among patients with radiosurgery-treated BM with concomitant IT or TT. CONCLUSIONS In patients with NSCLC BM treated with radiosurgery with concomitant IT or TT, preradiosurgery NLR represents a simple prognostic predictor for survival and is superior to other leukocyte-based ratios. NLR may be relevant for clinical decision making, therapeutic evaluation, patient counseling, and appropriate stratification of future clinical trials among patients with radiosurgery-treated BM.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Beate Kranawetter
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | | | - Farjad Khalaveh
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Sabine Zöchbauer-Müller
- Division of Oncology, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | | | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna North Hospital, Vienna, Austria
| | - Josa M Frischer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria.
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Hackner K, Buder A, Hochmair MJ, Strieder M, Grech C, Fabikan H, Burghuber OC, Errhalt P, Filipits M. Detection of EGFR Activating and Resistance Mutations by Droplet Digital PCR in Sputum of EGFR-Mutated NSCLC Patients. Clin Med Insights Oncol 2021; 15:1179554921993072. [PMID: 33642890 PMCID: PMC7894584 DOI: 10.1177/1179554921993072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Background Proof of the T790M resistance mutation is mandatory if patients with EGFR-mutated non-small cell lung cancer (NSCLC) progress under first- or second-generation tyrosine kinase inhibitor therapy. In addition to rebiopsy, analysis of plasma circulating tumor DNA is used to detect T790M resistance mutation. We studied whether sputum is another feasible specimen for detection of EGFR mutations. Methods Twenty-eight patients with advanced EGFR-mutated NSCLC were included during stable and/or progressive disease. The initial activating EGFR mutations (exon 19 deletions or L858R mutations) at stable disease and at progressive disease (together with T790M) were assessed in simultaneously collected plasma and sputum samples and detected by droplet digital polymerase chain reaction (ddPCR). Results Activating EGFR mutations were detected in 47% of the plasma samples and 41% of sputum samples during stable disease, and in 57% of plasma samples and 64% of sputum samples during progressive disease. T790M was detected in 44% of the plasma samples and 66% of the sputum samples at progressive disease. In ddPCR T790M-negative results for both specimens (plasma and sputum), negativity was confirmed by rebiopsy in 5 samples. Concordance rate of plasma and sputum for T790M was 0.86, with a positive percent agreement of 1.0 and a negative percent agreement of 0.80. Conclusions We demonstrated that EGFR mutation analysis with ddPCR is feasible in sputum samples. Combination of plasma and sputum analyses for detection of T790M in NSCLC patients with progressive disease increases the diagnostic yield compared with molecular plasma analysis alone.
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Affiliation(s)
- Klaus Hackner
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Matthaeus Strieder
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Christina Grech
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Hannah Fabikan
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University Medical School, Vienna, Austria
| | - Peter Errhalt
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Cho A, Untersteiner H, Hirschmann D, Shaltout A, Göbl P, Dorfer C, Rössler K, Marik W, Kirchbacher K, Kapfhammer I, Zöchbauer-Müller S, Gatterbauer B, Hochmair MJ, Frischer JM. Gamma Knife Radiosurgery for Brain Metastases in Non-Small Cell Lung Cancer Patients Treated with Immunotherapy or Targeted Therapy. Cancers (Basel) 2020; 12:cancers12123668. [PMID: 33297416 PMCID: PMC7762317 DOI: 10.3390/cancers12123668] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/03/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 12/28/2022] Open
Abstract
Simple Summary In non-small cell lung cancer patients with brain metastases, combined Gamma Knife radiosurgery and immunotherapy or targeted therapy showed an increase in overall survival. The combination of Gamma Knife radiosurgery and immunotherapy or targeted therapy did not increase complications related to radiosurgery. Therefore, the combined treatment seems to be a safe and powerful treatment option for non-small cell lung cancer patients with brain metastases. Abstract The combination of Gamma Knife radiosurgery (GKRS) and systemic immunotherapy (IT) or targeted therapy (TT) is a novel treatment method for brain metastases (BMs) in non-small cell lung cancer (NSCLC). To elucidate the safety and efficacy of concomitant IT or TT on the outcome after GKRS, 496 NSCLC patients with BMs, who were treated with GKRS were retrospectively reviewed. The median time between the initial lung cancer diagnosis and the diagnosis of brain metastases was one month. The survival after the initial BM diagnosis was significantly longer than the survival predicted by prognostic BM scores. After the first Gamma Knife radiosurgery treatment (GKRS1), the estimated median survival was 9.9 months (95% CI = 8.3–11.4). Patients with concurrent IT or TT presented with a significantly longer survival after GKRS1 than patients without IT or TT (p < 0.001). These significant differences in the survival were also apparent among the four treatment groups and remained significant after adjustment for Karnofsky performance status scale (KPS), recursive partitioning analysis (RPA) class, sex, and multiple BMs. About half of all our patients (46%) developed new distant BMs after GKRS1. Of note, no statistically significant differences in the occurrence of radiation reaction, radiation necrosis, or intralesional hemorrhage in association with IT or TT at or after GKRS1 were observed. In NSCLC-BM patients, the concomitant use of GKRS and IT or TT showed an increase in overall survival without increased complications related to GKRS. Therefore, the combined treatment with GKRS and IT or TT seems to be a safe and powerful treatment option and emphasizes the role of radiosurgery in modern BM treatment.
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Affiliation(s)
- Anna Cho
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Helena Untersteiner
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Dorian Hirschmann
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Abdallah Shaltout
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Philipp Göbl
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Karl Rössler
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Wolfgang Marik
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, 1090 Vienna, Austria;
| | | | | | - Sabine Zöchbauer-Müller
- Department of Internal Medicine I, Division of Oncology, Medical University Vienna, 1090 Vienna, Austria;
| | - Brigitte Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna North Hospital, 1210 Vienna, Austria;
| | - Josa M. Frischer
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria; (A.C.); (H.U.); (D.H.); (A.S.); (P.G.); (C.D.); (K.R.); (B.G.)
