1
|
Peters S, Loi S, André F, Chandarlapaty S, Felip E, Finn SP, Jänne PA, Kerr KM, Munzone E, Passaro A, Pérol M, Smit EF, Swanton C, Viale G, Stahel RA. Antibody-drug conjugates in lung and breast cancer: Current evidence and future directions - a position statement from the ETOP IBCSG Partners Foundation. Ann Oncol 2024:S0923-7534(24)00108-X. [PMID: 38648979 DOI: 10.1016/j.annonc.2024.04.002] [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: 02/14/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
Following the approval of the first antibody-drug conjugates (ADCs) in the early 2000s, development has increased dramatically, with 14 ADCs now approved and >100 in clinical development. In lung cancer, trastuzumab deruxtecan (T-DXd) is approved in human epidermal growth factor receptor 2 (HER2)-mutated, unresectable or metastatic non-small cell lung cancer, with ADCs targeting HER3 (patritumab deruxtecan), trophoblast cell-surface antigen 2 (datopotamab deruxtecan and sacituzumab govitecan [SG]) and mesenchymal-epithelial transition factor (telisotuzumab vedotin) in late-stage clinical development. In breast cancer, several agents are already approved and widely used, including trastuzumab emtansine, T-DXd and SG, and multiple late-stage trials are ongoing. Thus, in the coming years, we are likely to see significant changes to treatment algorithms. As the number of available ADCs increases, biomarkers (of response and resistance) to better select patients are urgently needed. Biopsy sample collection at the time of treatment selection and incorporation of translational research into clinical trial designs are therefore critical. Biopsy samples taken peri- and post-ADC treatment combined with functional genomics screens could provide insights into response/resistance mechanisms as well as the impact of ADCs on tumour biology and the tumour microenvironment, which could improve understanding of the mechanisms underlying these complex molecules. Many ADCs are undergoing evaluation as combination therapy, but a high bar should be set to progress clinical evaluation of any ADC-based combination, particularly considering the high cost and potential toxicity implications. Efforts to optimise ADC dosing/duration, sequencing and the potential for ADC rechallenge are also important, especially considering sustainability aspects. The ETOP IBCSG Partners Foundation are driving strong collaborations in this field and promoting the generation/sharing of databases, repositories and registries to enable greater access data. This will allow the most important research questions to be identified and prioritised, which will ultimately accelerate progress and help to improve patient outcomes.
Collapse
Affiliation(s)
- S Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University, Lausanne, Switzerland
| | - S Loi
- Department of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
| | - S Chandarlapaty
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - E Felip
- Medical Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - S P Finn
- Department of Histopathology and Cancer Molecular Diagnostics, St James's Hospital and Trinity College, Dublin, Ireland
| | - P A Jänne
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - K M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - E Munzone
- Division of Medical Senology, European Institute of Oncology IRCCS, Milan
| | - A Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Pérol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - E F Smit
- Department of Pulmonary Diseases, Leiden University Medical Center, Leiden, the Netherlands
| | - C Swanton
- Cancer Research UK (CRUK) Lung Cancer Centre of Excellence, UCL Cancer Institute, University College London, London, UK
| | - G Viale
- Department of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - R A Stahel
- Coordinating Center, ETOP IBCSG Partners Foundation, Bern, Switzerland.
| |
Collapse
|
2
|
Yu HA, Baik C, Kim DW, Johnson ML, Hayashi H, Nishio M, Yang JCH, Su WC, Gold KA, Koczywas M, Smit EF, Steuer CE, Felip E, Murakami H, Kim SW, Su X, Sato S, Fan PD, Fujimura M, Tanaka Y, Patel P, Sternberg DW, Sellami D, Jänne PA. Translational insights and overall survival in the U31402-A-U102 study of patritumab deruxtecan (HER3-DXd) in EGFR-mutated NSCLC. Ann Oncol 2024:S0923-7534(24)00047-4. [PMID: 38369013 DOI: 10.1016/j.annonc.2024.02.003] [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: 10/11/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Human epidermal growth factor receptor 3 (HER3) is broadly expressed in non-small-cell lung cancer (NSCLC) and is the target of patritumab deruxtecan (HER3-DXd), an antibody-drug conjugate consisting of a HER3 antibody attached to a topoisomerase I inhibitor payload via a tetrapeptide-based cleavable linker. U31402-A-U102 is an ongoing phase I study of HER3-DXd in patients with advanced NSCLC. Patients with epidermal growth factor receptor (EGFR)-mutated NSCLC that progressed after EGFR tyrosine kinase inhibitor (TKI) and platinum-based chemotherapy (PBC) who received HER3-DXd 5.6 mg/kg intravenously once every 3 weeks had a confirmed objective response rate (cORR) of 39%. We present median overall survival (OS) with extended follow-up in a larger population of patients with EGFR-mutated NSCLC and an exploratory analysis in those with acquired genomic alterations potentially associated with resistance to HER3-DXd. PATIENTS AND METHODS Safety was assessed in patients with EGFR-mutated NSCLC previously treated with EGFR TKI who received HER3-DXd 5.6 mg/kg; efficacy was assessed in those who also had prior PBC. RESULTS In the safety population (N = 102), median treatment duration was 5.5 (range 0.7-27.5) months. Grade ≥3 adverse events occurred in 76.5% of patients; the overall safety profile was consistent with previous reports. In 78/102 patients who had prior third-generation EGFR TKI and PBC, cORR by blinded independent central review (as per RECIST v1.1) was 41.0% [95% confidence interval (CI) 30.0% to 52.7%], median progression-free survival was 6.4 (95% CI 4.4-10.8) months, and median OS was 16.2 (95% CI 11.2-21.9) months. Patients had diverse mechanisms of EGFR TKI resistance at baseline. At tumor progression, acquired mutations in ERBB3 and TOP1 that might confer resistance to HER3-DXd were identified. CONCLUSIONS In patients with EGFR-mutated NSCLC after EGFR TKI and PBC, HER3-DXd treatment was associated with a clinically meaningful OS. The tumor biomarker characterization comprised the first description of potential mechanisms of resistance to HER3-DXd therapy.
Collapse
Affiliation(s)
- H A Yu
- Department of Medicine, Medical Oncology, Memorial Sloan Kettering Cancer Center, New York.
| | - C Baik
- University of Washington/Seattle Cancer Care Alliance, Seattle, USA
| | - D-W Kim
- Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - M L Johnson
- Sarah Cannon Research Institute at Tennessee Oncology, Nashville, USA
| | | | - M Nishio
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - J C-H Yang
- National Taiwan University Hospital, Taipei City
| | - W-C Su
- National Cheng Kung University Hospital, Tainan, Taiwan
| | - K A Gold
- Moores Cancer Center at UC San Diego Health, San Diego
| | | | - E F Smit
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C E Steuer
- Winship Cancer Institute of Emory University, Atlanta, USA
| | - E Felip
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - S-W Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - X Su
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - S Sato
- Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - P-D Fan
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | | | - Y Tanaka
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - P Patel
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | | | - D Sellami
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - P A Jänne
- Dana-Farber Cancer Institute, Boston, USA
| |
Collapse
|
3
|
Ricciuti B, Alessi JV, Elkrief A, Wang X, Cortellini A, Li YY, Vaz VR, Gupta H, Pecci F, Barrichello A, Lamberti G, Nguyen T, Lindsay J, Sharma B, Felt K, Rodig SJ, Nishino M, Sholl LM, Barbie DA, Negrao MV, Zhang J, Cherniack AD, Heymach JV, Meyerson M, Ambrogio C, Jänne PA, Arbour KC, Pinato DJ, Skoulidis F, Schoenfeld AJ, Awad MM, Luo J. Dissecting the clinicopathologic, genomic, and immunophenotypic correlates of KRAS G12D-mutated non-small-cell lung cancer. Ann Oncol 2022; 33:1029-1040. [PMID: 35872166 PMCID: PMC11006449 DOI: 10.1016/j.annonc.2022.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 04/17/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Allele-specific KRAS inhibitors are an emerging class of cancer therapies. KRAS-mutant (KRASMUT) non-small-cell lung cancers (NSCLCs) exhibit heterogeneous outcomes, driven by differences in underlying biology shaped by co-mutations. In contrast to KRASG12C NSCLC, KRASG12D NSCLC is associated with low/never-smoking status and is largely uncharacterized. PATIENTS AND METHODS Clinicopathologic and genomic information were collected from patients with NSCLCs harboring a KRAS mutation at the Dana-Farber Cancer Institute (DFCI), Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, and Imperial College of London. Multiplexed immunofluorescence for CK7, programmed cell death protein 1 (PD-1), programmed death-ligand 1 (PD-L1), Foxp3, and CD8 was carried out on a subset of samples with available tissue at the DFCI. Clinical outcomes to PD-(L)1 inhibition ± chemotherapy were analyzed according to KRAS mutation subtype. RESULTS Of 2327 patients with KRAS-mutated (KRASMUT) NSCLC, 15% (n = 354) harbored KRASG12D. Compared to KRASnon-G12D NSCLC, KRASG12D NSCLC had a lower pack-year (py) smoking history (median 22.5 py versus 30.0 py, P < 0.0001) and was enriched in never smokers (22% versus 5%, P < 0.0001). KRASG12D had lower PD-L1 tumor proportion score (TPS) (median 1% versus 5%, P < 0.01) and lower tumor mutation burden (TMB) compared to KRASnon-G12D (median 8.4 versus 9.9 mt/Mb, P < 0.0001). Of the samples which underwent multiplexed immunofluorescence, KRASG12D had lower intratumoral and total CD8+PD1+ T cells (P < 0.05). Among 850 patients with advanced KRASMUT NSCLC who received PD-(L)1-based therapies, KRASG12D was associated with a worse objective response rate (ORR) (15.8% versus 28.4%, P = 0.03), progression-free survival (PFS) [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.45-2.00, P = 0.003], and overall survival (OS; HR 1.45, 1.05-1.99, P = 0.02) to PD-(L)1 inhibition alone but not to chemo-immunotherapy combinations [ORR 30.6% versus 35.7%, P = 0.51; PFS HR 1.28 (95%CI 0.92-1.77), P = 0.13; OS HR 1.36 (95%CI 0.95-1.96), P = 0.09] compared to KRASnon-G12D. CONCLUSIONS KRASG12D lung cancers harbor distinct clinical, genomic, and immunologic features compared to other KRAS-mutated lung cancers and worse outcomes to PD-(L)1 blockade. Drug development for KRASG12D lung cancers will have to take these differences into account.
