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Kim HR, Awad MM, Navarro A, Gottfried M, Peters S, Csőszi T, Cheema PK, Rodriguez-Abreu D, Wollner M, Yang JCH, Mazieres J, Orlandi FJ, Luft A, Gümüş M, Kato T, Kalemkerian GP, Luo Y, Santorelli ML, Pietanza MC, Rudin CM. Patient-Reported Health-Related Quality of Life in KEYNOTE-604: Pembrolizumab or Placebo Added to Etoposide and Platinum as First-Line Therapy for Extensive-Stage SCLC. JTO Clin Res Rep 2023; 4:100572. [PMID: 37954964 PMCID: PMC10637979 DOI: 10.1016/j.jtocrr.2023.100572] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction In the phase 3 KEYNOTE-604 study (NCT03066778), pembrolizumab plus etoposide and platinum chemotherapy (EP) significantly (p = 0.0023) improved progression-free survival versus placebo plus EP in previously untreated extensive-stage SCLC (ES-SCLC). We present health-related quality of life (HRQoL) results from KEYNOTE-604. Methods Patients with stage IV SCLC were randomized 1:1 to pembrolizumab 200 mg or placebo every 3 weeks for 35 cycles plus four cycles of EP. Secondary end points included mean change from baseline to week 18 in the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (QLQ-C30) global health status/quality of life (GHS/QoL) scale and time to deterioration in the composite outcome of cough, chest pain, or dyspnea from QLQ-C30 and QLQ-Lung Cancer Module 13. Two-sided, nominal p values are reported. Results A total of 439 patients completed at least one QLQ-C30 and QLQ-Lung Cancer Module 13 assessment (pembrolizumab + EP, n = 221; placebo + EP, n = 218). GHS/QoL scores improved from baseline to week 18: least squares mean (95% confidence interval [CI]) changes were 8.7 (5.3-12.1) for pembrolizumab plus EP and 4.2 (0.9-7.5) for placebo plus EP. Between-group differences in least squares mean scores were improved for pembrolizumab plus EP (4.4 [95% CI: 0.2-8.7], p = 0.040]). Median time to deterioration for the composite end point was not reached and 8.7 (95% CI: 5.9-not reached) months, respectively (hazard ratio = 0.80 [95% CI: 0.56-1.14], p = 0.208). Conclusions First-line pembrolizumab plus EP therapy maintained HRQoL in patients with ES-SCLC and may be associated with greater improvement than placebo plus EP. Together with the efficacy and safety findings in KEYNOTE-604, HRQoL data support the benefit of pembrolizumab in ES-SCLC.
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Affiliation(s)
- Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Mark M. Awad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Alejandro Navarro
- Clinical Research Department (VHIO) and Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maya Gottfried
- Oncology Department, Meir Medical Center, Kfar-Saba, Israel
| | - Solange Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Tibor Csőszi
- Department of Oncology, Hetenyi G Korhaz Onkologiai Kozpont, Szolnok, Hungary
| | - Parneet K. Cheema
- Division of Medical Oncology, William Osler Health System, University of Toronto, Brampton, Ontario, Canada
| | - Delvys Rodriguez-Abreu
- Medical Oncology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Mirjana Wollner
- Department of Medical Oncology, Rambam Medical Center, Haifa, Israel
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital and Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Julien Mazieres
- Department of Thoracic Oncology, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Department of Oncology No. 1 (Thoracic Surgery), Leningrad Regional Clinical Hospital, St. Petersburg, Russia
| | - Mahmut Gümüş
- Department of Medical Oncology, Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | - Terufumi Kato
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Gregory P. Kalemkerian
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Yiwen Luo
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., Rahway, New Jersey
| | - Melissa L. Santorelli
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, New Jersey
| | | | - Charles M. Rudin
- Department of Medicine, Thoracic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Farid-Kapadia M, Barton M, Bider-Canfield Z, Cheema PK, Gyawali B, Nightingale NM, Latifovic L, Conter HJ. Comparison of tumor-agnostic and tumor-specific clinical oncology trial designs: a systematic review and meta-analysis. Future Oncol 2023; 19:1741-1752. [PMID: 37283038 DOI: 10.2217/fon-2022-0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Aim: To examine whether tumor-specific and tumor-agnostic oncology trials produce comparable estimates of objective response rate (ORR) in BRAF-altered cancers. Materials & methods: Electronic database searches were performed to identify phase I-III clinical trials testing tyrosine kinase inhibitors from 2000 to 2021. A random-effects model was used to pool ORRs. A total of 22 cohorts from five tumor-agnostic trials and 41 cohorts from 27 tumor-specific trials had published ORRs. Results: There was no significant difference between pooled ORRs from either trial design for multitumor analyses (37 vs 50%; p = 0.05); thyroid cancer (57 vs 33%; p = 0.10); non-small-cell lung cancer (39 vs 53%; p = 0.18); or melanoma (55 vs 51%; p = 0.58). Conclusion: For BRAF-altered advanced cancers, tumor-agnostic trials do not yield substantially different results from tumor-specific trials.