- Correspondence: ; Tel.: +43-1-40400-45510
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Goldman JW, Dvorkin M, Chen Y, Reinmuth N, Hotta K, Trukhin D, Statsenko G, Hochmair MJ, Özgüroğlu M, Ji JH, Garassino MC, Voitko O, Poltoratskiy A, Ponce S, Verderame F, Havel L, Bondarenko I, Każarnowicz A, Losonczy G, Conev NV, Armstrong J, Byrne N, Thiyagarajah P, Jiang H, Paz-Ares L. Durvalumab, with or without tremelimumab, plus platinum-etoposide versus platinum-etoposide alone in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): updated results from a randomised, controlled, open-label, phase 3 trial. Lancet Oncol 2020; 22:51-65. [PMID: 33285097 DOI: 10.1016/s1470-2045(20)30539-8] [Citation(s) in RCA: 297] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND First-line durvalumab plus etoposide with either cisplatin or carboplatin (platinum-etoposide) showed a significant improvement in overall survival versus platinum-etoposide alone in patients with extensive-stage small-cell lung cancer (ES-SCLC) in the CASPIAN study. Here we report updated results, including the primary analysis for overall survival with durvalumab plus tremelimumab plus platinum-etoposide versus platinum-etoposide alone. METHODS CASPIAN is an ongoing, open-label, sponsor-blind, randomised, controlled phase 3 trial at 209 cancer treatment centres in 23 countries worldwide. Eligible patients were aged 18 years or older (20 years in Japan) and had treatment-naive, histologically or cytologically documented ES-SCLC, with a WHO performance status of 0 or 1. Patients were randomly assigned (1:1:1) in blocks of six, stratified by planned platinum, using an interactive voice-response or web-response system to receive intravenous durvalumab plus tremelimumab plus platinum-etoposide, durvalumab plus platinum-etoposide, or platinum-etoposide alone. In all groups, patients received etoposide 80-100 mg/m2 on days 1-3 of each cycle with investigator's choice of either carboplatin area under the curve 5-6 mg/mL/min or cisplatin 75-80 mg/m2 on day 1 of each cycle. Patients in the platinum-etoposide group received up to six cycles of platinum-etoposide every 3 weeks and optional prophylactic cranial irradiation (investigator's discretion). Patients in the immunotherapy groups received four cycles of platinum-etoposide plus durvalumab 1500 mg with or without tremelimumab 75 mg every 3 weeks followed by maintenance durvalumab 1500 mg every 4 weeks. The two primary endpoints were overall survival for durvalumab plus platinum-etoposide versus platinum-etoposide and for durvalumab plus tremelimumab plus platinum-etoposide versus platinum-etoposide in the intention-to-treat population. Safety was assessed in all patients who received at least one dose of study treatment. This study is registered at ClinicalTrials.gov, NCT03043872. FINDINGS Between March 27, 2017, and May 29, 2018, 972 patients were screened and 805 were randomly assigned (268 to durvalumab plus tremelimumab plus platinum-etoposide, 268 to durvalumab plus platinum-etoposide, and 269 to platinum-etoposide). As of Jan 27, 2020, the median follow-up was 25·1 months (IQR 22·3-27·9). Durvalumab plus tremelimumab plus platinum-etoposide was not associated with a significant improvement in overall survival versus platinum-etoposide (hazard ratio [HR] 0·82 [95% CI 0·68-1·00]; p=0·045); median overall survival was 10·4 months (95% CI 9·6-12·0) versus 10·5 months (9·3-11·2). Durvalumab plus platinum-etoposide showed sustained improvement in overall survival versus platinum-etoposide (HR 0·75 [95% CI 0·62-0·91]; nominal p=0·0032); median overall survival was 12·9 months (95% CI 11·3-14·7) versus 10·5 months (9·3-11·2). The most common any-cause grade 3 or worse adverse events were neutropenia (85 [32%] of 266 patients in the durvalumab plus tremelimumab plus platinum-etoposide group, 64 [24%] of 265 patients in the durvalumab plus platinum-etoposide group, and 88 [33%] of 266 patients in the platinum-etoposide group) and anaemia (34 [13%], 24 [9%], and 48 [18%]). Any-cause serious adverse events were reported in 121 (45%) patients in the durvalumab plus tremelimumab plus platinum-etoposide group, 85 (32%) in the durvalumab plus platinum-etoposide group, and 97 (36%) in the platinum-etoposide group. Treatment-related deaths occurred in 12 (5%) patients in the durvalumab plus tremelimumab plus platinum-etoposide group (death, febrile neutropenia, and pulmonary embolism [n=2 each]; enterocolitis, general physical health deterioration and multiple organ dysfunction syndrome, pneumonia, pneumonitis and hepatitis, respiratory failure, and sudden death [n=1 each]), six (2%) patients in the durvalumab plus platinum-etoposide group (cardiac arrest, dehydration, hepatotoxicity, interstitial lung disease, pancytopenia, and sepsis [n=1 each]), and two (1%) in the platinum-etoposide group (pancytopenia and thrombocytopenia [n=1 each]). INTERPRETATION First-line durvalumab plus platinum-etoposide showed sustained overall survival improvement versus platinum-etoposide but the addition of tremelimumab to durvalumab plus platinum-etoposide did not significantly improve outcomes versus platinum-etoposide. These results support the use of durvalumab plus platinum-etoposide as a new standard of care for the first-line treatment of ES-SCLC. FUNDING AstraZeneca.
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Affiliation(s)
- Jonathan W Goldman
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Mikhail Dvorkin
- BHI of Omsk Region Clinical Oncology Dispensary, Omsk, Russia
| | - Yuanbin Chen
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI, USA
| | | | | | | | | | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Mustafa Özgüroğlu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Jun Ho Ji
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | | | | | | | - Santiago Ponce
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, H120-CNIO Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain
| | | | - Libor Havel
- Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - György Losonczy
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Nikolay V Conev
- Clinic of Medical Oncology, University Multiprofile Hospital for Active Treatment St Marina, Varna, Bulgaria
| | | | | | | | | | - Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, H120-CNIO Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain.
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Hochmair MJ, Fabikan H, Illini O, Weinlinger C, Setinek U, Krenbek D, Prosch H, Rauter M, Schumacher M, Wöll E, Wass R, Brehm E, Absenger G, Bundalo T, Errhalt P, Urban M, Valipour A. Later-Line Treatment with Lorlatinib in ALK- and ROS1-Rearrangement-Positive NSCLC: A Retrospective, Multicenter Analysis. Pharmaceuticals (Basel) 2020; 13:ph13110371. [PMID: 33171712 PMCID: PMC7694976 DOI: 10.3390/ph13110371] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 09/22/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
In clinical practice, patients with anaplastic lymphoma kinase (ALK)-rearrangement–positive non–small-cell lung cancer commonly receive sequential treatment with ALK tyrosine kinase inhibitors. The third-generation agent lorlatinib has been shown to inhibit a wide range of ALK resistance mutations and thus offers potential benefit in later lines, although real-world data are lacking. This multicenter study retrospectively investigated later-line, real-world use of lorlatinib in patients with advanced ALK- or ROS1-positive lung cancer. Fifty-one patients registered in a compassionate use program in Austria, who received second- or later-line lorlatinib between January 2016 and May 2020, were included in this retrospective real-world data analysis. Median follow-up was 25.3 months. Median time of lorlatinib treatment was 4.4 months for ALK-positive and 12.2 months for ROS-positive patients. ALK-positive patients showed a response rate of 43.2%, while 85.7% percent of the ROS1-positive patients were considered responders. Median overall survival from lorlatinib initiation was 10.2 and 20.0 months for the ALK- and ROS1-positive groups, respectively. In the ALK-positive group, lorlatinib proved efficacy after both brigatinib and alectinib. Lorlatinib treatment was well tolerated. Later-line lorlatinib treatment can induce sustained responses in patients with advanced ALK- and ROS1-positive lung cancer.
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Affiliation(s)
- Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria; (H.F.); (O.I.); (C.W.); (A.V.)
- Correspondence: ; Tel.: +43-1-27700-72212
| | - Hannah Fabikan
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria; (H.F.); (O.I.); (C.W.); (A.V.)
| | - Oliver Illini
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria; (H.F.); (O.I.); (C.W.); (A.V.)
| | - Christoph Weinlinger
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria; (H.F.); (O.I.); (C.W.); (A.V.)
| | - Ulrike Setinek
- Institute of Pathology and Clinical Microbiology, Wilhelminenspital, Montleartstrasse 37, 1160 Vienna, Austria; (U.S.); (D.K.)
| | - Dagmar Krenbek
- Institute of Pathology and Clinical Microbiology, Wilhelminenspital, Montleartstrasse 37, 1160 Vienna, Austria; (U.S.); (D.K.)
- Department of Pathology and Bacteriology, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währingergürtel 18–22, 1090 Vienna, Austria;
| | - Markus Rauter
- Clinic of Pneumology, Klinikum Klagenfurt am Wörthersee, Feschnigstrasse 11, 9020 Klagenfurt am Wörthersee, Austria;
| | - Michael Schumacher
- Ordensklinikum Linz Elisabethinen, Fadingerstrasse 1, 4020 Linz, Austria;
| | - Ewald Wöll
- St. Vinzenz Krankenhaus Betriebs GmbH, Klostergasse 10, 6511 Zams, Austria;
| | - Romana Wass
- Department of Pneumology, Johannes Kepler University Linz, Krankenhausstrasse 26–30/Med Campus IV, 4020 Linz, Austria; (E.B.); (R.W.)
- Department of Pneumology, Paracelsus Medical University, SALK, Müllner Hauptstrasse 46, 5020 Salzburg, Austria
| | - Elmar Brehm
- Department of Pneumology, Johannes Kepler University Linz, Krankenhausstrasse 26–30/Med Campus IV, 4020 Linz, Austria; (E.B.); (R.W.)
| | - Gudrun Absenger
- Department of Oncology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria;
| | - Tatjana Bundalo
- Landesklinikum Hochegg, Hocheggerstrasse 88, 2840 Hochegg, Austria;
| | - Peter Errhalt
- Clinical Department of Pneumology, University Hospital Krems, Mitterweg 10, 3500 Krems, Austria;
| | - Matthias Urban
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria;
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Brünner Strasse 68, 1210 Vienna, Austria; (H.F.); (O.I.); (C.W.); (A.V.)