Collapse
Affiliation(s)
- B Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - J V Alessi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - A Elkrief
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - X Wang
- Harvard School of Public Health, Boston, USA
| | - A Cortellini
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Y Y Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Cancer Program, Broad Institute of Harvard and Massachusetts Institute of Technology (MIT), Cambridge, USA
| | - V R Vaz
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - H Gupta
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - F Pecci
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - A Barrichello
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - G Lamberti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - T Nguyen
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - J Lindsay
- Knowledge Systems Group, Dana-Farber Cancer Institute, Boston, USA
| | - B Sharma
- ImmunoProfile, Brigham & Women's Hospital and Dana-Farber Cancer Institute, Boston, USA
| | - K Felt
- ImmunoProfile, Brigham & Women's Hospital and Dana-Farber Cancer Institute, Boston, USA
| | - S J Rodig
- ImmunoProfile, Brigham & Women's Hospital and Dana-Farber Cancer Institute, Boston, USA; Department of Pathology, Brigham and Women's Hospital, Boston, USA
| | - M Nishino
- Department of Radiology, Brigham and Women's Hospital and Department of Imaging, Dana-Farber Cancer Institute, Boston, USA
| | - L M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, USA
| | - D A Barbie
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M V Negrao
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Zhang
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A D Cherniack
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - J V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - C Ambrogio
- Molecular Biotechnology and Health Science, University of Turin, Turin, Italy
| | - P A Jänne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - K C Arbour
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D J Pinato
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - F Skoulidis
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A J Schoenfeld
- Thoracic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M M Awad
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - J Luo
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA.
| |
Collapse
|
4
|
Passaro A, Leighl N, Blackhall F, Popat S, Kerr K, Ahn MJ, Arcila ME, Arrieta O, Planchard D, de Marinis F, Dingemans AM, Dziadziuszko R, Faivre-Finn C, Feldman J, Felip E, Curigliano G, Herbst R, Jänne PA, John T, Mitsudomi T, Mok T, Normanno N, Paz-Ares L, Ramalingam S, Sequist L, Vansteenkiste J, Wistuba II, Wolf J, Wu YL, Yang SR, Yang JCH, Yatabe Y, Pentheroudakis G, Peters S. ESMO expert consensus statements on the management of EGFR mutant non-small-cell lung cancer. Ann Oncol 2022; 33:466-487. [PMID: 35176458 DOI: 10.1016/j.annonc.2022.02.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [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: 12/16/2021] [Revised: 01/14/2022] [Accepted: 02/06/2022] [Indexed: 12/14/2022] Open
Abstract
The European Society for Medical Oncology (ESMO) held a virtual consensus-building process on epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer in 2021. The consensus included a multidisciplinary panel of 34 leading experts in the management of lung cancer. The aim of the consensus was to develop recommendations on topics that are not covered in detail in the current ESMO Clinical Practice Guideline and where the available evidence is either limited or conflicting. The main topics identified for discussion were: (i) tissue and biomarkers analyses; (ii) early and locally advanced disease; (iii) metastatic disease and (iv) clinical trial design, patient's perspective and miscellaneous. The expert panel was divided into four working groups to address questions relating to one of the four topics outlined above. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the recommendations developed, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation.
Collapse
Affiliation(s)
- A Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy.
| | - N Leighl
- Division of Medical Oncology/Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - F Blackhall
- Division of Cancer Sciences, The University of Manchester, Manchester, UK; Department of Medical Oncology, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - S Popat
- National Heart and Lung Institute, Imperial College, London, UK; Lung Unit, Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - K Kerr
- Aberdeen Royal Infirmary, Aberdeen University Medical School, Aberdeen, UK
| | - M J Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - M E Arcila
- Department of Pathology, Molecular Diagnostics Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - O Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - D Planchard
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - F de Marinis
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - A M Dingemans
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdansk, Poland
| | - C Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - J Feldman
- Lung Cancer Patient and Advocate, Co-Founder of EGFR Resisters Patient Group
| | - E Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, European Institute of Oncology IRCCS, Milan, Italy
| | - R Herbst
- Yale Comprehensive Cancer Center, Yale University School of Medicine, New Haven, USA
| | - P A Jänne
- Lowe Center for Thoracic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - T John
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - T Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong, China
| | - N Normanno
- Cell Biology and Biotherapy and Scientific Directorate, Istituto Nazionale Tumori, "Fondazione G.Pascale" IRCCS, Naples, Italy
| | - L Paz-Ares
- Lung Cancer Clinical Research Unit, and Complutense University, Madrid, Spain
| | - S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia
| | - L Sequist
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - J Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - I I Wistuba
- Department of Translational Molecular Pathology, Unit 951, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Wolf
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany
| | - Y L Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangdong, China
| | - S R Yang
- The Institute of Cancer Research, London, UK
| | - J C H Yang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Republic of China
| | - Y Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Epirus, Greece
| | - S Peters
- Oncology Department - CHUV, Lausanne University, Lausanne, Switzerland
| |
Collapse
|
5
|
Planchard D, Feng PH, Karaseva N, Kim SW, Kim TM, Lee CK, Poltoratskiy A, Yanagitani N, Marshall R, Huang X, Howarth P, Jänne PA, Kobayashi K. Osimertinib plus platinum-pemetrexed in newly diagnosed epidermal growth factor receptor mutation-positive advanced/metastatic non-small-cell lung cancer: safety run-in results from the FLAURA2 study. ESMO Open 2021; 6:100271. [PMID: 34543864 PMCID: PMC8453202 DOI: 10.1016/j.esmoop.2021.100271] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background The phase III FLAURA2 (NCT04035486) study will evaluate efficacy and safety of first-line osimertinib with platinum–pemetrexed chemotherapy versus osimertinib monotherapy in epidermal growth factor receptor mutation-positive (EGFRm) advanced/metastatic non-small-cell lung cancer (NSCLC). The safety run-in, reported here, assessed the safety and tolerability of osimertinib with chemotherapy prior to the randomized phase III evaluation. Patients and methods Patients (≥18 years; Japan: ≥20 years) with EGFRm locally advanced/metastatic NSCLC received oral osimertinib 80 mg once daily (QD), with either intravenous (IV) cisplatin 75 mg/m2 or IV carboplatin target area under the curve 5, plus pemetrexed 500 mg/m2 every 3 weeks (Q3W) for four cycles. Maintenance was osimertinib 80 mg QD with pemetrexed 500 mg/m2 Q3W until progression/discontinuation. The primary objective was to evaluate safety and tolerability of the osimertinib–chemotherapy combination. Results Thirty patients (15 per group) received treatment [Asian, 73%; female, 63%; median age (range) 61 (45-84) years]. Adverse events (AEs) were reported by 27 patients (90%): osimertinib–carboplatin–pemetrexed, 100%; osimertinib–cisplatin–pemetrexed, 80%. Most common AEs were constipation (60%) with osimertinib–carboplatin–pemetrexed and nausea (60%) with osimertinib–cisplatin–pemetrexed. In both groups, 20% of patients reported serious AEs. No specific pattern of AEs leading to dose modifications/discontinuations was observed; one patient discontinued all study treatments including osimertinib due to pneumonitis (study-specific discontinuation criterion). Hematologic toxicities were as expected and manageable. Conclusions Osimertinib–chemotherapy combination had a manageable safety and tolerability profile in EGFRm advanced/metastatic NSCLC, supporting further assessment in the FLAURA2 randomized phase. FLAURA2 aims to assess efficacy and safety of first-line osimertinib with platinum–pemetrexed in EGFRm advanced NSCLC. In the FLAURA2 safety run-in period, 30 patients received osimertinib and pemetrexed with carboplatin or cisplatin. Most common AEs were constipation and nausea; no AE patterns leading to dose modifications/discontinuations were observed. The FLAURA2 safety run-in study showed that the safety profile of this combination was as expected and manageable.
Collapse
Affiliation(s)
- D Planchard
- Institut Gustave Roussy, Department of Medical Oncology, Thoracic Oncology Unit, Villejuif, France.
| | - P-H Feng
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - N Karaseva
- City Clinical Oncology Dispensary, St. Petersburg, Russia
| | - S-W Kim
- Asan Medical Center, Seoul, Republic of Korea
| | - T M Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - C K Lee
- Clinical Research Unit, Division of Cancer Services, St. George Hospital, Kogarah, Australia
| | - A Poltoratskiy
- Department of Clinical Trials, Petrov Research Institute of Oncology, St. Petersburg, Russia
| | - N Yanagitani
- Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | | | | | | | - P A Jänne
- Dana-Farber Cancer Institute, Boston, USA
| | - K Kobayashi
- Department of Respiratory Medicine, Saitama Medical School International Medical Center, Saitama, Japan
| |
Collapse
|
6
|
Goss G, Tsai CM, Shepherd FA, Ahn MJ, Bazhenova L, Crinò L, de Marinis F, Felip E, Morabito A, Hodge R, Cantarini M, Johnson M, Mitsudomi T, Jänne PA, Yang JCH. CNS response to osimertinib in patients with T790M-positive advanced NSCLC: pooled data from two phase II trials. Ann Oncol 2019; 29:687-693. [PMID: 29293889 DOI: 10.1093/annonc/mdx820] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Central nervous system (CNS) metastases are common in patients with non-small-cell lung cancer (NSCLC). Osimertinib has shown systemic efficacy in patients with CNS metastases, and early clinical evidence shows efficacy in the CNS. To evaluate osimertinib activity further, we present a pre-specified subgroup analysis of CNS response using pooled data from two phase II studies: AURA extension (NCT01802632) and AURA2 (NCT02094261). Patients and methods Patients with T790M-positive advanced NSCLC, who had progressed following prior epidermal growth factor receptor-tyrosine kinase inhibitor treatment, received osimertinib 80 mg od (n = 411). Patients with stable, asymptomatic CNS metastases were eligible for enrolment; prior CNS treatment was allowed. Patients with ≥1 measurable CNS lesion (per RECIST 1.1) on baseline brain scan by blinded independent central neuroradiology review (BICR) were included in the evaluable for CNS response set (cEFR). The primary outcome for this CNS analysis was CNS objective response rate (ORR) by BICR; secondary outcomes included CNS duration of response, disease control rate (DCR) and progression-free survival (PFS). Results Of 128 patients with CNS metastases on baseline brain scans, 50 were included in the cEFR. Confirmed CNS ORR and DCR were 54% [27/50; 95% confidence interval (CI) 39-68] and 92% (46/50; 95% CI 81-98), respectively. CNS response was observed regardless of prior radiotherapy to the brain. Median CNS duration of response (22% maturity) was not reached (range, 1-15 months); at 9 months, 75% (95% CI 53-88) of patients were estimated to remain in response. Median follow-up for CNS PFS was 11 months; median CNS PFS was not reached (95% CI, 7, not calculable). The safety profile observed in the cEFR was consistent with the overall patient population. Conclusions Osimertinib demonstrated clinically meaningful efficacy against CNS metastases, with a high DCR, encouraging ORR, and safety profile consistent with that reported previously. ClinicalTrials.gov number NCT01802632; NCT02094261.