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Affiliation(s)
- Mufiza Farid-Kapadia
- Hoffmann-La Roche Limited, 7070 Mississauga Road, Mississauga, ON, L5N 5M8, Canada
| | - Madelyn Barton
- Hoffmann-La Roche Limited, 7070 Mississauga Road, Mississauga, ON, L5N 5M8, Canada
| | - Zoe Bider-Canfield
- Hoffmann-La Roche Limited, 7070 Mississauga Road, Mississauga, ON, L5N 5M8, Canada
| | - Parneet K Cheema
- William Osler Health System, 2100 Bovaird Drive East, Brampton, ON, L6R 3J7, Canada
| | - Bishal Gyawali
- Queens University, 15 Arch Street, Kingston, ON, K7L 3L4, Canada
| | | | - Lidija Latifovic
- IQVIA Solutions Canada, 1875 Buckhorn Gate, Mississauga, ON, L4W 5P1, Canada
| | - Henry J Conter
- Hoffmann-La Roche Limited, 7070 Mississauga Road, Mississauga, ON, L5N 5M8, Canada
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3
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Cheema PK, Banerji SO, Blais N, Chu QSC, Juergens RA, Leighl NB, Sacher A, Sheffield BS, Snow S, Vincent M, Wheatley-Price PF, Yip S, Melosky BL. Canadian Consensus Recommendations on the Management of KRAS G12C-Mutated NSCLC. Curr Oncol 2023; 30:6473-6496. [PMID: 37504336 PMCID: PMC10377814 DOI: 10.3390/curroncol30070476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Activating mutations in Kirsten rat sarcoma viral oncogene homologue (KRAS), in particular, a point mutation leading to a glycine-to-cysteine substitution at codon 12 (G12C), are among the most frequent genomic alterations in non-small cell lung cancer (NSCLC). Several agents targeting KRAS G12C have recently entered clinical development. Sotorasib, a first-in-class specific small molecule that irreversibly inhibits KRAS G12C, has since obtained Health Canada approval. The emergence of novel KRAS-targeted therapies warrants the development of evidence-based consensus recommendations to help clinicians better understand and contextualize the available data. A Canadian expert panel was convened to define the key clinical questions, review recent evidence, and discuss and agree on recommendations for the treatment of advanced KRAS G12C-mutated NSCLC. The panel agreed that testing for KRAS G12C should be performed as part of a comprehensive panel that includes current standard-of-care biomarkers. Sotorasib, the only approved KRAS G12C inhibitor in Canada, is recommended for patients with advanced KRAS G12C-mutated NSCLC who progressed on guideline-recommended first-line standard of care for advanced NSCLC without driver alterations (immune-checkpoint inhibitor(s) [ICIs] +/- chemotherapy). Sotorasib could also be offered as second-line therapy to patients who progressed on ICI monotherapy that are not candidates for a platinum doublet and those that received first-line chemotherapy with a contraindication to ICIs. Preliminary data indicate the activity of KRAS G12C inhibitors in brain metastases; however, the evidence is insufficient to make specific recommendations. Regular liver function monitoring is recommended when patients are prescribed KRAS G12C inhibitors due to risk of hepatotoxicity.
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Affiliation(s)
- Parneet K. Cheema
- Division of Medical Oncology, William Osler Health System, University of Toronto, Brampton, ON L6R 3J7, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Shantanu O. Banerji
- CancerCare Manitoba Research Institute, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Normand Blais
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada;
| | - Quincy S.-C. Chu
- Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
| | - Rosalyn A. Juergens
- Department of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Natasha B. Leighl
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A8, Canada; (N.B.L.); (A.S.)
| | - Adrian Sacher
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A8, Canada; (N.B.L.); (A.S.)
| | - Brandon S. Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada
| | - Stephanie Snow
- Division of Medical Oncology, Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS B3H 2Y9, Canada;
| | - Mark Vincent
- Department of Medical Oncology, London Regional Cancer Program, London, ON N6A 5W9, Canada;
| | - Paul F. Wheatley-Price
- Department of Medicine, The Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Stephen Yip
- BC Cancer, Vancouver, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Barbara L. Melosky
- Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC V5Z 4E6, Canada;
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Melosky BL, Leighl NB, Dawe D, Blais N, Wheatley-Price PF, Chu QSC, Juergens RA, Ellis PM, Sun A, Schellenberg D, Ionescu DN, Cheema PK. Canadian Consensus Recommendations on the Management of Extensive-Stage Small-Cell Lung Cancer. Curr Oncol 2023; 30:6289-6315. [PMID: 37504325 PMCID: PMC10378571 DOI: 10.3390/curroncol30070465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Small-cell lung cancer (SCLC) is an aggressive, neuroendocrine tumour with high relapse rates, and significant morbidity and mortality. Apart from advances in radiation therapy, progress in the systemic treatment of SCLC had been stagnant for over three decades despite multiple attempts to develop alternative therapeutic options that could improve responses and survival. Recent promising developments in first-line and subsequent therapeutic approaches prompted a Canadian Expert Panel to convene to review evidence, discuss practice patterns, and reach a consensus on the treatment of extensive-stage SCLC (ES-SCLC). The literature search included guidelines, systematic reviews, and randomized controlled trials. Regular meetings were held from September 2022 to March 2023 to discuss the available evidence to propose and agree upon specific recommendations. The panel addressed biomarkers and histological features that distinguish SCLC from non-SCLC and other neuroendocrine tumours. Evidence for initial and subsequent systemic therapies was reviewed with consideration for patient performance status, comorbidities, and the involvement and function of other organs. The resulting consensus recommendations herein will help clarify evidence-based management of ES-SCLC in routine practice, help clinician decision-making, and facilitate the best patient outcomes.