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Goldman JW, Garassino MC, Chen Y, Özgüroğlu M, Dvorkin M, Trukhin D, Statsenko G, Hotta K, Ji JH, Hochmair MJ, Voitko O, Havel L, Poltoratskiy A, Losonczy G, Reinmuth N, Patel N, Laud PJ, Shire N, Jiang H, Paz-Ares L. Patient-reported outcomes with first-line durvalumab plus platinum-etoposide versus platinum-etoposide in extensive-stage small-cell lung cancer (CASPIAN): a randomized, controlled, open-label, phase III study. Lung Cancer 2020; 149:46-52. [PMID: 32961445 DOI: 10.1016/j.lungcan.2020.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/20/2020] [Revised: 09/04/2020] [Accepted: 09/06/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES In the phase III CASPIAN study, first-line durvalumab plus etoposide in combination with either cisplatin or carboplatin (EP) significantly improved overall survival (primary endpoint) versus EP alone in patients with extensive-stage small-cell lung cancer (ES-SCLC) at the interim analysis. Here we report patient-reported outcomes (PROs). MATERIALS AND METHODS Treatment-naïve patients with ES-SCLC received 4 cycles of durvalumab plus EP every 3 weeks followed by maintenance durvalumab every 4 weeks until progression, or up to 6 cycles of EP every 3 weeks. PROs, assessed with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) version 3 and its lung cancer module, the Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13), were prespecified secondary endpoints. Changes from baseline to disease progression or 12 months in prespecified key disease-related symptoms (cough, dyspnea, chest pain, fatigue, appetite loss) were analyzed with a mixed model for repeated measures. Time to deterioration (TTD) of symptoms, functioning, and global health status/quality of life (QoL) from randomization was analyzed. RESULTS In the durvalumab plus EP and EP arms, 261 and 260 patients were PRO-evaluable. Patients in both arms experienced numerically reduced symptom burden over 12 months or until progression for key symptoms. For the improvements from baseline in appetite loss, the between-arm difference was statistically significant, favoring durvalumab plus EP (difference, -4.5; 99% CI: -9.04, -0.04; nominal p = 0.009). Patients experienced longer TTD with durvalumab plus EP versus EP for all symptoms (hazard ratio [95% CI] for key symptoms: cough 0.78 [0.600‒1.026]; dyspnea 0.79 [0.625‒1.006]; chest pain 0.76 [0.575‒0.996]; fatigue 0.82 [0.653‒1.027]; appetite loss 0.70 [0.542‒0.899]), functioning, and global health status/QoL. CONCLUSION Addition of durvalumab to first-line EP maintained QoL and delayed worsening of patient-reported symptoms, functioning, and global health status/QoL compared with EP.
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Affiliation(s)
| | | | - Yuanbin Chen
- Cancer & Hematology Centers of Western Michigan, Grand Rapids, MI, USA
| | - Mustafa Özgüroğlu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Mikhail Dvorkin
- BHI of Omsk Region Clinical Oncology Dispensary, Omsk, Russia
| | | | | | | | - Jun Ho Ji
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | | | - Libor Havel
- Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Artem Poltoratskiy
- Petrov Research Institute of Oncology, St Petersburg, Russian Federation
| | | | | | | | - Peter J Laud
- Statistical Services Unit, University of Sheffield, Sheffield, UK
| | | | | | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, H120-CNIO Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain
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Hochmair MJ, Morabito A, Hao D, Yang CT, Soo RA, Yang JCH, Gucalp R, Halmos B, Märten A, Cufer T. Sequential afatinib and osimertinib in patients with EGFR mutation-positive non-small-cell lung cancer: final analysis of the GioTag study. Future Oncol 2020; 16:2799-2808. [PMID: 32854536 DOI: 10.2217/fon-2020-0740] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: Final overall survival (OS) and time on treatment analysis of patients with EGFR mutation-positive non-small-cell lung cancer (NSCLC) who received sequential afatinib and osimertinib. Patients & methods: Patients (n = 203) had T790M-positive disease following first-line afatinib and started osimertinib treatment ≥10 months before data entry. Primary outcome was time on treatment; OS analysis was exploratory. Results: Median time on treatment with afatinib and osimertinib was 27.7 months (90% CI: 26.7-29.9). Median OS was 37.6 months (90% CI: 35.5-41.3); median OS was 41.6 and 44.8 months in Del19-positive patients and Asian patients, respectively. Conclusion: In real-world clinical practice, sequential afatinib and osimertinib was associated with encouraging outcomes in patients with EGFR mutation-positive NSCLC, especially in Del19-positive patients and Asian patients. Clinical Trial Registration: NCT03370770 (ClinicalTrials.gov).
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Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory & Critical Care Medicine, Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Krankenhaus Nord, 3500 Vienna, Austria
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, 80131 Napoli, Italy
| | - Desiree Hao
- Tom Baker Cancer Center, Cummings School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, 333 Taoyuan, Taiwan
| | - Ross A Soo
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - James C-H Yang
- Department of Oncology, National Taiwan University Hospital & National Taiwan University Cancer Center, Taipei, Taiwan
| | - Rasim Gucalp
- Department of Oncology, Montefiore/Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Balazs Halmos
- Department of Oncology, Montefiore/Albert Einstein Cancer Center, Bronx, NY 10461, USA
| | - Angela Märten
- Boehringer Ingelheim International GmbH, 55216 Ingelheim am Rhein, Germany
| | - Tanja Cufer
- University Clinic Golnik, University of Ljubljana, 4204 Ljubljana, Slovenia
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Camidge DR, Kim HR, Ahn MJ, Yang JCH, Han JY, Hochmair MJ, Lee KH, Delmonte A, García Campelo MR, Kim DW, Griesinger F, Felip E, Califano R, Spira A, Gettinger SN, Tiseo M, Lin HM, Gupta N, Hanley MJ, Ni Q, Zhang P, Popat S. Brigatinib Versus Crizotinib in Advanced ALK Inhibitor-Naive ALK-Positive Non-Small Cell Lung Cancer: Second Interim Analysis of the Phase III ALTA-1L Trial. J Clin Oncol 2020; 38:3592-3603. [PMID: 32780660 PMCID: PMC7605398 DOI: 10.1200/jco.20.00505] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Brigatinib, a next-generation anaplastic lymphoma kinase (ALK) inhibitor, demonstrated superior progression-free survival (PFS) and improved health-related quality of life (QoL) versus crizotinib in advanced ALK inhibitor–naive ALK-positive non–small cell lung cancer (NSCLC) at first interim analysis (99 events; median brigatinib follow-up, 11.0 months) in the open-label, phase III ALTA-1L trial (ClinicalTrials.gov identifier: NCT02737501). We report results of the second prespecified interim analysis (150 events).