Collapse
Affiliation(s)
- G Goss
- Division of Medical Oncology, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
| | - C-M Tsai
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - F A Shepherd
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - M-J Ahn
- Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - L Bazhenova
- Division of Hematology and Oncology, UC San Diego Health, Moores Cancer Center, La Jolla, USA
| | - L Crinò
- Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia
| | - F de Marinis
- Thoracic Oncology Division, European Institute of Oncology, Milan, Italy
| | - E Felip
- Oncology Department, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - A Morabito
- Thoracic Medical Oncology, Istituto Nazionale Tumori, Fondazione "G. Pascale" - IRCCS, Naples, Italy
| | - R Hodge
- Biometrics and Information Sciences, AstraZeneca, Cambridge, UK
| | - M Cantarini
- Early Phase Clinical, AstraZeneca, Macclesfield, UK
| | - M Johnson
- Quantitative Clinical Pharmacology, AstraZeneca, Cambridge, UK
| | - T Mitsudomi
- Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - P A Jänne
- Department of Adult Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - J C-H Yang
- Department of Oncology, National Taiwan University Hospital, Taiwan
| |
Collapse
|
7
|
Soria JC, Fülöp A, Maciel C, Fischer JR, Girotto G, Lago S, Smit E, Ostoros G, Eberhardt WEE, Lishkovska P, Lovick S, Mariani G, McKeown A, Kilgour E, Smith P, Bowen K, Kohlmann A, Carlile DJ, Jänne PA. SELECT-2: a phase II, double-blind, randomized, placebo-controlled study to assess the efficacy of selumetinib plus docetaxel as a second-line treatment of patients with advanced or metastatic non-small-cell lung cancer. Ann Oncol 2018; 28:3028-3036. [PMID: 29045535 PMCID: PMC5834012 DOI: 10.1093/annonc/mdx628] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Combination of selumetinib plus docetaxel provided clinical benefit in a previous phase II trial for patients with KRAS-mutant advanced non-small-cell lung cancer (NSCLC). The phase II SELECT-2 trial investigated safety and efficacy of selumetinib plus docetaxel for patients with advanced or metastatic NSCLC. Patients and methods Patients who had disease progression after first-line anti-cancer therapy were randomized (2 : 2 : 1) to selumetinib 75 mg b.i.d. plus docetaxel 60 or 75 mg/m2 (SEL + DOC 60; SEL + DOC 75), or placebo plus docetaxel 75 mg/m2 (PBO + DOC 75). Patients were initially enrolled independently of KRAS mutation status, but the protocol was amended to include only patients with centrally confirmed KRAS wild-type NSCLC. Primary end point was progression-free survival (PFS; RECIST 1.1); statistical analyses compared each selumetinib group with PBO + DOC 75 for KRAS wild-type and overall (KRAS mutant or wild-type) populations. Results A total of 212 patients were randomized; 69% were KRAS wild-type. There were no statistically significant improvements in PFS or overall survival for overall or KRAS wild-type populations in either selumetinib group compared with PBO + DOC 75. Overall population median PFS for SEL + DOC 60, SEL + DOC 75 compared with PBO + DOC 75 was 3.0, 4.2, and 4.3 months, HRs: 1.12 (90% CI: 0.8, 1.61) and 0.92 (90% CI: 0.65, 1.31), respectively. In the overall population, a higher objective response rate (ORR; investigator assessed) was observed for SEL + DOC 75 (33%) compared with PBO + DOC 75 (14%); odds ratio: 3.26 (90% CI: 1.47, 7.95). Overall the tolerability profile of SEL + DOC was consistent with historical data, without new or unexpected safety concerns identified. Conclusion The primary end point (PFS) was not met. The higher ORR with SEL + DOC 75 did not translate into prolonged PFS for the overall or KRAS wild-type patient populations. No clinical benefit was observed with SEL + DOC in KRAS wild-type patients compared with docetaxel alone. No unexpected safety concerns were reported. Trial identifier Clinicaltrials.gov NCT01750281.
Collapse
Affiliation(s)
- J-C Soria
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - A Fülöp
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf (M.R.), Germany
| | - C Maciel
- Department of Electrical Engineering, University of São Paulo, São Carlos, São Paulo, Brazil
| | - J R Fischer
- Department of Internal Medicine II, Lungenklinik Löwenstein GmbH, Löwenstein, Germany
| | - G Girotto
- Department of Medical Oncology, Centro Integrado de Pesquisa, Fundação Faculdade Regional de Medicina de São José do Rio Preto, São José do Rio Preto
| | - S Lago
- Department of Oncology, Serviço de Oncologia do Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - E Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - G Ostoros
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - W E E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - P Lishkovska
- Department of Medical Oncology, Individualna Praktika Za Spetsializirana Meditsinska Pomosht, Vratsa, Bulgaria
| | | | | | | | | | | | | | | | | | - P A Jänne
- Lowe Center for Thoracic Oncology and The Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, USA
| |
Collapse
|
8
|
Eberhardt W, Garassino MC, Rizvi NA, Besse B, Jänne PA, Peters S, Keong Toh C, Kurata T, Carcereny Costa E, Koczywas M, Felip Font E, Chaft J, Qiu J, Kowanetz M, Zou W, Coleman S, Mocci S, Sandler A, Gettinger S, Johnson ML. Atezolizumab as first-line therapy (1L) for advanced PD-L1-selected NSCLC patients: updated ORR, PFS, OS and exploratory biomarker results from the BIRCH study. Pneumologie 2017. [DOI: 10.1055/s-0037-1598277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- W Eberhardt
- Universitätsklinikum Essen, Ruhrlandklinik, West German Cancer Center, Universität Duisburg-Essen
| | - MC Garassino
- Fondazione Irccs Istituto Nazionale Dei Tumori, Thoracic Oncology Unit
| | - NA Rizvi
- New York-Presbyterian/Columbia University Medical Center
| | - B Besse
- Gustave Roussy, Villejuif France and Paris Sud University
| | | | | | | | - T Kurata
- Kansai Medical University Hirakata Hospital
| | - E Carcereny Costa
- Catalan Institute of Oncology Badalona – Germans Trias I Pujol Hospital Badalona
| | | | | | - J Chaft
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Ramalingam SS, O'Byrne K, Boyer M, Mok T, Jänne PA, Zhang H, Liang J, Taylor I, Sbar EI, Paz-Ares L. Dacomitinib versus erlotinib in patients with EGFR-mutated advanced nonsmall-cell lung cancer (NSCLC): pooled subset analyses from two randomized trials. Ann Oncol 2016; 27:423-9. [PMID: 26768165 DOI: 10.1093/annonc/mdv593] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The irreversible epidermal growth factor receptor (EGFR) inhibitors have demonstrated efficacy in NSCLC patients with activating EGFR mutations, but it is unknown if they are superior to the reversible inhibitors. Dacomitinib is an oral, small-molecule irreversible inhibitor of all enzymatically active HER family tyrosine kinases. METHODS The ARCHER 1009 (NCT01360554) and A7471028 (NCT00769067) studies randomized patients with locally advanced/metastatic NSCLC following progression with one or two prior chemotherapy regimens to dacomitinib or erlotinib. EGFR mutation testing was performed centrally on archived tumor samples. We pooled patients with exon 19 deletion and L858R EGFR mutations from both studies to compare the efficacy of dacomitinib to erlotinib. RESULTS One hundred twenty-one patients with any EGFR mutation were enrolled; 101 had activating mutations in exon 19 or 21. For patients with exon19/21 mutations, the median progression-free survival was 14.6 months [95% confidence interval (CI) 9.0-18.2] with dacomitinib and 9.6 months (95% CI 7.4-12.7) with erlotinib [unstratified hazard ratio (HR) 0.717 (95% CI 0.458-1.124), two-sided log-rank, P = 0.146]. The median survival was 26.6 months (95% CI 21.6-41.5) with dacomitinib versus 23.2 months (95% CI 16.0-31.8) with erlotinib [unstratified HR 0.737 (95% CI 0.431-1.259), two-sided log-rank, P = 0.265]. Dacomitinib was associated with a higher incidence of diarrhea and mucositis in both studies compared with erlotinib. CONCLUSIONS Dacomitinib is an active agent with comparable efficacy to erlotinib in the EGFR mutated patients. The subgroup with exon 19 deletion had favorable outcomes with dacomitinib. An ongoing phase III study will compare dacomitinib to gefitinib in first-line therapy of patients with NSCLC harboring common activating EGFR mutations (ARCHER 1050; NCT01774721). CLINICAL TRIALS NUMBER ARCHER 1009 (NCT01360554) and A7471028 (NCT00769067).
Collapse
Affiliation(s)
- S S Ramalingam
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, USA
| | - K O'Byrne
- Department of Oncology, Princess Alexandra Hospital, Woolloongabba, Brisbane
| | - M Boyer
- Department of Oncology, Chris O'Brien Lifehouse, Camperdown, Sydney, Australia
| | - T Mok
- Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - P A Jänne
- Dana Farber Cancer Institute, Boston
| | - H Zhang
- Pfizer Oncology, New York, USA
| | - J Liang
- Pfizer Oncology, New York, USA
| | | | | | - L Paz-Ares
- Department of Oncology, Doce de Octubre University Hospital & CNIO, Madrid, Spain
| |
Collapse
|
10
|
Jänne PA, Smith I, McWalter G, Mann H, Dougherty B, Walker J, Orr MCM, Hodgson DR, Shaw AT, Pereira JR, Jeannin G, Vansteenkiste J, Barrios CH, Franke FA, Crinò L, Smith P. Impact of KRAS codon subtypes from a randomised phase II trial of selumetinib plus docetaxel in KRAS mutant advanced non-small-cell lung cancer. Br J Cancer 2015; 113:199-203. [PMID: 26125448 PMCID: PMC4506393 DOI: 10.1038/bjc.2015.215] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/14/2015] [Accepted: 05/07/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Selumetinib (AZD6244, ARRY-142886)+docetaxel increases median overall survival (OS) and significantly improves progression-free survival (PFS) and objective response rate (ORR) compared with docetaxel alone in patients with KRAS mutant, stage IIIB/IV non-small-cell lung cancer (NSCLC; NCT00890825). METHODS Retrospective analysis of OS, PFS, ORR and change in tumour size at week 6 for different sub-populations of KRAS codon mutations. RESULTS In patients receiving selumetinib+docetaxel and harbouring KRAS G12C or G12V mutations there were trends towards greater improvement in OS, PFS and ORR compared with other KRAS mutations. CONCLUSION Different KRAS mutations in NSCLC may influence selumetinib/docetaxel sensitivity.
