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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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Lang-Stöberl A, Fabikan H, Hochmair M, Kirchbacher K, Rodriguez VM, Ay L, Weinlinger C, Rosenthaler D, Illini O, Müser N, Funk GC, Valipour A. The Landsteiner lung cancer research platform (LALUCA) : Objectives, methodology and implementation of a real-world clinical lung cancer registry. Wien Klin Wochenschr 2024:10.1007/s00508-024-02351-3. [PMID: 38652311 DOI: 10.1007/s00508-024-02351-3] [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: 01/31/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Lung cancer is a major health burden in Austria; however, limited real-world data exist on the diagnostic and treatment reality of lung cancer patients in Austria. The collection of high-quality data in a clinical setting is needed to gain insights into the real-world diagnostic and therapeutic management of lung cancer patients. METHODS The Karl Landsteiner Institute for Lung Research and Pulmonary Oncology implemented the Landsteiner lung cancer research platform (LALUCA), recruiting unselected lung cancer patients from two high volume centers in Vienna. This article describes the objectives, design, methodology of the registry and the process of implementation. RESULTS A multidisciplinary team of lung cancer specialists created a custom designed variable catalogue for the LALUCA platform consisting of 17 categories with 180 variables. Detailed information on clinical characteristics, diagnostic interventions, molecular pathology as well as curative and palliative treatment modalities are collected. During an implementation phase in 2020, the platform was optimized using the data of 50 patients. Since then a total of 1200 patients have been enrolled. Recruitment for the registry is ongoing with a recruitment rate of approximately 400 patients per year. CONCLUSION The LALUCA registry is a web-based platform for the collection of real-world clinical data of lung cancer patients. Combining a large number of patients with a focus on gathering comprehensive data on diagnosis and treatment, the LALUCA registry provides a tool for investigation, evaluation, and improvement of the clinical management, survival and quality of care of Austrian lung cancer patients.
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Affiliation(s)
- Anna Lang-Stöberl
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria.
| | - Hannah Fabikan
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - Maximilan Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Klaus Kirchbacher
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- 2nd Department of Internal Medicine with Pneumology, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Vikaela Mania Rodriguez
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - Leya Ay
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Christoph Weinlinger
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - David Rosenthaler
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
| | - Oliver Illini
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
| | - Nino Müser
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- 2nd Department of Internal Medicine with Pneumology, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Georg-Christian Funk
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- 2nd Department of Internal Medicine with Pneumology, Klinik Ottakring, Vienna Healthcare Group, Vienna, Austria
| | - Arschang Valipour
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf and Klinik Ottakring, Vienna, Austria
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Vienna, Austria
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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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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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Illini O, Fabikan H, Swalduz A, Krenbek D, Vikström A, 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 H, Hashemi S, Mohorcic K, Stoff R, Rovitsky Y, Keren-Rosenberg S, Winder T, Weinlinger C, Valipour A, Hochmair M. EP08.02-122 Real-world Experience with Capmatinib in MET Exon 14-mutated Non-small Cell Lung Cancer (RECAP). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.805] [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: 10/14/2022]