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Affiliation(s)
- Barbara L. Melosky
- Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC V5Z 4E6, Canada
| | - Natasha B. Leighl
- Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - David Dawe
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Normand Blais
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada;
| | - Paul F. Wheatley-Price
- Department of Medicine, The Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Quincy S.-C. Chu
- Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
| | - Rosalyn A. Juergens
- Department of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Peter M. Ellis
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Alexander Sun
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G 2M9, Canada;
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Devin Schellenberg
- Department of Radiation Oncology, BC Cancer—Surrey Centre, 13750 96 Avenue, Surrey, BC V3V 1Z2, Canada;
| | - Diana N. Ionescu
- Department of Pathology, BC Cancer, Vancouver, BC V5Z 4E6, Canada;
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
| | - Parneet K. Cheema
- Division of Medical Oncology, William Osler Health System, University of Toronto, Brampton, ON L6R 3J7, Canada;
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Wang X, Beharry A, Sheffield BS, Cheema PK. Feasibility of Point-of-Care Genomic Profiling in the Diagnosis and Treatment of Cancer of Unknown Primary. Oncologist 2023:7080525. [PMID: 36933203 DOI: 10.1093/oncolo/oyad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/08/2023] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Cancer of unknown primary remains a challenging clinical entity. Despite receiving empiric chemotherapy, median overall survival is approximately 6-12 months. Site-specific therapy based on molecular characterization has been shown to improve outcomes; however, feasibility outside of clinical trials, especially in community centers, is lacking. This study explores the application of rapid next-generation sequencing in defining cancer of unknown primary and to identify therapeutic biomarkers. METHODS A retrospective chart review was performed by identifying pathological samples designated cancer of unknown primary. Next-generation sequencing testing was based on an automated workflow utilizing the Genexus integrated sequencer, validated for clinical use. Genomic profiling was further integrated within a routine immunohistochemistry service, with results reported directly by anatomic pathologists. RESULTS Between October 2020 and October 2021, 578 solid tumor samples underwent genomic profiling. Among this cohort, 40 were selected based on an initial diagnosis of cancer of unknown primary. The median (range) age at diagnosis was 70 (42-85) and 23 (57%) were female. Genomic data were used to support a site-specific diagnosis in 6 patients (15%). Median turnaround time was 3 business days (IQR: 1-5). Most common alterations identified were KRAS (35%), CDKN2A (15%), TP53 (15%), and ERBB2 (12%). Actionable molecular targeted therapies were identified in 23 (57%) patients, including alterations in BRAF, CDKN2A, ERBB2, FGFR2, IDH1, and KRAS. Immunotherapy-sensitizing mismatch repair deficiency was identified in 1 patient. CONCLUSION This study supports the adoption of rapid next-generation sequencing among patients with cancer of unknown primary. We also demonstrate the feasibility of integration of genomic profiling with diagnostic histopathology and immunohistochemistry in a community practice setting. Diagnostic algorithms incorporating genomic profiling to better define cancer of unknown primary should be considered for future study.