Collapse
Affiliation(s)
- P A Jänne
- Lowe Center for Thoracic Oncology and the Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA
| | - I Smith
- AstraZeneca, Alderley Park, Macclesfield SK10 4TF, UK
| | - G McWalter
- AstraZeneca, Alderley Park, Macclesfield SK10 4TF, UK
| | - H Mann
- AstraZeneca, Alderley Park, Macclesfield SK10 4TF, UK
| | - B Dougherty
- AstraZeneca, Gatehouse Park, Waltham, MA 02451, USA
| | - J Walker
- AstraZeneca, Alderley Park, Macclesfield SK10 4TF, UK
| | - M C M Orr
- AstraZeneca, Alderley Park, Macclesfield SK10 4TF, UK
| | - D R Hodgson
- AstraZeneca, Alderley Park, Macclesfield SK10 4TF, UK
| | - A T Shaw
- Department of Medicine, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA
| | - J R Pereira
- Instituto Brasileiro de Cancerologia Torácica, Rua Dr. Martinico Prado, 26/101, Higienópolis, Sao Paulo 01224-010, Brazil
| | - G Jeannin
- Department of Pneumology, Hôpital Gabriel Montpied, 58 Rue Montalembert, 63000 Clermont-Ferrand, France
| | - J Vansteenkiste
- Department of Pneumology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - C H Barrios
- Department of Medicine, PUCRS School of Medicine, Padre Chagas 66, 203, Porto Alegre RS 90 570 080, Brazil
| | - F A Franke
- CACON, Hospital de Caridade de Ijuí, Avenida David José Martins, 152-Centro, Ijuí RS 98700-000, Brazil
| | - L Crinò
- Department of Oncology, University Medical School Perugia, Piazza Università 1, 06123 Perugia, Italy
| | - P Smith
- AstraZeneca, Alderley Park, Macclesfield SK10 4TF, UK
| |
Collapse
|
11
|
Yonesaka K, Hirotani K, Kawakami H, Takeda M, Kaneda H, Sakai K, Okamoto I, Nishio K, Jänne PA, Nakagawa K. Anti-HER3 monoclonal antibody patritumab sensitizes refractory non-small cell lung cancer to the epidermal growth factor receptor inhibitor erlotinib. Oncogene 2015; 35:878-86. [PMID: 25961915 DOI: 10.1038/onc.2015.142] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/17/2015] [Accepted: 03/23/2015] [Indexed: 11/09/2022]
Abstract
Human epidermal growth factor receptor (HER) 3 is aberrantly overexpressed and correlates with poor prognosis in non-small cell lung cancer (NSCLC). Patritumab is a monoclonal antibody against HER3 that has shown promising results in early-phase clinical trials, but an optimal target population for the drug has yet to be identified. In the present study, we examined whether heregulin, a HER3 ligand that is also overexpressed in a subset of NSCLC, can be used as a biomarker to predict the antitumorigenic efficacy of patritumab and whether the drug can overcome the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) resistance induced by heregulin. Patritumab sensitivity was associated with heregulin expression, which, when abolished, resulted in the loss of HER3 and AKT activation and growth arrest. Furthermore, heregulin overexpression induced EGFR TKI resistance in NSCLC cells harbouring an activating EGFR mutation, while HER3 and AKT activation was maintained in the presence of erlotinib in heregulin-overexpressing, EGFR-mutant NSCLC cells. Sustained HER3-AKT activation was blocked by combining erlotinib with either anti-HER2 or anti-HER3 antibody. Notably, heregulin was upregulated in tissue samples from an NSCLC patient who had an activating EGFR mutation but was resistant to the TKI gefitinib. These results indicate that patritumab can overcome heregulin-dependent EGFR inhibitor resistance in NSCLC in vitro and in vivo and suggest that it can be used in combination with EGFR TKIs to treat a subset of heregulin-overexpressing NSCLC patients.
Collapse
Affiliation(s)
- K Yonesaka
- Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
| | - K Hirotani
- Daiichi-Sankyo Pharmaceutical Development, Tokyo, Japan
| | - H Kawakami
- Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
| | - M Takeda
- Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
| | - H Kaneda
- Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
| | - K Sakai
- Department of Genome Biology, Kinki University School of Medicine, Osaka, Japan
| | - I Okamoto
- Center for Clinical and Translational Research, Kyushu University, Fukuoka, Japan
| | - K Nishio
- Department of Genome Biology, Kinki University School of Medicine, Osaka, Japan
| | - P A Jänne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K Nakagawa
- Department of Medical Oncology, Kinki University School of Medicine, Osaka, Japan
| |
Collapse
|
12
|
Kris MG, Camidge DR, Giaccone G, Hida T, Li BT, O'Connell J, Taylor I, Zhang H, Arcila ME, Goldberg Z, Jänne PA. Targeting HER2 aberrations as actionable drivers in lung cancers: phase II trial of the pan-HER tyrosine kinase inhibitor dacomitinib in patients with HER2-mutant or amplified tumors. Ann Oncol 2015; 26:1421-7. [PMID: 25899785 DOI: 10.1093/annonc/mdv186] [Citation(s) in RCA: 228] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/09/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HER2 mutations and amplifications have been identified as oncogenic drivers in lung cancers. Dacomitinib, an irreversible inhibitor of HER2, EGFR (HER1), and HER4 tyrosine kinases, has demonstrated activity in cell-line models with HER2 exon 20 insertions or amplifications. Here, we studied dacomitinib in patients with HER2-mutant or amplified lung cancers. PATIENTS AND METHODS As a prespecified cohort of a phase II study, we included patients with stage IIIB/IV lung cancers with HER2 mutations or amplification. We gave oral dacomitinib at 30-45 mg daily in 28-day cycles. End points included partial response rate, overall survival, and toxicity. RESULTS We enrolled 30 patients with HER2-mutant (n = 26, all in exon 20 including 25 insertions and 1 missense mutation) or HER2-amplified lung cancers (n = 4). Three of 26 patients with tumors harboring HER2 exon 20 mutations [12%; 95% confidence interval (CI) 2% to 30%] had partial responses lasting 3+, 11, and 14 months. No partial responses occurred in four patients with tumors with HER2 amplifications. The median overall survival was 9 months from the start of dacomitinib (95% CI 7-21 months) for patients with HER2 mutations and ranged from 5 to 22 months with amplifications. Treatment-related toxicities included diarrhea (90%; grade 3/4: 20%/3%), dermatitis (73%; grade 3/4: 3%/0%), and fatigue (57%; grade 3/4: 3%/0%). One patient died on study likely due to an interaction of dacomitinib with mirtazapine. CONCLUSIONS Dacomitinib produced objective responses in patients with lung cancers with specific HER2 exon 20 insertions. This observation validates HER2 exon 20 insertions as actionable targets and justifies further study of HER2-targeted agents in specific HER2-driven lung cancers. CLINICALTRIALSGOV NCT00818441.
Collapse
Affiliation(s)
- M G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York
| | - D R Camidge
- Department of Medical Oncology, University of Colorado Denver, Aurora
| | - G Giaccone
- Lombardi Cancer Center, Georgetown University, Washington, USA
| | - T Hida
- Department of Thoracic Oncology, Aichi Cancer Center, Chikusa-ku Nagoya, Japan
| | - B T Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York
| | | | - I Taylor
- Translational Oncology, Pfizer, Inc., Groton, USA
| | - H Zhang
- Pfizer (China) Research & Development Co. Ltd, Pfizer, Inc., Shanghai, China
| | - M E Arcila
- Molecular Diagnostics Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - Z Goldberg
- Pfizer Oncology, Pfizer, Inc., San Diego
| | - P A Jänne
- Lowe Center for Thoracic Oncology and the Belfer Institute for Applied Cancer Science, Dana Farber Cancer Institute, Boston, USA
| |
Collapse
|
13
|
Ou SHI, Jänne PA, Bartlett CH, Tang Y, Kim DW, Otterson GA, Crinò L, Selaru P, Cohen DP, Clark JW, Riely GJ. Clinical benefit of continuing ALK inhibition with crizotinib beyond initial disease progression in patients with advanced ALK-positive NSCLC. Ann Oncol 2015; 25:415-22. [PMID: 24478318 DOI: 10.1093/annonc/mdt572] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [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: 12/12/2022] Open
Abstract
BACKGROUND Crizotinib is approved to treat advanced ALK-positive non-small-cell lung cancer (NSCLC), but most patients ultimately develop progressive disease (PD). We investigated whether continuing ALK inhibition with crizotinib beyond PD (CBPD) is clinically beneficial and attempted to identify clinicopathologic characteristics associated with patients who experience clinical benefit. PATIENTS AND METHODS Patients with advanced ALK-positive NSCLC enrolled in two ongoing multicenter, single-arm trials who developed RECIST-defined PD were allowed to continue crizotinib if they were deriving ongoing clinical benefit. In the present retrospective analysis, continuation of CBPD was defined as >3 weeks of crizotinib treatment after PD documentation. Patients who had PD as best response to initial crizotinib treatment were excluded. Baseline and post-progression characteristics, sites of PD, and overall survival (OS) were compared in patients who continued CBPD versus those who did not. The impact of continuing CBPD on OS after adjusting for potential confounding factors was assessed. RESULTS Among 194 crizotinib-treated patients with RECIST-defined PD, 120 (62%) continued CBPD. A significantly higher proportion of patients who continued CBPD than patients who did not had an ECOG performance status (PS) of 0/1 at PD (96% versus 82%; P=0.02). CBPD patients had significantly longer OS from the time of PD [median 16.4 versus 3.9 months; hazards ratio (HR) 0.27, 95% confidence interval (CI): 0.17-0.42; P<0.0001] and from the time of initial crizotinib treatment (median 29.6 versus 10.8 months; HR 0.30, 95% CI: 0.19-0.46; P<0.0001). The multiple-covariate Cox regression analysis revealed that CBPD remained significantly associated with improved OS after adjusting for relevant factors. CONCLUSIONS Patients who continued CBPD were more likely to have good ECOG PS (0/1) at the time of PD. Continuing ALK inhibition with crizotinib after PD may provide survival benefit to patients with advanced ALK-positive NSCLC.