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Affiliation(s)
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | | | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Ki Hyeong Lee
- Chungbuk National University Hospital, Cheongju, South Korea
| | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), IRCCS, Meldola, Italy
| | | | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Frank Griesinger
- Pius-Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany
| | | | - Raffaele Califano
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Alexander Spira
- Virginia Cancer Specialists and US Oncology Research, The Woodlands, TX
| | | | | | | | | | | | | | | | - Sanjay Popat
- Royal Marsden Hospital, London, United Kingdom.,The Institute of Cancer Research, London, United Kingdom
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Gadgeel S, Rodríguez-Abreu D, Speranza G, Esteban E, Felip E, Dómine M, Hui R, Hochmair MJ, Clingan P, Powell SF, Cheng SYS, Bischoff HG, Peled N, Grossi F, Jennens RR, Reck M, Garon EB, Novello S, Rubio-Viqueira B, Boyer M, Kurata T, Gray JE, Yang J, Bas T, Pietanza MC, Garassino MC. Updated Analysis From KEYNOTE-189: Pembrolizumab or Placebo Plus Pemetrexed and Platinum for Previously Untreated Metastatic Nonsquamous Non–Small-Cell Lung Cancer. J Clin Oncol 2020; 38:1505-1517. [DOI: 10.1200/jco.19.03136] [Citation(s) in RCA: 410] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE In KEYNOTE-189, first-line pembrolizumab plus pemetrexed-platinum significantly improved overall survival (OS) and progression-free survival (PFS) compared with placebo plus pemetrexed-platinum in patients with metastatic nonsquamous non‒small-cell lung cancer (NSCLC), irrespective of tumor programmed death-ligand 1 (PD-L1) expression. We report an updated analysis from KEYNOTE-189 (ClinicalTrials.gov: NCT02578680 ). METHODS Patients were randomly assigned (2:1) to receive pemetrexed and platinum plus pembrolizumab (n = 410) or placebo (n = 206) every 3 weeks for 4 cycles, then pemetrexed maintenance plus pembrolizumab or placebo for up to a total of 35 cycles. Eligible patients with disease progression in the placebo-combination group could cross over to pembrolizumab monotherapy. Response was assessed per RECIST (version 1.1) by central review. No alpha was assigned to this updated analysis. RESULTS As of September 21, 2018 (median follow-up, 23.1 months), the updated median (95% CI) OS was 22.0 (19.5 to 25.2) months in the pembrolizumab-combination group versus 10.7 (8.7 to 13.6) months in the placebo-combination group (hazard ratio [HR], 0.56; 95% CI, 0.45 to 0.70]). Median (95% CI) PFS was 9.0 (8.1 to 9.9) months and 4.9 (4.7 to 5.5) months, respectively (HR, 0.48; 95% CI, 0.40 to 0.58). Median (95% CI) time from randomization to objective tumor progression on next-line treatment or death from any cause, whichever occurred first (progression-free-survival-2; PFS-2) was 17.0 (15.1 to 19.4) months and 9.0 (7.6 to 10.4) months, respectively (HR, 0.49; 95% CI, 0.40 to 0.59). OS and PFS benefits with pembrolizumab were observed regardless of PD-L1 expression or presence of liver/brain metastases. Incidence of grade 3-5 adverse events was similar in the pembrolizumab-combination (71.9%) and placebo-combination (66.8%) groups. CONCLUSION First-line pembrolizumab plus pemetrexed-platinum continued to demonstrate substantially improved OS and PFS in metastatic nonsquamous NSCLC, regardless of PD-L1 expression or liver/brain metastases, with manageable safety and tolerability.
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Affiliation(s)
| | - Delvys Rodríguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Giovanna Speranza
- Centre Integré de Cancérologie de la Montérégie, Hôpital Charles-Le Moyne, Greenfield Park, Quebec, Canada
| | - Emilio Esteban
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Enriqueta Felip
- Vall d’Hebron University, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Manuel Dómine
- Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Rina Hui
- Westmead Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Philip Clingan
- Southern Medical Day Care Centre, Wollongong, New South Wales, Australia
| | | | | | | | - Nir Peled
- Soroka Medical Center, Ben-Gurion University, Beer Sheva, Israel
| | - Francesco Grossi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Edward B. Garon
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Silvia Novello
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria San Luigi, Orbassano, Italy
| | | | - Michael Boyer
- Chris O’Brien Lifehouse, Camperdown, New South Wales, Australia
| | | | | | | | | | | | - Marina C. Garassino
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy
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Lin HM, Pan X, Hou P, Allen S, Baumann P, Hochmair MJ. Real-world treatment duration in ALK-positive non-small-cell lung cancer patients receiving brigatinib through the early access program. Future Oncol 2020; 16:1031-1041. [PMID: 32338548 DOI: 10.2217/fon-2019-0849] [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: 12/24/2022] Open
Abstract
Aim: To assess time-to-treatment discontinuation (TTD) of brigatinib following treatment with ALK tyrosine kinase inhibitor(s) (TKIs) in patients with ALK-positive (ALK+) non-small-cell lung cancer (NSCLC) receiving brigatinib through the international early access program. Patients & analysis: Analysis was performed for patients with ALK+ NSCLC treated with prior ALK TKIs, including next-generation ALK TKIs. Results: Data for 604 patients (21 countries), including patients with prior next-generation ALK TKIs, were reported. The median TTD of brigatinib in patients with prior crizotinib, alectinib, ceritinib or lorlatinib was 10.0, 8.7, 10.3 and 7.5 months, respectively. Conclusion: Brigatinib appears to be effective and tolerable in real-world clinical practice regardless of prior treatment with first or NG ALK TKIs.
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Affiliation(s)
- Huamao M Lin
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | | | - Peijie Hou
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY 10591, USA
| | - Susan Allen
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Pia Baumann
- Millennium Pharmaceuticals, Inc., Cambridge, MA 02139, USA
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Department of Respiratory & Critical Care Medicine, Krankenhaus Nord, Vienna, Austria
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Buder A, Hochmair MJ, Setinek U, Pirker R, Filipits M. EGFR mutation tracking predicts survival in advanced EGFR-mutated non-small cell lung cancer patients treated with osimertinib. Transl Lung Cancer Res 2020; 9:239-245. [PMID: 32420063 PMCID: PMC7225165 DOI: 10.21037/tlcr.2020.03.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Indexed: 12/22/2022]
Abstract
Background Osimertinib has become standard therapy of advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) patients and T790M-mediated resistance. We investigated the clinical utility of EGFR mutation tracking in plasma-based circulating tumor DNA (ctDNA) after start of osimertinib therapy in metastatic, EGFR-mutant NSCLC patients who had progressed on prior therapy with EGFR tyrosine kinase inhibitors (TKIs). Methods We enrolled 141 patients with advanced EGFR-mutated NSCLC who underwent second-line osimertinib treatment for T790M-positive disease. After initiation of osimertinib, we obtained plasma samples from 108 patients. Plasma ctDNA was tested for EGFR mutations by means of droplet digital PCR and was termed positive if any EGFR mutation was detected. Results Plasma ctDNA was detected in 58 of 108 (54%) patients after osimertinib initiation and was associated with poor progression-free survival (PFS) [hazard ratio (HR) 4.26, 95% confidence interval (CI): 2.55–7.10, P<0.0001] and overall survival (OS) (HR 3.23, 95% CI: 1.80–5.78, P<0.0001). In multivariable analysis, ctDNA status remained significantly associated with PFS and OS (HR 4.87, 95% CI: 2.81–8.44, P<0.0001; HR 3.49, 95% CI: 1.88–6.50, P<0.0001). Patients with persistence of activating EGFR mutations within eight weeks had shorter durations of PFS (HR 6.17, 95% CI: 3.03–12.56, P<0.0001) and OS (HR 4.83, 95% CI: 2.25–10.36, P<0.0001) than patients with total clearance of the activating EGFR mutation. Persistence of activating EGFR mutations in plasma ctDNA remained an independent predictor of poor PFS and OS in multivariable analyses. Conclusions Patients with persistence of activating EGFR mutations in plasma ctDNA within eight weeks after osimertinib initiation have worse prognosis and may require the addition of chemotherapy or other treatments in order to achieve better outcome.