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Affiliation(s)
- Xin Wang
- Medical Oncology Training Program, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea Beharry
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON, Canada
| | - Brandon S Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON, Canada
| | - Parneet K Cheema
- Medical Oncology Training Program, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, William Osler Health System, Brampton, ON, Canada
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Carrizosa DR, Burkard ME, Elamin YY, Desai J, Gadgeel SM, Lin JJ, Waqar SN, Spigel DR, Chae YK, Cheema PK, Haura EB, Liu SV, Nguyen D, Reckamp KL, Tsai FYC, Jansen VM, Drilon AE, Ou SHI, Camidge DR, Patil T. CRESTONE: Initial efficacy and safety of seribantumab in solid tumors harboring NRG1 fusions. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3006 Background: NRG1 fusions are rare oncogenic drivers found in ̃0.2% of all solid tumors. These fusions elicit ERBB3/HER3 overactivation to drive tumor growth and cancer cell survival. Currently there are no approved targeted therapies for NRG1 fusion-positive tumors. Furthermore, patients (pts) with tumors harboring NRG1 fusions have poor outcomes with standard therapies. Seribantumab is a fully human anti-HER3 IgG2 monoclonal antibody that suppressed tumor growth in NRG1 fusion-driven preclinical models. Here, we present initial clinical data from the CRESTONE study (NCT04383210). Methods: CRESTONE is a Phase 2, global, multicenter, open-label study of seribantumab in adult pts with locally advanced or metastatic solid tumors harboring NRG1 fusions. A dose ranging phase established the RP2D as a 3g once weekly (QW) intravenous dose administered until treatment discontinuation criteria are met. In the expansion phase, cohort 1 will enroll at least 55 pts who had received at least one prior therapy and are naïve to ERBB-targeted therapy. Exploratory cohorts 2 or 3 will enroll pts previously treated with ERBB-targeted therapies and/or tumors harboring additional molecular alterations. The primary endpoint is objective response rate (ORR) by independent central review per RECIST v1.1. Initial data from cohort 1 pts who received seribantumab 3g QW with investigator (INV)-assessed response per RECIST v1.1 are reported. Results: By JAN-13-2022, 12 pts have received seribantumab 3g QW in cohort 1. Median age was 65 years (range 44–76), 67% were female, and median number of prior therapies was 1 (range 1–5). 92% (11/12) of pts had non-small cell lung cancer (NSCLC); 5 different NRG1 fusion partners ( ATP1B1, CD74, ITG B1, SDC4, SLC3 A2) were reported by local next-generation sequencing tests. Among 10 pts evaluable for INV-assessed response, the confirmed ORR was 30%, and the disease control rate was 90% (1 complete response, 2 partial responses, 6 stable disease, 1 progressive disease). 58% (7/12) of pts remain on study treatment, including 2 pts with NSCLC who achieved objective responses with an ongoing duration of response of 6 and 8.5 months. Seribantumab 3g QW was well tolerated with no drug discontinuations or dose reductions. Across all cohorts (n = 29), the most frequently (≥20%) reported treatment-related adverse events (TRAEs) were diarrhea (38%), fatigue (34%), and rash (24%), all were grade 1 or 2. One grade 3 TRAE of vomiting occurred; there were no Grade 4 or 5 TRAEs. Efficacy analysis is ongoing and updated efficacy data from evaluable pts in cohort 1 will be presented. Conclusions: Initial data indicate seribantumab induced durable responses in advanced solid tumors harboring NRG1 fusions and has a favorable safety profile. These data support the continued evaluation of seribantumab in NRG1 fusion-positive solid tumors in the ongoing CRESTONE study. Clinical trial information: NCT04383210.
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Affiliation(s)
| | | | - Yasir Y Elamin
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jayesh Desai
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | | | - Tejas Patil
- University of Colorado Cancer Center, Aurora, CO
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O'Brien ME, Cheema PK, Grohé C, Costa EC, Girard N, Chiappori A, Ross S, Rossetti M, Dubois F, Lager JJ, Srivastava S, Velcheti V. Randomized phase 2 study evaluating efficacy and safety of inupadenant in combination with chemotherapy in adults with metastatic non–small cell lung cancer (mNSCLC) who progressed on immunotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9158] [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
TPS9158 Background: In cancer, the accumulation of adenosine in the tumor microenvironment (TME) mediates immune suppression mainly via the high affinity A2A receptor (A2AR), causing dysregulation of innate and adaptative immune cell subsets and dampening the antitumor immune response. This results in increased tumor cell survival and immune escape (Blay 1997; Merighi 2003; Muller-Haegele 2014). Therefore, inhibiting A2AR could reverse immunosuppression and re-establish immune surveillance in the tumor microenvironment. Inupadenant is an antagonist of the A2AR with potent inhibition of A2AR even at the high concentrations of adenosine present in the tumor microenvironment. Ongoing clinical studies have established inupadenant as a molecule with a favorable safety profile with preliminary evidence of clinical activity in multiple tumor types, including durable PRs in patients who have exhausted standard treatment options (Buisseret 2021). The standard treatment for patients without a driving mutation who progress on first-line IO is a platinum-based doublet chemotherapy regimen. Carboplatin plus Pemetrexed (C+P) is the preferred chemotherapy in nonsquamous mNSCLC. Study A2A-005 will evaluate the efficacy of inupadenant in combination with C+P as a second-line therapy in adult patients with nonsquamous mNSCLC (post-IO). A successful outcome from study A2A-005 will help address a high unmet need for this patient population and could lead to new therapeutic options. Methods: This is a 2-part study. The first part is an open label dose-finding part to determine the safety and recommended Phase 2 dose (RP2D) of inupadenant in combination with C+P (N = 40). In Part 2, 150 patients will be randomized 1:1 to inupadenant or placebo, both in combination with C+P. Tumor response will be determined according to RECIST 1.1 criteria and safety findings will be reviewed by the Safety Review Committee (for Part 1) and the Data Monitoring Committee (for Part 2). Key eligibility criteria include 1) mNSCLC of nonsquamous pathology, 2) have received only 1 line of anti-PD-(L)1 therapy in the metastatic setting, without concomitant chemotherapy, and have progressed (IO/IO combination therapy is allowed), 3) have measurable disease as defined by RECIST v1.1 criteria and 4) Eastern Cooperative Oncology Group status ≤1. Primary endpoints are RP2D (for Part 1) and PFS (for Part 2). Secondary endpoints include change in tumor size, ORR, OS, and adverse events. Correlative aims include assessing blood and tissue biomarkers for association with clinical benefit. The study will be conducted in approximately 11 countries in North America and Europe. Clinical trial information: EudraCT 2021-005487-22.