Collapse
Affiliation(s)
- S-H I Ou
- Chao Family Comprehensive Cancer Center, University of California at Irvine, Irvine
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Blumenschein GR, Smit EF, Planchard D, Kim DW, Cadranel J, De Pas T, Dunphy F, Udud K, Ahn MJ, Hanna NH, Kim JH, Mazieres J, Kim SW, Baas P, Rappold E, Redhu S, Puski A, Wu FS, Jänne PA. A randomized phase II study of the MEK1/MEK2 inhibitor trametinib (GSK1120212) compared with docetaxel in KRAS-mutant advanced non-small-cell lung cancer (NSCLC)†. Ann Oncol 2015; 26:894-901. [PMID: 25722381 DOI: 10.1093/annonc/mdv072] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/11/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND KRAS mutations are detected in 25% of non-small-cell lung cancer (NSCLC) and no targeted therapies are approved for this subset population. Trametinib, a selective allosteric inhibitor of MEK1/MEK2, demonstrated preclinical and clinical activity in KRAS-mutant NSCLC. We report a phase II trial comparing trametinib with docetaxel in patients with advanced KRAS-mutant NSCLC. PATIENTS AND METHODS Eligible patients with histologically confirmed KRAS-mutant NSCLC previously treated with one prior platinum-based chemotherapy were randomly assigned in a ratio of 2 : 1 to trametinib (2 mg orally once daily) or docetaxel (75 mg/m(2) i.v. every 3 weeks). Crossover to the other arm after disease progression was allowed. Primary end point was progression-free survival (PFS). The study was prematurely terminated after the interim analysis of 92 PFS events, which showed the comparison of trametinib versus docetaxel for PFS crossed the futility boundary. RESULTS One hundred and twenty-nine patients with KRAS-mutant NSCLC were randomized; of which, 86 patients received trametinib and 43 received docetaxel. Median PFS was 12 weeks in the trametinib arm and 11 weeks in the docetaxel arm (hazard ratio [HR] 1.14; 95% CI 0.75-1.75; P = 0.5197). Median overall survival, while the data are immature, was 8 months in the trametinib arm and was not reached in the docetaxel arm (HR 0.97; 95% CI 0.52-1.83; P = 0.934). There were 10 (12%) partial responses (PRs) in the trametinib arm and 5 (12%) PRs in the docetaxel arm (P = 1.0000). The most frequent adverse events (AEs) in ≥20% of trametinib patients were rash, diarrhea, nausea, vomiting, and fatigue. The most frequent grade 3 treatment-related AEs in the trametinib arm were hypertension, rash, diarrhea, and asthenia. CONCLUSION Trametinib showed similar PFS and a response rate as docetaxel in patients with previously treated KRAS-mutant-positive NSCLC. CLINICALTRIALSGOV REGISTRATION NUMBER NCT01362296.
Collapse
Affiliation(s)
- G R Blumenschein
- MD Anderson Cancer Center, The University of Texas, Houston, USA.
| | - E F Smit
- Department of Pulmonary Diseases, Vrije Universiteit VU Medical Centre, Amsterdam, The Netherlands
| | - D Planchard
- Medical Oncology Department, Gustave Roussy (GR), Villejuif, France
| | - D-W Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - J Cadranel
- Department of Respiratory Medicine, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - T De Pas
- European Institute of Oncology, Milan, Italy
| | - F Dunphy
- Duke University Medical Center, Durham, USA
| | - K Udud
- Korányi National Institute of Tuberculosis and Pulmonology, Budapest, Hungary
| | - M-J Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - N H Hanna
- IU Melvin and Bren Simon Cancer Center, Indianapolis, USA
| | - J-H Kim
- Yonsei Cancer Center, Division of Medical Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Mazieres
- Hopital Larrey CHU Toulouse, Toulouse, France
| | - S-W Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - P Baas
- Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - S Redhu
- GlaxoSmithKline, Collegeville, USA
| | - A Puski
- GlaxoSmithKline Kft., Budapest, Hungary
| | - F S Wu
- GlaxoSmithKline, Collegeville, USA
| | - P A Jänne
- Lowe Center for Thoracic Oncology, Belfer Institute for Applied Cancer Science Dana-Farber Cancer Institute, Boston, USA
| |
Collapse
|
15
|
Nishino M, Jackman DM, DiPiro PJ, Hatabu H, Jänne PA, Johnson BE. Revisiting the relationship between tumour volume and diameter in advanced NSCLC patients: An exercise to maximize the utility of each measure to assess response to therapy. Clin Radiol 2014; 69:841-8. [PMID: 24857677 DOI: 10.1016/j.crad.2014.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/12/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
AIM To revisit the presumed relationship between tumour diameter and volume in advanced non-small-cell lung cancer (NSCLC) patients, and determine whether the measured volume using volume-analysis software and its proportional changes during therapy matches with the calculated volume obtained from the presumed relationship and results in concordant response assessment. MATERIALS AND METHODS Twenty-three patients with stage IIIB/IV NSCLC with a total of 53 measurable lung lesions, treated in a phase II trial of erlotinib, were studied with institutional review board approval. Tumour volume and diameter were measured at baseline and at the first follow-up computed tomography (CT) examination using volume-analysis software. Using the measured diameter (2r) and the equation, calculated volume was obtained as (4/3)πr(3) at baseline and at the follow-up. Percent volume change was obtained by comparing to baseline for measured and calculated volumes, and response assessment was assigned. RESULTS The measured volume was significantly smaller than the calculated volume at baseline (median 11,488.9 mm(3) versus 17,148.6 mm(3); p < 0.0001), with a concordance correlation coefficient (CCC) of 0.7022. At follow-up, the measured volume was once again significantly smaller than the calculated volume (median 6573.5 mm(3) versus 9198.1 mm(3); p = 0.0022), with a CCC of 0.7408. Response assessment by calculated versus measured volume changes had only moderate agreement (weighted κ = 0.545), with discordant assessment results in 20% (8/40) of lesions. CONCLUSION Calculated volume based on the presumed relationship significantly differed from the measured volume in advanced NSCLC patients, with only moderate concordance in response assessment, indicating the limitations of presumed relationship.
Collapse
Affiliation(s)
- M Nishino
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., 75 Francis St., Boston, MA 02215, USA.
| | - D M Jackman
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., Boston, MA 02215, USA
| | - P J DiPiro
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., 75 Francis St., Boston, MA 02215, USA
| | - H Hatabu
- Department of Radiology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., 75 Francis St., Boston, MA 02215, USA
| | - P A Jänne
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., Boston, MA 02215, USA
| | - B E Johnson
- Department of Medical Oncology and Department of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 450 Brookline Ave., Boston, MA 02215, USA
| |
Collapse
|
16
|
Vaishnavi A, Capelletti M, Le AT, Kako S, Butaney M, Ercan D, Mahale S, Davies KD, Aisner DL, Pilling AB, Berge EM, Kim J, Sasaki H, Park S, Kryukov G, Garraway LA, Hammerman PS, Haas J, Andrews SW, Lipson D, Stephens PJ, Miller VA, Varella-Garcia M, Jänne PA, Doebele RC. Oncogenic and drug-sensitive NTRK1 rearrangements in lung cancer. Nat Med 2013; 19:1469-1472. [PMID: 24162815 PMCID: PMC3823836 DOI: 10.1038/nm.3352] [Citation(s) in RCA: 454] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 08/15/2013] [Indexed: 12/31/2022]
Abstract
We identified novel gene fusions in patients with lung cancer harboring the kinase domain of the NTRK1 gene that encodes the TRKA receptor. Both the MPRIP-NTRK1 and CD74-NTRK1 fusions lead to constitutive TRKA kinase activity and are oncogenic. Treatment of cells expressing NTRK1 fusions with inhibitors of TRKA kinase activity inhibited autophosphorylation of TRKA and cell growth. Three of 91 lung cancer patients (3.3%), without known oncogenic alterations, assayed by NGS or FISH demonstrated evidence of NTRK1 gene fusions.
Collapse
Affiliation(s)
- A Vaishnavi
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - M Capelletti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - A T Le
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - S Kako
- University of Colorado Cancer Center, Aurora, CO
| | - M Butaney
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - D Ercan
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - S Mahale
- University of Colorado Cancer Center, Aurora, CO
| | - K D Davies
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - D L Aisner
- University of Colorado Cancer Center, Aurora, CO.,Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - A B Pilling
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - E M Berge
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - J Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - H Sasaki
- Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - S Park
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - L A Garraway
- Broad Institute, Cambridge, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Peter S Hammerman
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - J Haas
- Array BioPharma, Boulder, CO
| | | | - D Lipson
- Foundation Medicine, Inc., Boston, MA
| | | | | | - M Varella-Garcia
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.,University of Colorado Cancer Center, Aurora, CO
| | - P A Jänne
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA.,Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA
| | - R C Doebele
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.,University of Colorado Cancer Center, Aurora, CO
| |
Collapse
|
17
|
Cappuzzo F, Jänne PA, Skokan M, Finocchiaro G, Rossi E, Ligorio C, Zucali PA, Terracciano L, Toschi L, Roncalli M, Destro A, Incarbone M, Alloisio M, Santoro A, Varella-Garcia M. MET increased gene copy number and primary resistance to gefitinib therapy in non-small-cell lung cancer patients. Ann Oncol 2008; 20:298-304. [PMID: 18836087 DOI: 10.1093/annonc/mdn635] [Citation(s) in RCA: 246] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND MET amplification has been detected in approximately 20% of non-small-cell lung cancer patients (NSCLC) with epidermal growth factor receptor (EGFR) mutations progressing after an initial response to tyrosine kinase inhibitor (TKI) therapy. PATIENTS AND METHODS We analyzed MET gene copy number using FISH in two related NSCLC cell lines, one sensitive (HCC827) and one resistant (HCC827 GR6) to gefitinib therapy and in two different NSCLC patient populations: 24 never smokers or EGFR FISH-positive patients treated with gefitinib (ONCOBELL cohort) and 182 surgically resected NSCLC not exposed to anti-EGFR agents. RESULTS HCC827 GR6-resistant cell line displayed MET amplification, with a mean MET copy number >12, while sensitive HCC827 cell line had a mean MET copy number of 4. In the ONCOBELL cohort, no patient had gene amplification and MET gene copy number was not associated with outcome to gefitinib therapy. Among the surgically resected patients, MET was amplified in 12 cases (7.3%) and only four (2.4%) had a higher MET copy number than the resistant HCC827 GR6 cell line. CONCLUSIONS MET gene amplification is a rare event in patients with advanced NSCLC. The development of anti-MET therapeutic strategies should be focused on patients with acquired EGFR-TKI resistance.
Collapse
Affiliation(s)
- F Cappuzzo
- Department of Oncology-Hematology, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Koivunen JP, Kim J, Lee J, Rogers AM, Park JO, Zhao X, Naoki K, Okamoto I, Nakagawa K, Yeap BY, Meyerson M, Wong KK, Richards WG, Sugarbaker DJ, Johnson BE, Jänne PA. Mutations in the LKB1 tumour suppressor are frequently detected in tumours from Caucasian but not Asian lung cancer patients. Br J Cancer 2008; 99:245-52. [PMID: 18594528 PMCID: PMC2480968 DOI: 10.1038/sj.bjc.6604469] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Somatic mutations of LKB1 tumour suppressor gene have been detected in human cancers including non-small cell lung cancer (NSCLC). The relationship between LKB1 mutations and clinicopathological characteristics and other common oncogene mutations in NSCLC is inadequately described. In this study we evaluated tumour specimens from 310 patients with NSCLC including those with adenocarcinoma, adenosquamous carcinoma, and squamous cell carcinoma histologies. Tumours were obtained from patients of US (n=143) and Korean (n=167) origin and screened for LKB1, KRAS, BRAF, and EGFR mutations using RT—PCR-based SURVEYOR-WAVE method followed by Sanger sequencing. We detected mutations in the LKB1 gene in 34 tumours (11%). LKB1 mutation frequency was higher in NSCLC tumours of US origin (17%) compared with 5% in NSCLCs of Korean origin (P=0.001). They tended to occur more commonly in adenocarcinomas (13%) than in squamous cell carcinomas (5%) (P=0.066). LKB1 mutations associated with smoking history (P=0.007) and KRAS mutations (P=0.042) were almost mutually exclusive with EGFR mutations (P=0.002). The outcome of stages I and II NSCLC patients treated with surgery alone did not significantly differ based on LKB1 mutation status. Our study provides clinical and molecular characteristics of NSCLC, which harbour LKB1 mutations.