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Affiliation(s)
- Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Department of Respiratory and Critical Care Medicine, Hospital North, Vienna, Austria
| | - Ulrike Setinek
- Institute for Pathology and Bacteriology, Otto Wagner Hospital, Vienna, Austria
| | - Robert Pirker
- Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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38
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Garassino MC, Gadgeel S, Esteban E, Felip E, Speranza G, Domine M, Hochmair MJ, Powell S, Cheng SYS, Bischoff HG, Peled N, Reck M, Hui R, Garon EB, Boyer M, Wei Z, Burke T, Pietanza MC, Rodríguez-Abreu D. Patient-reported outcomes following pembrolizumab or placebo plus pemetrexed and platinum in patients with previously untreated, metastatic, non-squamous non-small-cell lung cancer (KEYNOTE-189): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2020; 21:387-397. [PMID: 32035514 DOI: 10.1016/s1470-2045(19)30801-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pembrolizumab plus pemetrexed-platinum led to superior overall survival and progression-free survival, and a higher proportion of patients with a confirmed complete or partial response over placebo plus pemetrexed-platinum in the KEYNOTE-189 study. We aimed to evaluate prespecified exploratory patient-reported outcomes (PROs) in patients in KEYNOTE-189. METHODS In the multicentre, double-blind, randomised, placebo-controlled, phase 3 KEYNOTE-189 study done at 126 cancer centres in 16 countries, eligible patients aged 18 years or older with histologically or cytologically confirmed metastatic non-squamous non-small-cell lung cancer without sensitising EGFR or ALK alterations, measurable disease as per Response Evaluation Criteria in Solid Tumors (version 1.1), and an Eastern Cooperative Oncology Group performance status of 0 or 1 were enrolled. Patients were randomly assigned (2:1) to receive intravenous pembrolizumab (200 mg) or saline placebo every 3 weeks for up to 2 years (35 cycles); all patients received four cycles of intravenous pemetrexed (500 mg/m2) with carboplatin (5 mg/mL per min) or cisplatin (75 mg/m2; investigator's choice) every 3 weeks for four cycles, followed by pemetrexed maintenance therapy every 3 weeks. Permuted block randomisation (block size six) was done with an interactive voice-response system and stratified by PD-L1 expression, choice of platinum, and smoking status. Patients, investigators, and other study personnel were unaware of treatment assignment. The European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (QLQ-C30) and Lung Cancer 13 (QLQ-LC13) were administered at cycles 1-5, every three cycles thereafter during year 1, and every four cycles during years 2-3. The primary endpoints (overall survival and progression-free survival) have been published previously. Key PRO endpoints were change from baseline to week 12 (during chemotherapy) and week 21 (following chemotherapy) in QLQ-C30 global health status/quality of life (GHS/QOL) score, and time to deterioration in cough, chest pain, or dyspnoea. PROs were analysed in all randomly assigned patients who received at least one dose of study medication and who completed at least one PRO assessment, and the results are provided with two-sided, nominal p values. This ongoing study is registered with ClinicalTrials.gov, number NCT02578680. FINDINGS Between Feb 26, 2016, and March 6, 2017, 616 patients were enrolled; median follow-up was 10·5 months (range 0·2-20·4) as of data cutoff on Nov 8, 2017. 402 (99%) of 405 patients in the pembrolizumab plus pemetrexed-platinum group and 200 (99%) of 202 patients in the placebo plus pemetrexed-platinum-treated group completed at least one PRO assessment. At baseline, 359 (89%) of 402 patients in the pembrolizumab plus pemetrexed-platinum group and 180 (90%) of 200 in the placebo plus pemetrexed-platinum group were compliant with QLQ-C30; at week 12, 319 (90%) of 354 and 149 (89%) of 167 patients were compliant, respectively; and at week 21, 249 (76%) of 326 and 91 (64%) of 143 patients were compliant, respectively. From baseline to week 12, GHS/QOL scores were maintained with both pembrolizumab plus pemetrexed-platinum (least-squares mean change: 1·0 point [95% CI -1·3 to 3·2] increase) and placebo plus pemetrexed-platinum (-2·6 points [-5·8 to 0·5] decrease; between-group difference: 3·6 points [-0·1 to 7·2]; p=0·053). From baseline to week 21, GHS/QOL scores were better maintained with pembrolizumab plus pemetrexed-platinum (least-squares mean change: 1·3 points [95% CI -1·2 to 3·6] increase) than with placebo plus pemetrexed-platinum (-4·0 points [-7·7 to -0·3] decrease; between-group difference: 5·3 points [1·1 to 9·5]; p=0·014). Median time to deterioration in cough, chest pain, or dyspnoea was not reached (95% CI 10·2 months to not reached) with pembrolizumab plus pemetrexed-platinum, and was 7·0 months (4·8 months to not reached) with placebo plus pemetrexed-platinum (hazard ratio 0·81 [95% CI 0·60-1·09], p=0·16). INTERPRETATION The addition of pembrolizumab to standard chemotherapy maintained GHS/QOL, with improved GHS/QOL scores at week 21 in the pembrolizumab plus chemotherapy group compared with the placebo plus chemotherapy group. These data further support use of pembrolizumab plus pemetrexed-platinum as first-line therapy for patients with metastatic non-squamous non-small-cell lung cancer. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
| | - Shirish Gadgeel
- Department of Medical Oncology 1, University of Michigan, Ann Arbor, MI, USA
| | - Emilio Esteban
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Enriqueta Felip
- Vall d'Hebron University, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giovanna Speranza
- Centre Intégré de Cancérologie de la Montérégie, Hôpital Charles-Le Moyne, Greenfield Park, QC, Canada
| | - Manuel Domine
- Hospital Universitario Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | | | | | | | - Nir Peled
- Clalit Health Services, Soroka Medical Center, Beer-Sheeva, Israel
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Rina Hui
- Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | | | | | - Delvys Rodríguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Yamamoto N, Mera T, Märten A, Hochmair MJ. Observational Study of Sequential Afatinib and Osimertinib in EGFR Mutation-Positive NSCLC: Patients Treated with a 40-mg Starting Dose of Afatinib. Adv Ther 2020; 37:759-769. [PMID: 31863283 PMCID: PMC7004431 DOI: 10.1007/s12325-019-01187-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Indexed: 12/15/2022]
Abstract
Introduction Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the standard of care for patients with EGFR mutation-positive non-small cell lung cancer (NSCLC). However, questions remain about the optimal treatment sequence of EGFR TKIs. The global, observational GioTag study demonstrated prolonged time on treatment with sequential afatinib and osimertinib therapy in patients who acquired the T790M mutation. Here, we assessed outcomes in patients who received the approved 40-mg starting dose of afatinib, as used in the clinical trial setting. Methods In the non-interventional, global, multicenter GioTag study, patients had T790M-positive disease following first-line afatinib and started osimertinib treatment ≥ 10 months prior to data entry. Primary outcome was time on treatment. This subanalysis assessed outcomes in patients who received afatinib 40 mg. Results In 169 patients who received an afatinib starting dose of 40 mg, median time on treatment was 27.6 months (90% confidence interval [CI] 26.3–31.3). Benefit was seen across patient subgroups, particularly those with Del19-positive disease and Asian patients; median time on treatment was 29.9 months (90% CI 27.6–46.7) in patients with Del19-positive disease and 46.7 months (90% CI 28.4–not reached) in Asian patients. The 2-year overall survival rate was 80%. Conclusions These real-world results support the overall study results and demonstrate prolonged time on treatment with sequential afatinib and osimertinib. The results suggest that sequential afatinib and osimertinib is a feasible therapeutic strategy for patients who acquire the T790M mutation, particularly those with Del19-positive disease or Asian patients. Trial Registration Number NCT03370770. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01187-y) contains supplementary material, which is available to authorized users.
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40
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Buder A, Setinek U, Hochmair MJ, Schwab S, Kirchbacher K, Keck A, Burghuber OC, Pirker R, Filipits M. EGFR Mutations in Cell-free Plasma DNA from Patients with Advanced Lung Adenocarcinoma: Improved Detection by Droplet Digital PCR. Target Oncol 2020; 14:197-203. [PMID: 30810887 PMCID: PMC6453866 DOI: 10.1007/s11523-019-00623-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Analysis of cell-free DNA from blood could provide an alternative method for identifying genomic changes in the tumors of patients with advanced lung adenocarcinoma. Objective We compared the performance of droplet digital PCR (ddPCR) and Cobas® EGFR Mutation Test v2 (Cobas) for detecting EGFR mutations in cell-free plasma DNA. Patients and Methods Plasma samples from patients with advanced EGFR-mutated lung adenocarcinoma were analyzed for EGFR T790M, exon 19 deletions, and L858R mutations by both ddPCR and Cobas. Results T790M testing was performed in 354 plasma samples collected from 129 patients. The concordance rate between ddPCR and Cobas for T790M, sensitivity, and specificity were 86, 100, and 85%, respectively. Exon 19 deletions were analyzed in 196 plasma samples obtained from 71 of the 129 patients using both platforms. The concordance rate between ddPCR and Cobas for exon 19 deletions, sensitivity, and specificity were 90, 92, and 89%, respectively. L858R mutations were studied in 124 plasma samples obtained from 44 of the 129 patients using both assays. The concordance rate between ddPCR and Cobas for L858R, sensitivity, and specificity were 90, 91, and 89%, respectively. In patients who progressed under treatment with an EGFR TKI (n = 50), the T790M positivity rate was 66% using ddPCR, but only 24% using Cobas. Conclusions We observed a high concordance between ddPCR and Cobas in detecting EGFR mutations in plasma samples of patients with advanced EGFR-mutated lung adenocarcinoma, but ddPCR was more sensitive than Cobas.