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Affiliation(s)
- Mary E.R. O'Brien
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Surrey, United Kingdom
| | - Parneet K. Cheema
- William Osler Health System, University of Toronto, Toronto, ON, Canada
| | - Christian Grohé
- Department of Respiratory Diseases, ELK Berlin, Berlin, Germany
| | | | | | | | | | | | | | | | - Shouryadeep Srivastava
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
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8
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Li AY, Gaebe K, Jerzak KJ, Cheema PK, Sahgal A, Das S. Intracranial Metastatic Disease: Present Challenges, Future Opportunities. Front Oncol 2022; 12:855182. [PMID: 35330715 PMCID: PMC8940535 DOI: 10.3389/fonc.2022.855182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Intracranial metastatic disease (IMD) is a prevalent complication of cancer that significantly limits patient survival and quality of life. Over the past half-century, our understanding of the epidemiology and pathogenesis of IMD has improved and enabled the development of surveillance and treatment algorithms based on prognostic factors and tumor biomolecular characteristics. In addition to advances in surgical resection and radiation therapy, the treatment of IMD has evolved to include monoclonal antibodies and small molecule antagonists of tumor-promoting proteins or endogenous immune checkpoint inhibitors. Moreover, improvements in the sensitivity and specificity of imaging as well as the development of new serological assays to detect brain metastases promise to revolutionize IMD diagnosis. In this review, we will explore current treatment principles in patients with IMD, including the emerging role of targeted and immunotherapy in select primary cancers, and discuss potential areas for further investigation.
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Affiliation(s)
- Alyssa Y Li
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karolina Gaebe
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katarzyna J Jerzak
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Parneet K Cheema
- Division of Oncology, William Osler Health System, Brampton, ON, Canada
| | - Arjun Sahgal
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sunit Das
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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9
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Sheffield BS, Beharry A, Diep J, Perdrizet K, Iafolla MAJ, Raskin W, Dudani S, Brett MA, Starova B, Olsen B, Cheema PK. Point of Care Molecular Testing: Community-Based Rapid Next-Generation Sequencing to Support Cancer Care. Curr Oncol 2022; 29:1326-1334. [PMID: 35323313 PMCID: PMC8947443 DOI: 10.3390/curroncol29030113] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Biomarker data are critical to the delivery of precision cancer care. The average turnaround of next-generation sequencing (NGS) reports is over 2 weeks, and in-house availability is typically limited to academic centers. Lengthy turnaround times for biomarkers can adversely affect outcomes. Traditional workflows involve moving specimens through multiple facilities. This study evaluates the feasibility of rapid comprehensive NGS using the Genexus integrated sequencer and a novel streamlined workflow in a community setting. Methods: A retrospective chart review was performed to assess the early experience and performance characteristics of a novel approach to biomarker testing at a large community center. This approach to NGS included an automated workflow utilizing the Genexus integrated sequencer, validated for clinical use. NGS testing was further integrated within a routine immunohistochemistry (IHC) service, utilizing histotechnologists to perform technical aspects of NGS, with results reported directly by anatomic pathologists. Results: Between October 2020 and October 2021, 578 solid tumor samples underwent genomic profiling. Median turnaround time for biomarker results was 3 business days (IQR: 2-5). Four hundred eighty-one (83%) of the cases were resulted in fewer than 5 business days, and 66 (11%) of the cases were resulted simultaneously with diagnosis. Tumor types included lung cancer (310), melanoma (97), and colorectal carcinoma (68), among others. NGS testing detected key driver alterations at expected prevalence rates: lung EGFR (16%), ALK (3%), RET (1%), melanoma BRAF (43%), colorectal RAS/RAF (67%), among others. Conclusion: This is the first study demonstrating clinical implementation of rapid NGS. This supports the feasibility of automated comprehensive NGS performed and interpreted in parallel with diagnostic histopathology and immunohistochemistry. This novel approach to biomarker testing offers considerable advantages to clinical cancer care.
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Affiliation(s)
- Brandon S. Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Andrea Beharry
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Joanne Diep
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Kirstin Perdrizet
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Marco A. J. Iafolla
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - William Raskin
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Shaan Dudani
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
| | - Mary Anne Brett
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Blerta Starova
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Brian Olsen
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada; (A.B.); (J.D.); (M.A.B.); (B.S.); (B.O.)
| | - Parneet K. Cheema
- Division of Medical Oncology, William Osler Health System, Brampton, ON L6R 3J7, Canada; (K.P.); (M.A.J.I.); (W.R.); (S.D.); (P.K.C.)