Collapse
Affiliation(s)
- J P Koivunen
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Cappuzzo F, Varella-Garcia M, Finocchiaro G, Skokan M, Gajapathy S, Carnaghi C, Rimassa L, Rossi E, Ligorio C, Di Tommaso L, Holmes AJ, Toschi L, Tallini G, Destro A, Roncalli M, Santoro A, Jänne PA. Primary resistance to cetuximab therapy in EGFR FISH-positive colorectal cancer patients. Br J Cancer 2008; 99:83-9. [PMID: 18577988 PMCID: PMC2453041 DOI: 10.1038/sj.bjc.6604439] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [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: 02/08/2023] Open
Abstract
The impact of KRAS mutations on cetuximab sensitivity in epidermal growth factor receptor fluorescence in situ hybridisation-positive (EGFR FISH+) metastatic colorectal cancer patients (mCRC) has not been previously investigated. In the present study, we analysed KRAS, BRAF, PI3KCA, MET, and IGF1R in 85 mCRC treated with cetuximab-based therapy in whom EGFR status was known. KRAS mutations (52.5%) negatively affected response only in EGFR FISH+ patients. EGFR FISH+/KRAS mutated had a significantly lower response rate (P=0.04) than EGFR FISH+/KRAS wild type patients. Four EGFR FISH+ patients with KRAS mutations responded to cetuximab therapy. BRAF was mutated in 5.0% of patients and none responded to the therapy. PI3KCA mutations (17.7%) were not associated to cetuximab sensitivity. Patients overexpressing IGF1R (74.3%) had significantly longer survival than patients with low IGF1R expression (P=0.006), with no difference in response rate. IGF1R gene amplification was not detected, and only two (2.6%) patients, both responders, had MET gene amplification. In conclusion, KRAS mutations are associated with cetuximab failure in EGFR FISH+ mCRC, even if it does not preclude response. The rarity of MET and IGF1R gene amplification suggests a marginal role in primary resistance. The potential prognostic implication of IGF1R expression merits further evaluation.
Collapse
Affiliation(s)
- F Cappuzzo
- Department of Medical Oncology, Istituto Clinico Humanitas IRCCS, Milan University, Rozzano, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Holmes A, Joshi VA, Kuang Y, Rogers A, Jänne PA. Comparison of genotyping with direct sequencing as a method to detect EGFR mutations in NSCLC. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.22013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
21
|
Wu Y, Mok TS, Chen H, Zhang X, Guo A, Jänne PA. T790M mutation and c-MET amplification might be correlated to TTP of EGFR-TKI in NSCLC. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
22
|
Cappuzzo F, Finocchiaro G, Rossi E, Jänne PA, Carnaghi C, Calandri C, Bencardino K, Ligorio C, Ciardiello F, Pressiani T, Destro A, Roncalli M, Crino L, Franklin WA, Santoro A, Varella-Garcia M. EGFR FISH assay predicts for response to cetuximab in chemotherapy refractory colorectal cancer patients. Ann Oncol 2007; 19:717-23. [PMID: 17974556 DOI: 10.1093/annonc/mdm492] [Citation(s) in RCA: 229] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Standardized conditions to distinguish subpopulations of colorectal cancer (CRC) patients more and less sensitive to cetuximab therapy remain undefined. MATERIALS AND METHODS We retrospectively analyzed epidermal growth factor receptor (EGFR) copy number by fluorescence in situ hybridization (FISH) in paraffin-embedded tumor blocks from 85 chemorefractory CRC patients treated with cetuximab. Results were analyzed according to different score systems previously reported in colorectal and lung cancers. The primary end point of the study was identification of the EGFR FISH score that best associates with response rate (RR). RESULTS Using receiver operating characteristic (ROC) analysis, the cut-off that best discriminated responders versus nonresponders to cetuximab was a mean of 2.92 EGFR gene copies per cell. This model showed sensitivity of 58.6% [95% confidence interval (CI) = 47.1-70.1) and specificity of 93.3% (95% CI = 80.6-100). EGFR FISH-positive patients (N = 43, 50.6%) had significantly higher RR (P = 0.0001) and significantly longer time to disease progression (P = 0.02) than EGFR FISH negative (N = 42, 49.4%). Other scoring systems resulted less accurate in discriminating patients with the highest likelihood of response to cetuximab therapy. CONCLUSIONS CRC patients with high EGFR gene copy number have an increased likelihood to respond to cetuximab therapy. Prospective clinical trials with a careful standardization of assay conditions and pattern interpretation are urgently needed.
Collapse
Affiliation(s)
- F Cappuzzo
- Department of Medical Oncology, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Toschi L, Cappuzzo F, Jänne PA. Evolution and future perspectives in the treatment of locally advanced non-small cell lung cancer. Ann Oncol 2007; 18 Suppl 9:ix150-5. [PMID: 17631569 DOI: 10.1093/annonc/mdm311] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Agents/therapeutic use
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Non-Small-Cell Lung/therapy
- Clinical Trials, Phase II as Topic
- Clinical Trials, Phase III as Topic
- Combined Modality Therapy
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Lung Neoplasms/surgery
- Lung Neoplasms/therapy
- Neoplasm Staging
- Preoperative Care
- Prognosis
- Radiography
- Randomized Controlled Trials as Topic
- Survival Analysis
- Treatment Outcome
Collapse
Affiliation(s)
- L Toschi
- Istituto Clinico Humanitas, Department of Oncology and Hematology, Rozzano, Italy
| | | | | |
Collapse
|
24
|
Finocchiaro G, Cappuzzo F, Jänne PA, Bencardino K, Carnaghi C, Franklin WA, Roncalli M, Crinò L, Santoro A, Varella-Garcia M. EGFR, HER2 and Kras as predictive factors for cetuximab sensitivity in colorectal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4021 Background: In colorectal cancer, biological mechanisms underlying response or resistance to cetuximab, a monoclonal antibody against the extracellular domain of the EGFR are not defined. Small retrospective studies suggested that EGFR increased gene copy number measured by fluorescence in situ hybridization (FISH) or presence of KRAS mutations were associated with cetuximab response or resistance, respectively. This study aimed to identify biological predictors for sensitivity/resistance to cetuximab treatment in colorectal cancer. We also compared biomarker results in primary tumors and corresponding metastases. Methods: We analyzed EGFR (IHC, FISH), HER2 (FISH), and KRAS (mutation) in paraffin embedded tumor blocks from 85 colorectal cancer patients treated with cetuximab. For FISH analyses, a positive result was defined according to criteria described in breast (Wolff et al. J Clin Oncol 2007), lung (Cappuzzo et al. JNCI 2005) and colorectal cancer (Moroni et al. Lancet Oncology 2005). EGFR, HER2 and PIK3CA mutation analyses are ongoing. Results: EGFR FISH positive patients (N=41), defined as ratio EGFR/nucleus =3, had a significantly higher RR (29.3% versus 6.8%, p=0.007) and TTP (6.6 versus 3.7 months, p=0.053) than EGFR FISH negative (N=44). No difference for clinical endpoints was observed using other scoring systems. EGFR expression assessed by IHC was not associated with any clinical end-point. Increased HER2 gene copy number was associated with shorter TTP (p=0.09) and survival (p=0.03). Compared to patients with wild type KRAS (N=49), KRAS mutation carriers (N=32) had a significantly lower RR (6.3% versus 26.5%, p= 0.02), shorter TTP (3.7 versus 6.3 months, p=0.07) and shorter survival (8.3 versus 10.8 months, p=0.2). In 22 patients with available primary and metastatic tumor tissue, there was no difference between these sites for EGFR FISH, HER2 FISH and KRAS results. Conclusions: This study, the largest biomarker analysis in colorectal cancer patients treated with cetuximab, shows a significant benefit in response and TTP for EGFR FISH positive patients. KRAS mutation analysis identifies a group of patients with the lowest chance to benefit from the therapy. Increased HER2 gene copy number predicts early escape from cetuximab therapy. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- G. Finocchiaro
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - F. Cappuzzo
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - P. A. Jänne
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - K. Bencardino
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - C. Carnaghi
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - W. A. Franklin
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - M. Roncalli
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - L. Crinò
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - A. Santoro
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| | - M. Varella-Garcia
- Istituto Clinico Humanitas IRCCS, Rozzano, Italy; Dana-Farber Cancer Institute, Boston, MA; Policlinico S. Matteo, Pavia, Italy; Colorado Cancer Center, Aurora, CO; Ospedale Silvestrini, Perugia, Italy
| |
Collapse
|
25
|
Sequist LV, Martins RG, Spigel D, Grunberg SM, Jänne PA, McCollum D, Spira A, Evans T, Johnson BE, Lynch TJ. iTARGET: A phase II trial to assess the response to gefitinib in epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) tumors. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7504 Background: Somatic EGFR mutations correlate with increased response and survival in NSCLC patients (pts) treated with gefitinib. We conducted the 1st prospective US trial of 1st-line gefitinib in pts with advanced NSCLC harboring EGFR mutations. Methods: Chemotherapy-naïve pts with stage IIIB with effusion or IV NSCLC, measurable disease, and = 1 characteristic associated with mutations (female (F), adenocarcinoma (AC), never-smoking (NS), East Asian (EA)) underwent direct DNA sequencing of tumor tissue EGFR exons 18–24. Mutation-positive pts received gefitinib (250 mg/d) until progression or unacceptable toxicity. The primary outcome was response rate (RR) by RECIST criteria. Results: We sequenced 98 pts and detected EGFR mutations in 34 (35%); 3 were not assessable. Observed mutations were 18 (53%) exon 19 deletions (del), 9 (26%) L858R, 3 (9%) exon 20 insertions (ins), 2 T790M/L858R, 1 G719A, and 1 L861Q. Characteristics of the 98 screened pts were 69 F, 89 AC, 37 NS, and 5 EA; those of the 34 mutation pts were 20 (59%) F, 31 (91%) AC, 19 (56%) NS and 2 (6%) EA. The best predictor of EGFR mutation was NS. Of the 34 mutation pts, 31 (91%) received gefinitib. Reasons for non-treatment were pt preference (1 exon 19 del) and mutation associated with gefitinib-resistance (1 T790M/L858R, 1 exon 20 ins). Adverse events were mainly grade 1–2 rash and diarrhea; 1 case of grade 4 interstitial lung disease occurred after 2 weeks of therapy. The RR was 58% (95% confidence interval 39–75) and was 78% in L858R pts and 65% in del 19 pts. There were no responses among the G719A, L861Q, T790M/L858R and exon 20 ins pts treated. 12 pts have progressed, 18 remain on therapy. The median progression-free survival (PFS) is currently 11.8 mo and does not differ by mutation type, though follow-up is short (median 6.8 mo, range 1–24). 27 pts are still alive. Of the 31 pts treated, 22 (71%) had high EGFR gene copy number (amplification (3) or high polysomy (19)); RR and PFS did not vary by copy number. Conclusions: 1st-line gefitinib therapy in EGFR mutation-positive NSCLC pts is feasible in a multi-institutional study, well tolerated, and yields a substantial RR and PFS. This strategy should be compared to standard chemotherapy in a genotype-directed randomized trial. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- L. V. Sequist
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - R. G. Martins
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - D. Spigel