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Affiliation(s)
- Anna Buder
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria
| | - Ulrike Setinek
- Institute for Pathology and Bacteriology, Otto Wagner Hospital, Vienna, Austria
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Sophia Schwab
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | | | | | - Otto C Burghuber
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital and Sigmund Freud University, Medical School, Vienna, Austria
| | - Robert Pirker
- Division of Oncology, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Borschkegasse 8a, 1090, Vienna, Austria.
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Paz-Ares L, Dvorkin M, Chen Y, Reinmuth N, Hotta K, Trukhin D, Statsenko G, Hochmair MJ, Özgüroğlu M, Ji JH, Voitko O, Poltoratskiy A, Ponce S, Verderame F, Havel L, Bondarenko I, Kazarnowicz A, Losonczy G, Conev NV, Armstrong J, Byrne N, Shire N, Jiang H, Goldman JW. Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet 2019; 394:1929-1939. [PMID: 31590988 DOI: 10.1016/s0140-6736(19)32222-6] [Citation(s) in RCA: 1056] [Impact Index Per Article: 211.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Most patients with small-cell lung cancer (SCLC) have extensive-stage disease at presentation, and prognosis remains poor. Recently, immunotherapy has demonstrated clinical activity in extensive-stage SCLC (ES-SCLC). The CASPIAN trial assessed durvalumab, with or without tremelimumab, in combination with etoposide plus either cisplatin or carboplatin (platinum-etoposide) in treatment-naive patients with ES-SCLC. METHODS This randomised, open-label, phase 3 trial was done at 209 sites across 23 countries. Eligible patients were adults with untreated ES-SCLC, with WHO performance status 0 or 1 and measurable disease as per Response Evaluation Criteria in Solid Tumors, version 1.1. Patients were randomly assigned (in a 1:1:1 ratio) to durvalumab plus platinum-etoposide; durvalumab plus tremelimumab plus platinum-etoposide; or platinum-etoposide alone. All drugs were administered intravenously. Platinum-etoposide consisted of etoposide 80-100 mg/m2 on days 1-3 of each cycle with investigator's choice of either carboplatin area under the curve 5-6 mg/mL per min or cisplatin 75-80 mg/m2 (administered on day 1 of each cycle). Patients received up to four cycles of platinum-etoposide plus durvalumab 1500 mg with or without tremelimumab 75 mg every 3 weeks followed by maintenance durvalumab 1500 mg every 4 weeks in the immunotherapy groups and up to six cycles of platinum-etoposide every 3 weeks plus prophylactic cranial irradiation (investigator's discretion) in the platinum-etoposide group. The primary endpoint was overall survival in the intention-to-treat population. We report results for the durvalumab plus platinum-etoposide group versus the platinum-etoposide group from a planned interim analysis. Safety was assessed in all patients who received at least one dose of their assigned study treatment. This study is registered at ClinicalTrials.gov, NCT03043872, and is ongoing. FINDINGS Patients were enrolled between March 27, 2017, and May 29, 2018. 268 patients were allocated to the durvalumab plus platinum-etoposide group and 269 to the platinum-etoposide group. Durvalumab plus platinum-etoposide was associated with a significant improvement in overall survival, with a hazard ratio of 0·73 (95% CI 0·59-0·91; p=0·0047]); median overall survival was 13·0 months (95% CI 11·5-14·8) in the durvalumab plus platinum-etoposide group versus 10·3 months (9·3-11·2) in the platinum-etoposide group, with 34% (26·9-41·0) versus 25% (18·4-31·6) of patients alive at 18 months. Any-cause adverse events of grade 3 or 4 occurred in 163 (62%) of 265 treated patients in the durvalumab plus platinum-etoposide group and 166 (62%) of 266 in the platinum-etoposide group; adverse events leading to death occurred in 13 (5%) and 15 (6%) patients. INTERPRETATION First-line durvalumab plus platinum-etoposide significantly improved overall survival in patients with ES-SCLC versus a clinically relevant control group. Safety findings were consistent with the known safety profiles of all drugs received. FUNDING AstraZeneca.
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Affiliation(s)
- Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, H120-CNIO Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain.
| | - Mikhail Dvorkin
- BHI of Omsk Region Clinical Oncology Dispensary, Omsk, Russia
| | - Yuanbin Chen
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI, USA
| | | | | | | | | | - Maximilian J Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria
| | - Mustafa Özgüroğlu
- Istanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Jun Ho Ji
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | | | | | - Santiago Ponce
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, H120-CNIO Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain
| | | | - Libor Havel
- Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czechia
| | | | | | | | - Nikolay V Conev
- Clinic of Medical Oncology, UMHAT St Marina, Varna, Bulgaria
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Huber RM, Hansen KH, Paz-Ares Rodríguez L, West HL, Reckamp KL, Leighl NB, Tiseo M, Smit EF, Kim DW, Gettinger SN, Hochmair MJ, Kim SW, Langer CJ, Ahn MJ, Kim ES, Kerstein D, Groen HJM, Camidge DR. Brigatinib in Crizotinib-Refractory ALK+ NSCLC: 2-Year Follow-up on Systemic and Intracranial Outcomes in the Phase 2 ALTA Trial. J Thorac Oncol 2019; 15:404-415. [PMID: 31756496 DOI: 10.1016/j.jtho.2019.11.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [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: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION We report updated data from a phase 2 randomized study evaluating brigatinib in crizotinib-refractory anaplastic lymphoma kinase-positive NSCLC. METHODS Patients were randomized 1:1 to take either oral brigatinib 90 mg once daily (arm A) or 180 mg once daily with a 7-day lead-in at 90 mg (arm B), stratified by central nervous system (CNS) metastases and best response to crizotinib. The primary end point was investigator-assessed confirmed objective response rate per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary end points included independent review committee (IRC)-assessed progression-free survival (PFS), intracranial PFS (iPFS), and overall survival (OS). Exploratory analyses included CNS versus ex-CNS target lesion response and correlation of depth of response with PFS and OS. RESULTS Among 222 randomized patients (112 and 110 in arms A and B, respectively), 59 (27%) remained on brigatinib at analysis (median follow-up: 19.6 versus 24.3 months). At baseline, 71% and 67% had brain lesions among A and B arms, respectively. Investigator-assessed confirmed objective response rate was 46% versus 56%. Median IRC-assessed PFS was 9.2 months (95% confidence interval: 7.4-12.8) versus 16.7 months (11.6-21.4). Median OS was 29.5 months (18.2-not reached) versus 34.1 months (27.7-not reached). IRC-confirmed intracranial objective response rate in patients with measurable baseline brain lesions was 50% (13 of 26) versus 67% (12 of 18); median duration of intracranial response was 9.4 versus 16.6 months. IRC-assessed iPFS was 12.8 versus 18.4 months. Across arms, median IRC-assessed PFS was 1.9, 5.5, 11.1, 16.7, and 15.6 months for patients with no, 1%-25%, 26%-50%, 51%-75%, and 76%-100% target lesion shrinkage, respectively. No new safety findings were observed with longer follow-up. CONCLUSIONS Brigatinib (180 mg once daily with lead-in) continues to demonstrate robust PFS, long iPFS and duration of intracranial response, and high intracranial objective response rate in crizotinib-refractory patients. Depth of response may be an important end point to capture in future targeted therapy trials.