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
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10
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Tjong MC, Ragulojan M, Poon I, Louie AV, Cheng SY, Doherty M, Zhang L, Ung Y, Cheung P, Cheema PK. Safety Related to the Timing of Radiotherapy and Immune Checkpoint Inhibitors in Patients with Advanced Non-Small Cell Lung Cancer: A Single Institutional Experience. Curr Oncol 2022; 29:221-230. [PMID: 35049695 PMCID: PMC8775081 DOI: 10.3390/curroncol29010021] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The safety impact of radiotherapy (RT) timing relative to immune checkpoint inhibitors (ICIs) for advanced non-small-cell lung cancer (NSCLC) is unclear. We investigated if RT within 14 days (Interval 1) and 90 days (Interval 2) of ICI use is associated with toxicities compared to RT outside these intervals. Methods: Advanced NSCLC patients treated with both RT and ICIs were reviewed. Toxicities were graded as per CTCAE v4.0 and attributed to either ICIs or RT by clinicians. Associations between RT timing and Grade ≥2 toxicities were analyzed using logistic regression models adjusted for patient, disease, and treatment factors (α = 0.05). Results: Sixty-four patients were identified. Twenty received RT within Interval 1 and 40 within Interval 2. There were 20 Grade ≥2 toxicities in 18 (28%) patients; pneumonitis (6) and nausea (2) were most prevalent. One treatment-related death (immune encephalitis) was observed. Rates of patients with Grade ≥2 toxicities were 35%/25% in the group with/without RT within Interval 1 and 30%/25% in the group with/without RT within Interval 2. No significant association between RT timing relative to ICI use period and Grade ≥2 toxicities was observed. Conclusion: Albeit limited by the small sample size, the result suggested that pausing ICIs around RT use may not be necessary.
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Affiliation(s)
- Michael C. Tjong
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (M.C.T.); (A.V.L.); (L.Z.); (Y.U.); (P.C.)
| | - Malavan Ragulojan
- Faculty of Medicine, McMaster University, Hamilton, ON L8S4L8, Canada;
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (M.C.T.); (A.V.L.); (L.Z.); (Y.U.); (P.C.)
- Correspondence: (I.P.); (P.K.C.)
| | - Alexander V. Louie
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (M.C.T.); (A.V.L.); (L.Z.); (Y.U.); (P.C.)
| | - Susanna Y. Cheng
- Department of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (S.Y.C.); (M.D.)
| | - Mark Doherty
- Department of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (S.Y.C.); (M.D.)
| | - Liying Zhang
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (M.C.T.); (A.V.L.); (L.Z.); (Y.U.); (P.C.)
| | - Yee Ung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (M.C.T.); (A.V.L.); (L.Z.); (Y.U.); (P.C.)
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Sunnybrook Hospital, Toronto, ON M4N3M5, Canada; (M.C.T.); (A.V.L.); (L.Z.); (Y.U.); (P.C.)
| | - Parneet K. Cheema
- Department of Medical Oncology and Hematology, William Osler Health System, Brampton, ON L6R3J7, Canada
- Correspondence: (I.P.); (P.K.C.)
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11
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Perdrizet K, Cheema PK. The Evolving Role of Immunotherapy in Stage III Non-Small Cell Lung Cancer. Curr Oncol 2021; 28:5408-5421. [PMID: 34940090 PMCID: PMC8700596 DOI: 10.3390/curroncol28060451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/23/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
The management of Stage III non-small cell lung cancer (NSCLC) is complex and requires multidisciplinary input. Since the publication of the PACIFIC trial (consolidative durvalumab post concurrent chemotherapy and radiation in Stage III disease) which showed improved survival for patients in the immunotherapy arm, there has been much interest in the use of immunotherapy in the Stage III setting. In this review, we explore the biologic and clinical rationale for the use of immunotherapy in Stage III NSCLC, present previously published and upcoming data in the neoadjuvant, adjuvant, and concurrent realms of Stage III management, and discuss unanswered questions and challenges moving forward.
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Affiliation(s)
- Kirstin Perdrizet
- Division of Medical Oncology, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Medical Oncology/Hematology, William Osler Health System, Brampton, ON L6R 3J7, Canada
| | - Parneet K. Cheema
- Division of Medical Oncology, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Medical Oncology/Hematology, William Osler Health System, Brampton, ON L6R 3J7, Canada
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12
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Cheema PK, Banerji SO, Blais N, Chu QSC, Desmeules P, Juergens RA, Leighl NB, Sheffield BS, Wheatley-Price PF, Melosky BL. Canadian Consensus Recommendations on the Management of MET-Altered NSCLC. Curr Oncol 2021; 28:4552-4576. [PMID: 34898564 PMCID: PMC8628757 DOI: 10.3390/curroncol28060386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/29/2022] Open
Abstract
In Canada, the therapeutic management of patients with advanced non-small cell lung cancer (NSCLC) with rare actionable mutations differs between provinces, territories, and individual centres based on access to molecular testing and funded treatments. These variations, together with the emergence of several novel mesenchymal-epithelial transition (MET) factor-targeted therapies for the treatment of NSCLC, warrant the development of evidence-based consensus recommendations for the use of these agents. A Canadian expert panel was convened to define key clinical questions, review evidence, discuss practice recommendations and reach consensus on the treatment of advanced MET-altered NSCLC. Questions addressed by the panel include: 1. How should the patients most likely to benefit from MET-targeted therapies be identified? 2. What are the preferred first-line and subsequent therapies for patients with MET exon 14 skipping mutations? 3. What are the preferred first-line and subsequent therapies for advanced NSCLC patients with de novo MET amplification? 4. What is the preferred therapy for patients with advanced epidermal growth factor receptor (EGFR)-mutated NSCLC with acquired MET amplification progressing on EGFR inhibitors? 5. What are the potential strategies for overcoming resistance to MET inhibitors? Answers to these questions, along with the consensus recommendations herein, will help streamline the management of MET-altered NSCLC in routine practice, assist clinicians in therapeutic decision-making, and help ensure optimal outcomes for NSCLC patients with MET alterations.