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - S. M. Grunberg
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - P. A. Jänne
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - D. McCollum
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - A. Spira
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - T. Evans
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - B. E. Johnson
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| | - T. J. Lynch
- Massachusetts General Hospital Cancer Center, Boston, MA; University of Washington, Seattle, WA; Sarah Cannon Cancer Center, Nashville, TN; University of Vermont, Burlington, VT; Dana-Farber Cancer Institute, Boston, MA; Texas Oncology and Baylor Sammons Cancer Center, Dallas, TX; Fairfax Northern Virginia Hematology Oncology, Fairfax, VA; University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
26
|
Thomas RK, Nickerson E, Simons JF, Jänne PA, Tengs T, Yuza Y, Garraway LA, LaFramboise T, Lee JC, Shah K, O'Neill K, Sasaki H, Lindeman N, Wong KK, Borras AM, Gutmann EJ, Dragnev KH, DeBiasi R, Chen TH, Glatt KA, Greulich H, Desany B, Lubeski CK, Brockman W, Alvarez P, Hutchison SK, Leamon JH, Ronan MT, Turenchalk GS, Egholm M, Sellers WR, Rothberg JM, Meyerson M. Erratum: Sensitive mutation detection in heterogeneous cancer specimens by massively parallel picoliter reactor sequencing. Nat Med 2006. [DOI: 10.1038/nm1006-1220a] [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: 11/09/2022]
|
27
|
Sequist LV, Joshi VA, Jänne PA, Fidias P, Muzikansky A, Meyerson M, Haber DA, Kucherlapati R, Johnson BE, Lynch TJ. Epidermal growth factor receptor ( EGFR) mutation testing in non-small cell lung cancer (NSCLC) patients (pts). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7177] [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
7177 Background: Somatic mutations in EGFR are associated with response to therapy and prolonged overall survival (OS) of NSCLC pts treated with tyrosine kinase inhibitors (TKI). We began EGFR mutation screening in 2004 with a CLIA certified test. We determined the characteristics of pts tested, EGFR mutations identified, and analyzed response to therapy and OS. Methods: We performed a retrospective cohort study of all NSCLC pts referred for EGFR testing over 1 year. Samples underwent direct sequence analysis of EGFR exons 18–24. We used multivariable logistic regression models to examine associations between mutation and pt characteristics. We used chi-square tests to assess differences in response to therapy by EGFR status and analyzed OS with Cox proportional hazard models, adjusting for age, gender and stage. Results: We screened 269 NSCLC pts for EGFR mutations, including 188 (71%) with unresectable disease and 245 (91%) with adenocarcinoma. Mutations were identified in 62 (23%) pts. 15 samples (6%) yielded insufficient DNA for testing. Mutation was more likely in the 59 never-smokers compared to the 185 ever-smokers [odds ratio (OR) 4.8, 95% confidence interval (CI) 2.5–9.2]. Each added pack-year of smoking history lowered the odds of mutation by 5% (OR 0.95, 95% CI 0.94–0.97). Mutation was more likely in the 12 Asians than in the 212 of all other races (OR 3.7, 95% CI 1.1–12.0). In multivariable analyses, pack-years of smoking remained predictive of mutation (OR 0.96, 95% CI 0.94–0.99). Among 44 pts with unresectable disease undergoing subsequent TKI therapy, the 20 EGFR positive pts had an increased response rate (RR) compared to the 24 EGFR negative pts (60% v. 4%, p < 0.0001). In 27 pts given subsequent chemotherapy, RR was 33% and did not differ by EGFR status. Median follow-up was 9.8 months (mo) (range 0.2–135.8 mo). Among pts with unresectable disease, median OS is estimated to be 22.7 mo in EGFR negative pts and is not reached in EGFR positive pts (HR 0.22, 95% CI 0.80–0.63). Conclusions: Sequencing EGFR for somatic mutations is feasible in routine care of NSCLC pts. 23% of screened pts tested positive, and never smoking was the strongest predictor of mutation. Among patients with unresectable disease, EGFR mutation was associated with an increased RR to TKI therapy and OS. [Table: see text]
Collapse
Affiliation(s)
- L. V. Sequist
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - V. A. Joshi
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - P. A. Jänne
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - P. Fidias
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - A. Muzikansky
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Meyerson
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D. A. Haber
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - R. Kucherlapati
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - B. E. Johnson
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - T. J. Lynch
- Massachusetts General Hospital, Boston, MA; Laboratory for Molecular Medicine, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
28
|
Jänne PA, Rodriguez-Thompson D, Metcalf DR, Swanson SJ, Greisman HA, Wilkins-Haug L, Johnson BE. Chemotherapy for a patient with advanced non-small-cell lung cancer during pregnancy: a case report and a review of chemotherapy treatment during pregnancy. Oncology 2002; 61:175-83. [PMID: 11574771 DOI: 10.1159/000055371] [Citation(s) in RCA: 43] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer death in women in the USA. Lung cancer arising during pregnancy is rare and has been reported only 15 times since the 1950s. However, the use of chemotherapy for lung cancer during pregnancy has not previously been reported. METHODS The history, treatment and outcome of a patient with stage IV non-small-cell lung carcinoma (NSCLC) diagnosed during pregnancy is presented. Previous published reports on lung cancer were retrieved by a literature search of Medline and Cancerlit. RESULTS A 31-year-old woman was diagnosed as having stage IV NSCLC with bilateral pulmonary involvement when 26 weeks pregnant. Her shortness of breath progressed to dyspnea at rest on 100% inspired oxygen. Therefore, she was treated with systemic chemotherapy using cisplatin and vinorelbine. Despite this treatment, her oxygenation declined further over the next 4 days and thus the baby was delivered via cesarean section after 27 weeks of gestation. Four cycles of vinorelbine and cisplatin have now been administered. Following this treatment, the patient has experienced a significant clinical improvement and no longer requires supplemental oxygen. No chemotherapy-related adverse effects have been noted in the baby. In the 15 previously reported patients with concurrent lung cancer and pregnancy, chemotherapy administration during pregnancy has not been described. CONCLUSIONS Treatment of lung cancer with chemotherapy during pregnancy should be considered on an individual basis with regard to the stage of the cancer and the maturity of the fetus. To our knowledge, the case presented here is the first report of a woman receiving chemotherapy for lung cancer while pregnant.
Collapse
Affiliation(s)
- P A Jänne
- Department of Adult Oncology, Lowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, Mass. 02115, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Hellsten E, Evans JP, Bernard DJ, Jänne PA, Nussbaum RL. Disrupted sperm function and fertilin beta processing in mice deficient in the inositol polyphosphate 5-phosphatase Inpp5b. Dev Biol 2001; 240:641-53. [PMID: 11784089 DOI: 10.1006/dbio.2001.0476] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Inpp5b is an ubiquitously expressed type II inositol polyphosphate 5-phosphatase. We have disrupted the Inpp5b gene in mice and found that homozygous mutant males are infertile. Here we examine the causes for the infertility in detail. We demonstrate that sperm from Inpp5b(-/-) males have reduced motility and reduced ability to fertilize eggs, although capacitation and acrosome exocytosis appear to be normal. In addition, fertilin beta, a sperm surface protein involved in sperm-egg membrane interactions that is normally proteolytically processed during sperm transit through the epididymis, showed reduced levels of processing in the Inpp5b(-/-) animals. Inpp5b was expressed in the Sertoli cells and epididymis and at low levels in the developing germ cells; however, mice lacking Inpp5b in spermatids and not in other cell types generated by conditional gene targeting, were fully fertile. The abnormalities in mutant sperm function and maturation appear to arise from defects in the functioning of Sertoli and epididymal epithelial cells. Our results directly demonstrate a previously unknown role for phosphoinositides in normal sperm maturation beyond their previously characterized involvement in the acrosome reaction. Inpp5b(-/-) mice provide an excellent model to study the role of Sertoli and epididymal epithelial cells in the differentiation and maturation of sperm.
Collapse
Affiliation(s)
- E Hellsten
- Genetic Diseases Research Branch, National Human Genome Research Institute, Bethesda, Maryland 20892, USA
| | | | | | | | | |
Collapse
|
30
|
Affiliation(s)
- P A Jänne
- Departments of Adult Oncology, Medicine, Radiology, and Pathology, Dana-Farber Cancer Institute, Brigham and Woman's Hospital, and Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|
31
|
Affiliation(s)
- P A Jänne
- Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
| | | |
Collapse
|
32
|
Jänne PA, Datta MW, Johnson BE. Lung cancer presenting with solitary bone metastases. Case 2: acrometastasis as an initial presentation of non-small-cell lung carcinoma. J Clin Oncol 1999; 17:2998-3001. [PMID: 10561378 DOI: 10.1200/jco.1999.17.9.2998] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P A Jänne
- Lowe Center for Thoracic Oncology, Department of Adult Oncology, Dana Farber Cancer Institute, and Departments of Pathology and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | |
Collapse
|
33
|
Jänne PA, Suchy SF, Bernard D, MacDonald M, Crawley J, Grinberg A, Wynshaw-Boris A, Westphal H, Nussbaum RL. Functional overlap between murine Inpp5b and Ocrl1 may explain why deficiency of the murine ortholog for OCRL1 does not cause Lowe syndrome in mice. J Clin Invest 1998; 101:2042-53. [PMID: 9593760 PMCID: PMC508792 DOI: 10.1172/jci2414] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The oculocerebrorenal syndrome of Lowe (OCRL) is an X-linked human genetic disorder characterized by mental retardation, congenital cataracts, and renal tubular dysfunction. The Lowe syndrome gene, OCRL1, encodes a phosphatidylinositol 4,5-bisphosphate 5-phosphatase in the Golgi complex. The pathogenesis of Lowe syndrome due to deficiency of a phosphatidylinositol 4,5-bisphosphate 5-phosphatase in the Golgi complex is unknown. We have used targeted disruption in embryonic stem cells to make mice deficient in Ocrl1, the mouse homologue for OCRL1, as an animal model for the disease. Surprisingly, mice deficient in Ocrl1 do not develop the congenital cataracts, renal Fanconi syndrome, or neurological abnormalities seen in the human disorder. We hypothesized that Ocrl1 deficiency is complemented in mice by inositol polyphosphate 5-phosphatase (Inpp5b), an autosomal gene that encodes a phosphatidylinositol bisphosphate 5-phosphatase highly homologous to Ocrl1. We created mice deficient in Inpp5b; the mice were viable and fertile without phenotype except for testicular degeneration in males beginning after sexual maturation. We crossed mice deficient in Ocrl1 to mice deficient in Inpp5b. No liveborn mice or embryos lacking both enzymes were found, demonstrating that Ocrl1 and Inpp5b have overlapping functions in mice and suggesting that the lack of phenotype in Ocrl1-deficient mice may be due to compensating Inpp5b function.