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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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7
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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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Obermayr E, Koppensteiner N, Heinzl N, Schuster E, Holzer B, Fabikan H, Weinlinger C, Illini O, Hochmair M, Zeillinger R. Cancer Stem Cell-Like Circulating Tumor Cells Are Prognostic in Non-Small Cell Lung Cancer. J Pers Med 2021; 11:jpm11111225. [PMID: 34834576 PMCID: PMC8620949 DOI: 10.3390/jpm11111225] [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] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/19/2023] Open
Abstract
Despite recent advances in the treatment of non-small cell lung cancer (NSCLC), less than 10% of patients survive the first five years when the disease has already spread at primary diagnosis. Methods: Blood samples were taken from 118 NSCLC patients at primary diagnosis or at progression of the disease before the start of a new treatment line and enriched for circulating tumor cells (CTCs) by microfluidic Parsortix™ (Angle plc, Guildford GU2 7AF, UK) technology. The gene expression of epithelial cancer stem cell (CSC), epithelial to mesenchymal (EMT), and lung-related markers was assessed by qPCR, and the association of each marker with overall survival (OS) was evaluated using log-rank tests. Results: EpCAM was the most prevalent transcript, with 53.7% positive samples at primary diagnosis and 25.6% at recurrence. EpCAM and CK19, as well as NANOG, PROM1, TERT, CDH5, FAM83A, and PTHLH transcripts, were associated with worse OS. However, only the CSC-specific NANOG and PROM1 were related to the outcome both at primary diagnosis (NANOG: HR 3.21, 95%CI 1.02–10.14, p = 0.016; PROM1: HR 4.23, 95% CI 0.65–27.56, p = 0.007) and disease progression (NANOG: HR 4.17, 95%CI 0.72–24.14, p = 0.025; PROM1: HR 4.77, 95% CI 0.29–78.94, p = 0.032). Conclusions: The present study further underlines the relevance of the molecular characterization of CTCs. Our multi-marker analysis highlighted the prognostic value of cancer stem cell-related transcripts at primary diagnosis and disease progression.
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Affiliation(s)
- Eva Obermayr
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (N.K.); (N.H.); (E.S.); (B.H.); (R.Z.)
- Correspondence: ; Tel.: +43-14-0400-78270
| | - Nina Koppensteiner
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (N.K.); (N.H.); (E.S.); (B.H.); (R.Z.)
| | - Nicole Heinzl
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (N.K.); (N.H.); (E.S.); (B.H.); (R.Z.)
| | - Eva Schuster
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (N.K.); (N.H.); (E.S.); (B.H.); (R.Z.)
| | - Barbara Holzer
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (N.K.); (N.H.); (E.S.); (B.H.); (R.Z.)
| | - Hannah Fabikan
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Bruenner Strasse 68, 1210 Vienna, Austria; (H.F.); (C.W.); (O.I.); (M.H.)
| | - Christoph Weinlinger
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Bruenner Strasse 68, 1210 Vienna, Austria; (H.F.); (C.W.); (O.I.); (M.H.)
| | - Oliver Illini
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Bruenner Strasse 68, 1210 Vienna, Austria; (H.F.); (C.W.); (O.I.); (M.H.)
| | - Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Bruenner Strasse 68, 1210 Vienna, Austria; (H.F.); (C.W.); (O.I.); (M.H.)
| | - Robert Zeillinger
- Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria; (N.K.); (N.H.); (E.S.); (B.H.); (R.Z.)
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Hochmair MJ, Illini O, Prosch H, Krenbek D, Valipour A. Complete Remission to Afatinib in a Patient Harboring a Novel Epidermal Growth Factor Mutation in De Novo Small-Cell Lung Cancer: A Case Report: Clinical Lung Cancer. Clin Lung Cancer 2021; 23:e289-e292. [PMID: 34865962 DOI: 10.1016/j.cllc.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria.