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Affiliation(s)
- Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, University Hospital of Munich, Thoracic Oncology Centre Munich, German Centre for Lung Research, Munich, Bavaria, Germany.
| | - Karin H Hansen
- Department of Clinical Oncology, Odense University Hospital, Odense, Denmark
| | | | - Howard L West
- Thoracic Oncology Program, Swedish Cancer Institute, Seattle, Washington
| | - Karen L Reckamp
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, California
| | - Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna, Austria
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - Corey J Langer
- University of Pennsylvania Abramson Cancer Center, Philadelphia, Pennsylvania
| | - Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - David Kerstein
- Millennium Pharmaceuticals, Inc. (wholly owned subsidiary of Takeda Pharmaceutical Company Limited), Cambridge, Massachusetts
| | - Harry J M Groen
- University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
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Yang JC, Kim HR, Ahn MJ, Han JY, Hochmair MJ, Lee KH, Delmonte A, Campelo MRG, Kim DW, Felip E, Califano R, Spira A, Gettinger S, Tiseo M, Haney J, Kerstein D, Popat S, Camidge D. Brigatinib (BRG) vs Crizotinib (CRZ) in Patients (Pts) With ALK Inhibitor-Naive Advanced ALK+ NSCLC from ALTA-1L. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz339.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hochmair MJ, Morabito A, Hao D, Yang CT, Soo RA, Yang JCH, Gucalp R, Halmos B, Wang L, Märten A, Cufer T. Sequential afatinib and osimertinib in patients with EGFR mutation-positive non-small-cell lung cancer: updated analysis of the observational GioTag study. Future Oncol 2019; 15:2905-2914. [DOI: 10.2217/fon-2019-0346] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Aims: Overall survival (OS) and updated time to treatment failure (TTF) analysis of patients with EGFR mutation-positive (Del19, L858R) non-small-cell lung cancer who received sequential afatinib/osimertinib in the real-world GioTag study. Patients & methods: Patients had T790M-positive disease following first-line afatinib and received osimertinib treatment (n = 203). Primary outcome was TTF. The OS analysis was exploratory. Results: Median OS was 41.3 months (90% CI: 36.8–46.3) overall and 45.7 months (90% CI: 45.3–51.5) in patients with Del19-positive tumors (n = 149); 2-year survival was 80 and 82%, respectively. Updated median TTF with afatinib and osimertinib was 28.1 months (90% CI: 26.8–30.3). Conclusion: Sequential afatinib/osimertinib was associated with encouraging OS/TTF in patients with EGFR T790M-positive non-small-cell lung cancer, especially in patients with Del19-positive tumors. Trial registration number: NCT03370770
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Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory & Critical Care Medicine, & Ludwig Boltzmann Institute of COPD & Respiratory Epidemiology, Otto Wagner Hospital, Sanatoriumstrasse 2, Vienna 1140, Austria
| | - Alessandro Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, ‘Fondazione G Pascale’-IRCCS, 80131 Napoli, Italy
| | - Desiree Hao
- Tom Baker Cancer Center, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ross A Soo
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - James C-H Yang
- Department of Oncology, National Taiwan University Hospital & National Taiwan University Cancer Center, Taipei, Taiwan
| | - Rasim Gucalp
- Department of Oncology, Montefiore/Albert Einstein Cancer Center, Bronx, NY, USA
| | - Balazs Halmos
- Department of Oncology, Montefiore/Albert Einstein Cancer Center, Bronx, NY, USA
| | - Lara Wang
- Boehringer Ingelheim Taiwan Ltd, Taiwan
| | - Angela Märten
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Tanja Cufer
- University Clinic Golnik, University of Ljubljana, Ljubljana, Slovenia
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Abstract
Introduction: Brigatinib is a second-line inhibitor for the treatment of rearranged anaplastic lymphoma kinase (ALK) in lung cancer patients which has significant activity against brain metastases. This tyrosine kinase inhibitor (TKI) overcomes a wide range of ALK mutations which confer therapeutic resistance and is increasingly applied in first-line therapy due to improved benefit for patients compared to crizotinib, the current standard of care. Areas covered: The authors review the development and characteristics of brigatinib and discuss the optimal clinical use and sequence of the application of ALK inhibitors in patients progressing under therapy. Expert opinion: ALK-rearranged NSCLC can be treated with a broad range of approved and novel inhibitors at various stages of therapy, including the second-line therapeutic brigatinib. Besides this TKI, the second-line ALK inhibitors alectinib and ceritinib, as well as the third-line lorlatinib are approved for the treatment of ALK-positive NSCLC patients. The main challenge is to find sequences and combinations of ALK inhibitors which provide the best benefit for the patients.
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Affiliation(s)
- G Hamilton
- Department of Surgery, Medical University of Vienna , Vienna , Austria
| | - M J Hochmair
- Respiratory Oncology Unit, Otto Wagner Hospital , Vienna , Austria
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Garassino MC, Gadgeel S, Esteban E, Felip E, Speranza G, Angelis FD, Domine M, Clingan P, Hochmair MJ, Powell SF, Cheng SYS, Bischoff HG, Peled N, Grossi F, Jennens RR, Reck M, Hui R, Garon EB, Boyer M, Rubio-Viqueira B, Novello S, Kurata T, Gray JE, Cardellino A, Yang J, Pietanza MC, Rodríguez-Abreu D. Abstract CT043: Outcomes among patients (pts) with metastatic nonsquamous NSCLC with liver metastases or brain metastases treated with pembrolizumab (pembro) plus pemetrexed-platinum: Results from the KEYNOTE-189 study. Clin Trials 2019. [DOI: 10.1158/1538-7445.am2019-ct043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gadgeel SM, Garassino MC, Esteban E, Speranza G, Felip E, Hochmair MJ, Powell SF, Cheng SY, Bischoff H, Peled N, Hui R, Reck M, Kurata T, Garon EB, Boyer MJ, Yang J, Pietanza MC, Rodriguez-Abreu D. KEYNOTE-189: Updated OS and progression after the next line of therapy (PFS2) with pembrolizumab (pembro) plus chemo with pemetrexed and platinum vs placebo plus chemo for metastatic nonsquamous NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9013] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9013 Background: Pembro + chemo significantly improved OS and PFS over chemo alone and had manageable safety as 1L therapy for metastatic nonsquamous NSCLC in the KEYNOTE-189 study (NCT02578680). The benefit was observed irrespective of PD-L1 TPS. We present updated OS based on longer follow-up and, for the first time, PFS2. Methods: Eligible pts were randomized 2:1 to pembro (n = 410) or placebo (n = 206) + pemetrexed and carboplatin or cisplatin for 4 cycles followed by pembro or placebo for up to 35 cycles + maintenance pemetrexed. Pts in the chemo arm could crossover to pembro alone upon PD. Poststudy anticancer therapy and outcomes were collected. PFS2 was defined as time from randomization to PD per investigator after start of 2L therapy or death, whichever occurred first. There was no multiplicity adjustment, and all P values are nominal. Data cutoff was 21 Sep 2018. Results: With 18.7-mo median follow-up, pembro + chemo continued to provide longer OS (HR 0.56 [95% CI 0.45-0.70], P < .00001; median 22.0 mo vs 10.7 mo) and PFS (HR 0.48 [95% CI 0.40-0.58], P < .00001). Benefit was seen in all PD-L1 TPS groups (Table). 2L+ therapy was received by 45% in the pembro + chemo arm and 59% (54% 2L+ immunotherapy) in the placebo + chemo arm. PFS2 was longer for 1L pembro + chemo (HR 0.49 [95% CI 0.40-0.59], P < .00001; median 17.0 mo vs 9.0 mo), with no difference by TPS (Table). Conclusions: 1L pembro + pemetrexed/platinum continued to show substantial OS benefit in metastatic nonsquamous NSCLC, regardless of PD-L1 TPS and despite 54% of pts in the placebo + chemo arm receiving subsequent immunotherapy. Median OS, PFS and PFS2 were approximately doubled with pembro + chemo. These data confirm that pembro should be given as part of 1L therapy to maximize outcomes in both PD-L1expressing and PD-L1non-expressing NSCLC. Clinical trial information: NCT02578680. [Table: see text]