Collapse
Affiliation(s)
- P A Jänne
- Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19102, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
The oculocerebrorenal syndrome of Lowe (OCRL; McKusick 309,000) is a rare X-linked disorder characterized by mental retardation, congenital cataracts, and Fanconi syndrome of the proximal renal tubules. We have carried out physical mapping of the OCRL1 gene and determined that it contains 24 exons occupying 58 kb. The gene, located in Xq25-26, is transcribed in a centromeric to telomeric direction. Primers have been developed that allow all coding exons and their intron/exon boundaries to be amplified from genomic DNA for mutation detection. Two tetranucleotide tandem repeat polymorphisms were characterized that immediately flank the OCRL1 gene and, together, are informative in over 90% of females. Variable splicing was seen in the OCRL1 transcript, involving a small 24-bp exon. These results should prove useful to medical and molecular geneticists studying mutations and providing DNA diagnostic services to families dealing with Lowe syndrome as well as to cell biologists interested in structure-function relationships for the OCRL1 protein.
Collapse
Affiliation(s)
- R L Nussbaum
- Laboratory of Genetic Disease Research, National Center for Human Genome Research, NIH, Bethesda, MD 20892-4472, USA.
| | | | | | | | | |
Collapse
|
35
|
Danoff TM, Chiang M, Jänne PA, Neilson EG. Screening for homologous recombination in ES cells using RT-PCR. Biotechniques 1997; 22:22-4, 26. [PMID: 8994638 DOI: 10.2144/97221bm02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- T M Danoff
- University of Pennsylvania, Philadelphia 19104-6144, USA.
| | | | | | | |
Collapse
|
36
|
Olivos-Glander IM, Jänne PA, Nussbaum RL. The oculocerebrorenal syndrome gene product is a 105-kD protein localized to the Golgi complex. Am J Hum Genet 1995; 57:817-23. [PMID: 7573041 PMCID: PMC1801524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The oculocerebrorenal syndrome of Lowe (OCRL) is a multisystem disorder affecting the lens, kidney, and CNS. The predicted amino acid sequence of the OCRL gene, OCRL-1, was used to develop antibodies against the OCRL-1 protein. Western blot analysis using affinity-purified serum against the amino terminus of the OCRL-1 gene product (ocrl-1) demonstrates a single protein of 105 kD in fibroblasts of a normal individual that is absent in fibroblasts of an OCRL patient who lacks OCRL-1 transcript. A single protein with the same electrophoretic mobility is found by western analysis in various human cultured cell lines, and approximately the same size protein is also found in all mouse tissues tested. Northern analysis of various human and mouse tissues demonstrate that OCRL-1 transcript is expressed in nearly all tissues examined. By immunofluorescence, the ocrl-1 antibody stains a juxtanuclear region in normal fibroblast cells, while no specific staining is evident in the OCRL patient who produces no transcript. Colocalization of the ocrl-1 protein to the Golgi complex was demonstrated using a known monoclonal antibody against a Golgi-specific coat protein, beta-COP (beta coatomer protein).
Collapse
|
37
|
Jänne PA, Rochelle JM, Martin-DeLeon PA, Stambolian D, Seldin MF, Nussbaum RL. Mapping of the 75-kDa inositol polyphosphate-5-phosphatase (Inpp5b) to distal mouse chromosome 4 and its exclusion as a candidate gene for dysgenetic lens. Genomics 1995; 28:280-5. [PMID: 8530037 DOI: 10.1006/geno.1995.1142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We have determined the chromosomal localization of the murine gene encoding a 75-kDa inositol polyphosphate-5-phosphatase (Inpp5b). Using two independent approaches, fluorescence in situ hybridization and interspecific backcross analysis, we show that Inpp5b maps to distal mouse Chromosome 4. This map position is within the conserved linkage group corresponding to the short arm of human Chromosome 1, where the human homologue, INPP5B, has been shown to map previously. The position of Inpp5b on mouse Chromosome 4 is in the vicinity of the mouse developmental mutation dysgenetic lens (dyl). However, using a genetic approach, we show that Inpp5b maps distal to dyl on mouse Chromosome 4.
Collapse
Affiliation(s)
- P A Jänne
- Department of Genetics, University of Pennsylvania, School of Medicine, Philadelphia, USA
| | | | | | | | | | | |
Collapse
|
38
|
Jänne PA, Dutra AS, Dracopoli NC, Charnas LR, Puck JM, Nussbaum RL. Localization of the 75-kDa inositol polyphosphate-5-phosphatase (INPP5B) to human chromosome band 1p34. Cytogenet Cell Genet 1994; 66:164-6. [PMID: 8125013 DOI: 10.1159/000133691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The 75-kDa (type II) inositol polyphosphate-5-phosphatase, originally described in platelets, is one of at least three known enzymes capable of dephosphorylating inositol-1,4,5-trisphosphate (IP3) to inositol-1,4-bisphosphate (IP2). To further characterize these enzymatic forms, we have mapped the gene (INPP5B) coding for the 75-kDa type II enzyme. Using a combination of human x rodent somatic cell hybrids and fluorescence in situ hybridization, we have determined that this gene maps to human chromosome band 1p34.
Collapse
Affiliation(s)
- P A Jänne
- Department of Genetics, University of Pennsylvania, School of Medicine, Philadelphia
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Choroideremia is an X chromosome-linked retinal dystrophy of unknown pathogenesis. We have isolated cDNAs from a human retinal library with a genomic probe located at the X chromosomal breakpoint in a female with choroideremia and an X;13 translocation. This cDNA spans the breakpoint in the X;13 translocation female and is deleted in males who have choroideremia as part of a complex phenotype including mental retardation and deafness. However, this cDNA detects no alterations in the DNA of 34 males with isolated choroideremia. Nonetheless, the cDNA does detect reduced or absent levels of mRNA in three-quarters of male patients with an apparently intact gene. These data support the hypothesis that this cDNA represents the gene in which mutations cause choroideremia.
Collapse
Affiliation(s)
- D E Merry
- Department of Human Genetics, University of Pennsylvania School of Medicine, Philadelphia 19104
| | | | | | | | | |
Collapse
|
40
|
Huang LS, Jänne PA, de Graaf J, Cooper M, Deckelbaum RJ, Kayden H, Breslow JL, Decklebaum RJ. Exclusion of linkage between the human apolipoprotein B gene and abetalipoproteinemia. Am J Hum Genet 1990; 46:1141-8. [PMID: 2339706 PMCID: PMC1683822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abetalipoproteinemia (ABLP) is a rare autosomal recessive disease characterized by a lack of plasma apolipoprotein B (apo B). In this report, the hypothesis that ABLP is due to rare mutations in the apo B gene was tested. A total of eight ABLP families were studied. Apo B gene RFLPs were used to establish the haplotypes of the apo B alleles in family members. LOD score analysis was used to study the linkage between the apo B alleles and ABLP. These families were categorized arbitrarily as class I, II, III, or IV because of differences in the results derived from both haplotyping and LOD score analysis. In a class I family, affected siblings, who on the basis of the hypothesis would be expected to have the same apo B alleles, had different ones. LOD score analysis of this family gave an infinite negative number at a recombination fraction (theta) of zero. In two class II families, probands who were the result of consanguineous marriages and who, on the basis of the hypothesis, should be homozygotes for a defective apo B allele, were heterozygotes at this locus. The sum of the LOD scores from these two families was -1.7 at theta = 0. In one class III family, a parent was apparently homozygous for a particular apo B allele and yet not affected. This also contributed negatively to the LOD score. In four class IV families, disease inheritance was compatible with segregation of the apo B alleles. This, however, was not statistically significant (LOD score = 0.97 at theta = 0).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- L S Huang
- Laboratory of Biochemical Genetics and Metabolism, Rockefeller University, New York, NY 10021
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Hickok NJ, Seppänen PJ, Kontula KK, Jänne PA, Bardin CW, Jänne OA. Two ornithine decarboxylase mRNA species in mouse kidney arise from size heterogeneity at their 3' termini. Proc Natl Acad Sci U S A 1986; 83:594-8. [PMID: 3456155 PMCID: PMC322910 DOI: 10.1073/pnas.83.3.594] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Ornithine decarboxylase (OrnDCase; L-ornithine carboxy-lyase, EC 4.1.1.17) mRNA present in mouse kidney comprises two species with molecular sizes of approximately 2.2 and approximately 2.7 kilobases (kb). cDNA clones prepared from murine kidney OrnDCase mRNA were used to determine the reason for the size heterogeneity of these mRNAs. Two of the cDNA clones (pODC16 and pODC74) that differed at the 3' termini were isolated and sequenced. DNA sequencing indicated that each cDNA had a poly(A) tail; however, pODC74 was 429 nucleotides longer than pODC16 at the 3' end and contained two AATAAA signals for poly(A) addition. That the longer cDNA corresponded to the larger mRNA was confirmed by hybridization of a unique Pst I/Pst I fragment from the 3' terminus of pODC74 only to the 2.7-kb OrnDCase mRNA. The two cDNAs did not represent full-length copies of OrnDCase mRNAs and were 1199 (pODC16) and 1204 base pairs (bp) (pODC74) long. There were five mismatches in their 759-bp-long overlapping nucleotide sequence, suggesting that the 2.2- and 2.7-kb OrnDCase mRNAs may be products of two separate, yet very similar, OrnDCase genes. Androgen regulation of the accumulation of these two OrnDCase mRNAs appeared to occur coordinately, as testosterone administration brought about comparable increases in their concentrations in mouse kidney.
Collapse
|