| | - Oliver Illini
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dagmar Krenbek
- Department of Pathology and Bacteriology, Klinik Floridsdorf, Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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Illini O, Hochmair MJ, Fabikan H, Weinlinger C, Tufman A, Swalduz A, Lamberg K, Hashemi SMS, Huemer F, Vikström A, Wermke M, Absenger G, Addeo A, Banerji S, Calles A, Clarke S, Di Maio M, Durand A, Duruisseaux M, Itchins M, Kääränien OS, Krenn F, Laack E, de Langen AJ, Mohorcic K, Pall G, Passaro A, Prager G, Rittmeyer A, Rothenstein J, Schumacher M, Wöll E, Valipour A. Selpercatinib in RET fusion-positive non-small-cell lung cancer (SIREN): a retrospective analysis of patients treated through an access program. Ther Adv Med Oncol 2021; 13:17588359211019675. [PMID: 34178121 PMCID: PMC8202258 DOI: 10.1177/17588359211019675] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Rearranged during transfection (RET) gene fusions are rare genetic drivers in non-small cell lung cancer (NSCLC). Selective RET-inhibitors such as selpercatinib have shown therapeutic activity in early clinical trials; however, their efficacy in the real-world setting is unknown. METHODS A retrospective efficacy and safety analysis was performed on data from RET fusion-positive NSCLC patients who participated in a selpercatinib access program (named patient protocol) between August 2019 and January 2021. RESULTS Data from 50 patients with RET fusion-positive advanced NSCLC treated with selpercatinib at 27 centers in 12 countries was analyzed. Most patients were Non-Asian (90%), female (60%), never-smokers (74%), with a median age of 65 years (range, 38-89). 32% of the patients had known brain metastasis at the time of selpercatinib treatment. Overall, 13 patients were treatment-naïve, while 37 were pretreated with a median of three lines of therapy (range, 1-8). The objective response rate (ORR) was 68% [95% confidence interval (CI), 53-81] in the overall population. The disease control rate was 92%. The median progression-free survival was 15.6 months (95% CI, 8.8-22.4) after a median follow-up of 9 months. In patients with measurable brain metastases (n = 8) intracranial ORR reached 100%. In total, 88% of patients experienced treatment-related adverse events (TRAEs), a large majority of them being grade 1 or 2. The most common grade ⩾ 3 TRAEs were increased liver enzyme levels (in 10% of patients), prolonged QTc time (4%), abdominal pain (4%), hypertension (4%), and fatigue/asthenia (4%). None of patients discontinued selpercatinib treatment for safety reasons. No new safety concerns were observed, nor where there any treatment-related death. CONCLUSIONS In this real-world setting, the selective RET-inhibitor selpercatinib demonstrated durable systemic and intracranial antitumor activity in RET fusion-positive NSCLC and was well tolerated.
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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, Brünner Strasse 68, Vienna, 1210, Austria
| | - Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, 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
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Klinikum der Universitaet Muenchen, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung, CPC-M, Munich, Bayern, Germany
| | | | - Kristina Lamberg
- Department of Pulmonary and Allergic diseases, Uppsala University hospital, Uppsala, Sweden
| | - Sayed M. S. Hashemi
- Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Florian Huemer
- Department of Respiratory Care, Ludwig Boltzmann Institute Lung Health, Klinik Penzing, Vienna, Austria
| | - Anders Vikström
- Pulmonary clinic, University hospital Linköping, Linköping, Sweden
| | - Martin Wermke
- Medical Faculty C.-G.-Carus, NCT/UCC Early Clinical Trial Unit Dresden, Technical University Dresden, Germany
| | - Gudrun Absenger
- Department of Oncology, Medical University of Graz, Graz, Austria
| | - Alfredo Addeo
- Oncology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Shantanu Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Antonio Calles
- Medical Oncology Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Stephen Clarke
- Medical Oncology Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Italy
- Medical Oncology, Ordine Mauriziano Hospital, Torino, Italy
| | - Alice Durand
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Michaël Duruisseaux
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France
- Oncopharmacology Laboratory, Cancer Research Center of Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Malinda Itchins
- Medical Oncology Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Florian Krenn
- LKH Hochsteiermark – Standort Leoben, Abteilung für Lungenkrankheiten, Austria
| | - Eckart Laack
- Studiengesellschaft Hämato-Onkologie Hamburg, Hamburg, Germany
| | | | - Katja Mohorcic
- Medical Oncology Unit, University Clinic Golnik, Golnik, Slovenia
| | - Georg Pall
- Department of Internal Medicine V, Hematology/Oncology, University Hospital Innsbruck, Innsbruck, Austria
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Gerald Prager
- Department of Medicine I, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Achim Rittmeyer
- LKI Lungenfachklinik Immenhausen, Department of Thoracic Oncology, Immenhausen, Germany
| | - Jeffrey Rothenstein
- R.S. McLaughlin Durham Regional Cancer Center at Lakeridge Health, Adjunct Assistant Professor Queen’s University, Ontario, Canada
| | - Michael Schumacher
- Department of Pneumology, Ordensklinikum Elisabethinen Linz, Linz, Austria
| | - Ewald Wöll
- Department Internal Medicine, St. Vinzenz Krankenhaus Betriebs GmbH, Sanatoriumstr. 43, 6511 Zams, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna
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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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Hochmair MJ, Setinek U, Krenbek D, Fazekas A, Illini O, Weinlinger C, Draxler H, Marcher M, Valipour A, Müllauer L, Beer L. Rapid Clinical and Radiologic Responses With Larotrectinib Treatment in a Patient With TRK-Fusion-Positive Metastatic Lung Cancer. Clin Lung Cancer 2019; 21:e49-e53. [PMID: 31879191 DOI: 10.1016/j.cllc.2019.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Maximilian Johannes Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria.