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Affiliation(s)
- Parneet K. Cheema
- Medical Oncology/Hematology, William Osler Health System, Brampton, ON L6R 3J7, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Shantanu O. Banerji
- CancerCare Manitoba Research Institute, Department of Medical Oncology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Normand Blais
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada;
| | - Quincy S.-C. Chu
- Cross Cancer Institute, Alberta Health Services, Edmonton, AB T6G 1Z2, Canada;
| | - Patrice Desmeules
- Service d’Anatomopathologie et de Cytologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC G1V 0A6, Canada;
| | - Rosalyn A. Juergens
- Department of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada;
| | - Natasha B. Leighl
- Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - Brandon S. Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON L6R 3J7, Canada;
| | - Paul F. Wheatley-Price
- Department of Medicine, The Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Barbara L. Melosky
- Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC V5Z 4E6, Canada;
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13
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Moldaver D, Hurry M, Evans WK, Cheema PK, Sangha R, Burkes R, Melosky B, Tran D, Boehm D, Venkatesh J, Walisser S, Orava E, Grima D. A reply to "Correspondence Re: Development, validation and results from the impact of treatment evolution in non-small cell lung cancer (iTEN) model". Lung Cancer 2020; 151:110-111. [PMID: 33323299 DOI: 10.1016/j.lungcan.2020.11.015] [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] [Received: 10/29/2020] [Accepted: 11/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Diana Tran
- Eversana Life Sciences Services, Burlington, Ontario, Canada
| | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Jaya Venkatesh
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | | | - Erik Orava
- AstraZeneca Canada, Mississauga, Ontario, Canada
| | - Daniel Grima
- Eversana Life Sciences Services, Burlington, Ontario, Canada.
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14
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Cheema PK, Gomes M, Banerji S, Joubert P, Leighl NB, Melosky B, Sheffield BS, Stockley T, Ionescu DN. Consensus recommendations for optimizing biomarker testing to identify and treat advanced EGFR-mutated non-small-cell lung cancer. Curr Oncol 2020; 27:321-329. [PMID: 33380864 PMCID: PMC7755440 DOI: 10.3747/co.27.7297] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The advent of personalized therapy for non-small-cell lung carcinoma (nsclc) has improved patient outcomes. Selection of appropriate targeted therapy for patients with nsclc now involves testing for multiple biomarkers, including EGFR. EGFR mutation status is required to optimally treat patients with nsclc, and thus timely and accurate biomarker testing is necessary. However, in Canada, there are currently no standardized processes or methods in place to ensure consistent testing implementation. That lack creates challenges in ensuring that all appropriate biomarkers are tested for each patient and that the medical oncologist receives the results for making informed treatment decisions in a timely way. An expert multidisciplinary working group was convened to create consensus recommendations about biomarker testing in advanced nsclc in Canada, with a primary focus on EGFR testing. Recognizing that there are biomarkers beyond EGFR that require timely identification, the expert multidisciplinary working group considered EGFR testing in the broader context of integration into complex lung biomarker testing. Primarily, the panel of experts recommends that all patients with nonsquamous nsclc, regardless of stage, should undergo comprehensive reflex biomarker testing at diagnosis with targeted next-generation sequencing. The panel also considered the EGFR testing algorithm and the challenges associated with the pre-analytic, analytic, and post-analytic elements of testing. Strategies for funding testing by reducing silos of single biomarker testing for EGFR and for optimally implementing the recommendations presented here and educating oncology professionals about them are also discussed.