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Affiliation(s)
- Shirish M. Gadgeel
- Karmanos Cancer Institute (currently at University of Michigan, Ann Arbor, MI, USA), Detroit, MI
| | | | - Emilio Esteban
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Giovanna Speranza
- Centre integré de cancérologie de la Montérégie, Université de Sherbrooke, Greenfield Park, QC, Canada
| | - Enriqueta Felip
- Vall d’Hebron University, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | | | | | | | - Nir Peled
- Davidoff Cancer Center, Tel Aviv University (currently at Soroka Medical Center, Ben-Gurion University, Beer-Sheeva, Israel), Petah Tikva, Israel
| | - Rina Hui
- Westmead Hospital and the University of Sydney, Sydney, NSW, Australia
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | | | | | | | | | | | - Delvys Rodriguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas De Gran Canaria, Spain
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Ahn MJ, Kim H, Yang JCH, Han JY, Lee JS, Hochmair MJ, Li JYC, Chang GC, Lee KH, Gridelli C, Campelo RG, Delmonte A, Kim DW, Kerstein D, Ni Q, Zhang P, Popat S, Camidge DR. Brigatinib (BRG) versus crizotinib (CRZ) in Asian versus non-Asian patients (pts) in the phase III ALTA-1L trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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
9026 Background: We report an analysis of BRG vs CRZ in Asian vs non-Asian pts with ALK inhibitor–naive, ALK+ NSCLC from ALTA-1L (NCT02737501). Methods: Pts were randomized 1:1 to BRG 180 mg QD (7-day lead-in at 90 mg) or CRZ 250 mg BID. Primary endpoint: blinded independent review committee (BIRC)-assessed PFS (RECIST v1.1). Secondary efficacy endpoints: BIRC-assessed ORR, intracranial (i) ORR, and iPFS. Results: 275 pts were randomized; 108 Asian (BRG/CRZ, n = 59/49), 167 non-Asian (n = 78/89); median age: Asian, 55/56 y; non-Asian, 60/60 y. 32/24% of Asians vs 22/28% of non-Asians received prior chemotherapy for advanced disease; 36/33% vs 24/28% had baseline CNS metastases. As of 19 Feb 2018, median follow-up was 10.1/10.0 mo (BRG/CRZ) in Asians vs 11.0/9.0 mo in non-Asians, with 12 vs 20 PFS events in Asians and 24 vs 43 in non-Asians. In Asians, median BIRC-assessed PFS (mo) was not reached (NR; 95% CI 11.2–NR) with BRG vs 11.1 (9.2–NR) with CRZ (HR 0.41 [95% CI 0.20–0.86]; log-rank P= 0.0261); in non-Asians, BRG PFS was NR (NR) vs 9.4 (7.3–NR) with CRZ (HR 0.54 [0.33–0.90]; log-rank P= 0.0132) (Table). AE profile of each drug was similar in Asians vs non-Asians. Most common any-grade AEs (≥25%) in Asians in BRG arm: diarrhea; elevated blood CPK, ALT, and AST. Discontinuation due to AE (BRG/CRZ): 8.5/6.3% in Asian pts; 14.3/10.1% in non-Asian pts. Conclusions: BRG showed comparable improvement in PFS vs CRZ both in Asians and non-Asians in ALK inhibitor–naive ALK+ NSCLC. Clinical trial information: NCT02737501. [Table: see text]
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Affiliation(s)
- Myung-Ju Ahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - HyeRyun Kim
- Yonsei University Severance Hospital, Seoul, South Korea
| | | | - Ji-Youn Han
- Center for Lung Cancer, National Cancer Center, Gyeonggi-Do, South Korea
| | - Jong Seok Lee
- Seoul National University Bundang Hospital, Seoul, South Korea
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | | | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, and Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ki Hyeong Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | | | | | - Angelo Delmonte
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, South Korea
| | - David Kerstein
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Quanhong Ni
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Pingkuan Zhang
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Sanjay Popat
- The Royal Marsden Hospital, London, United Kingdom
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Hochmair MJ. How can better identification of T790M help to inform treatment sequencing decisions in EGFR mutation-positive non-small-cell lung cancer? Future Oncol 2019; 15:2895-2898. [PMID: 31030557 DOI: 10.2217/fon-2019-0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory & Critical Care Medicine & Ludwig Boltzmann Institute for COPD & Respiratory Epidemiology, Otto Wagner Hospital, 1140 Vienna, Austria
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Halmos B, Hochmair MJ, Morabito A, Hao D, Yang CT, Soo RA, C-H Yang J, Gucalp R, Wang L, Märten A, Cufer T. CLO19-033: Afatinib Followed by Osimertinib in EGFR Mutation-Positive (EGFRm+) Advanced NSCLC: Subgroup Analyses of the GioTag Study by ECOG PS, Age, and Ethnicity. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7184] [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: 11/17/2022]
Abstract
Background: EGFR TKIs have shown first-line efficacy in EGFRm+ NSCLC but acquired resistance is inevitable; with afatinib, this is predominantly through the emergence of T790M. Therefore, a key consideration when assessing therapeutic choices is the availability of subsequent treatment options. The GioTag study (NCT03370770) is the first to assess outcomes of real-world patients (Pts) who received first-line afatinib followed by osimertinib; for pts with EGFRm+ NSCLC and acquired T790M this sequence resulted in a median time on treatment (ToT) of 27.6 months, which did not include chemotherapy. We present subgroup analyses of pts from the GioTag study who are under-represented in randomized controlled trials (RCTs) and assess the impact of afatinib treatment on ECOG PS. Methods: The GioTag study is an observational, multicenter study. Data were collected retrospectively (Dec 2017–May 2018). Pts had EGFRm+ (Del19/L858R) advanced NSCLC and acquired T790M after first-line afatinib. Pts completed afatinib and started osimertinib treatment ≥10 months before data entry to avoid early censoring and ensure mature data collection. Patient subgroups were defined based on baseline characteristics (eg, ECOG PS, age, ethnicity). The primary outcome was ToT from afatinib initiation to osimertinib discontinuation. Results: A total of 204 pts were included in the GioTag study: 15.2% had ECOG PS ≥2; 7.4% were aged ≥75 years; 8.8% were African-American. Pts generally considered to have a poor prognosis derived clinical benefit from the afatinib–osimertinib sequence: median ToT for pts with ECOG PS ≥2 (n=31) was 22.2 months (90%CI 16.0–27.0; vs pts with ECOG PS 0/1 [n=153; 31.3 months; 27.6–44.5] P<.001); and for pts aged ≥75 years (n=15), ToT was 19.9 months (9.7–not evaluable [NE]; vs pts aged <75 years [n=189; 28.1 months; 26.6–31.3] P=.382). In African-American pts, median ToT was 27.6 months (90%CI 24.7–NE). Of 180 pts with available data, 75.0% had no change or an improvement in ECOG PS from the start of afatinib to the start of osimertinib treatment; 24.4% of pts had a deterioration in ECOG PS by 1 step and 0.6% of pts had a deterioration by 2 steps. Conclusions: First-line afatinib followed by osimertinib is a feasible therapeutic strategy in pts with EGFRm+ NSCLC and acquired T790M, including those who are often under-represented in RCTs. Clinical benefit (measured by ToT) was seen among pts with poor prognosis (ECOG PS ≥2), pts aged ≥75 years, and African-American pts.
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Affiliation(s)
- Balazs Halmos
- aMontefiore Albert Einstein Cancer Center, Bronx, NY
| | | | | | - Desiree Hao
- dTom Baker Cancer Center, University of Calgary, Calgary, Alberta, Canada
| | | | | | - James C-H Yang
- gNational Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Rasim Gucalp
- aMontefiore Albert Einstein Cancer Center, Bronx, NY
| | - Lara Wang
- hBoehringer Ingelheim Taiwan Limited, Taipei, Taiwan
| | - Angela Märten
- iBoehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Tanja Cufer
- jUniversity of Ljubljana, Ljubljana, Slovenia
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