| | - Ulrike Setinek
- Department of Pathology, Wilhelminenspital, Vienna, Austria
| | - Dagmar Krenbek
- Department of Pathology, Wilhelminenspital, Vienna, Austria; Department of Pathology, Klinik Floridsdorf, Krankenhaus Nord, Vienna, Austria
| | - Andreas Fazekas
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria
| | - Oliver Illini
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria
| | - Christoph Weinlinger
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria
| | - Hermann Draxler
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria
| | - Markus Marcher
- Department of Thoracic Surgery, Klinik Floridsdorf, Krankenhaus Nord, Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Krankenhaus Nord, Vienna, Austria
| | - Leonhard Müllauer
- Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Lucian Beer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Department of Radiology and Cancer Research UK, Cambridge, England, UK
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Hochmair M, Weinlinger C, Fabikan H, Illini O, Krenbek D, Setinek U, Watzka S, Koger R, Meilinger M, Absenger G, Wanke M, Semmelweis C, Rauter M, Valipour A. P2.14-46 Treatment Observations and Clinical Experience with Lorlatinib in Pretreated ALK and ROS1 Rearranged NSCLC Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE Assessment of gustatory function in human subjects using the 'taste strips' test is an easy and validated procedure. The aim of this study was to extend this test in order to detect subjects with superior gustatory sensitivity. METHODS The investigation included 134 subjects (29.5±12.6 years, range 18-84 years) with normal gustatory function. Four concentrations of sweet, sour, salty, and bitter were augmented with additional low concentrations (sweet: 25/12.5 mg/ml sucrose; sour: 27/15 mg/ml citric acid; salty: 6.4/2.6 mg/ml sodium chloride, bitter: 0.15/0.06 mg/ml quinine hydrochloride), resulting in a maximum extended taste score (ETS) of 24. RESULTS The mean ETS was 14.5 ± 3.2. Specifically, it was 4.5 ± 1.2 for sweet, 2.8 ± 1.0 for sour, 4.0 ± 1.3 for salty, and 3.2 ± 1.2 for bitter. In contrast to the original version of the taste strips test, no ceiling effect was observed. Cluster analysis separated three groups of subjects by ETS, whereas test scores derived from the original four concentrations were insufficient to discriminate the subgroup with higher gustatory sensitivity. CONCLUSIONS The extended taste strips test seems to be a useful tool for the detection of patients with low gustatory thresholds for sweet, sour, salty, or bitter taste.
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Affiliation(s)
- Axel Wolf
- Department of Otorhinolaryngology, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Austria
| | - Oliver Illini
- Department of Otorhinolaryngology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria
| | - Daniel Uy
- Department of Otorhinolaryngology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria
| | - Bertold Renner
- Institute of Experimental and Clinical Pharmacology, University of Erlangen-Nurnberg, Krankenhausstr. 9, 91054 Erlangen, Germany
| | - Christian A Mueller
- Department of Otorhinolaryngology, Medical University Vienna, Waehringer Guertel 18-20, 1090 Wien, Austria
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