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Affiliation(s)
- P K Cheema
- William Osler Health System, University of Toronto, Brampton, ON
| | - M Gomes
- The Ottawa Hospital Research Institute and Department of Pathology, University of Ottawa, Ottawa, ON
| | - S Banerji
- Research Institute in Oncology and Hematology, CancerCare Manitoba, and Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - P Joubert
- Princess Margaret Cancer Centre, Toronto, ON
| | - N B Leighl
- Department of Pathology, Quebec Heart and Lung Institute, Université Laval, Quebec City, QC
| | - B Melosky
- BC Cancer-Vancouver Centre, Vancouver, BC
| | - B S Sheffield
- Department of Laboratory Medicine, William Osler Health System, Brampton, ON
| | - T Stockley
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - D N Ionescu
- BC Cancer, Department of Pathology, Vancouver, BC
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15
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Melosky B, Cheema PK, Brade A, McLeod D, Liu G, Price PW, Jao K, Schellenberg DD, Juergens R, Leighl N, Chu Q. Prolonging Survival: The Role of Immune Checkpoint Inhibitors in the Treatment of Extensive-Stage Small Cell Lung Cancer. Oncologist 2020; 25:981-992. [PMID: 32860288 PMCID: PMC7648366 DOI: 10.1634/theoncologist.2020-0193] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/08/2020] [Accepted: 07/02/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) represents approximately 15% of lung cancers, and approximately 70% are diagnosed as extensive-stage SCLC (ES-SCLC). Although ES-SCLC is highly responsive to chemotherapy, patients typically progress rapidly, and there is an urgent need for new therapies. Immune checkpoint inhibitors (ICIs) have recently been investigated in SCLC, and this review provides guidance on the use of these agents in ES-SCLC based on phase III evidence. METHODS Published and presented literature on phase III data addressing use of ICIs in ES-SCLC was identified using the key search terms "small cell lung cancer" AND "checkpoint inhibitors" (OR respective aliases). Directed searches of eligible studies were periodically performed to ensure capture of the most recent data. RESULTS Six phase III trials were identified, with four assessing the benefits of ICIs plus chemotherapy first-line, one evaluating ICIs as first-line therapy maintenance, and one assessing ICI monotherapy after progression on platinum-based chemotherapy. The addition of ipilimumab or tremelimumab to first-line treatment or as first-line maintenance did not improve survival. Two out of three studies combining PD-1/PD-L1 inhibitors with first-line platinum-based chemotherapy demonstrated significant long-lasting survival benefits and improved quality of life with no unexpected safety concerns. PD-1/PD-L1 inhibitors as first-line maintenance or in later lines of therapy did not improve survival. Biomarker research is ongoing as well as research into the role of ICIs in combination with radiation therapy in limited-stage SCLC. CONCLUSION The addition of atezolizumab or durvalumab to first-line platinum-based chemotherapy for ES-SCLC prolongs survival and improves quality of life. IMPLICATIONS FOR PRACTICE Platinum-based chemotherapy has been standard of care for extensive-stage small cell lung cancer (ES-SCLC) for more than a decade. Six recent phase III trials investigating immune checkpoint inhibitors (ICIs) have clarified the role of these agents in this setting. Although ICIs were assessed first-line, as first-line maintenance, and in later lines of therapy, the additions of atezolizumab or durvalumab to first-line platinum-based chemotherapy were the only interventions that significantly improved overall survival and increased quality of life. These combinations should therefore be considered standard therapy for first-line ES-SCLC. Biomarker research and investigations into the role of ICIs for limited-stage disease are ongoing.
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Affiliation(s)
- Barbara Melosky
- BC Cancer, Vancouver Centre, University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Parneet K. Cheema
- William Osler Health System, University of Toronto, Brampton and TorontoOntarioCanada
| | - Anthony Brade
- Trillium Health Partners, University of TorontoMississaugaOntarioCanada
| | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, University of TorontoTorontoOntarioCanada
| | | | - Kevin Jao
- Hôpital Sacré‐Cœur, Université de MontréalMontrealQuebecCanada
| | - Devin D. Schellenberg
- BC Cancer, Surrey Centre, University of British ColumbiaSurreyBritish ColumbiaCanada
| | - Rosalyn Juergens
- Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Natasha Leighl
- Princess Margaret Cancer Centre, University of TorontoTorontoOntarioCanada
| | - Quincy Chu
- Cross Cancer Institute, University of AlbertaEdmontonAlbertaCanada
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16
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Leighl NB, Kamel-Reid S, Cheema PK, Laskin J, Karsan A, Zhang T, Stockley T, Barnes TA, Tudor RA, Liu G, Owen S, Rothenstein J, Burkes RL, Iqbal M, Spatz A, van Kempen LC, Izevbaye I, Laurence D, Le LW, Tsao MS. Multicenter Validation Study to Implement Plasma Epidermal Growth Factor Receptor T790M Testing in Clinical Laboratories. JCO Precis Oncol 2020; 4:520-533. [PMID: 35050743 DOI: 10.1200/po.19.00335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Plasma detection of EGFR T790M mutations is an emerging alternative to tumor rebiopsy in acquired epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor resistance. Validation of analytical sensitivity and clinical utility is required before routine diagnostic use in clinical laboratories. PATIENTS AND METHODS Sixty-three patients with advanced EGFR-mutant lung cancer at 7 Canadian centers, who were being screened for the ASTRIS trial (ClinicalTrials.gov identifier: NCT02474355), participated in this companion study. Plasma T790M mutation was detected using droplet digital polymerase chain reaction, Cobas (Roche Diagnostics, Indianapolis, IN), or next-generation sequencing in 4 laboratories. T790M concordance was assessed between plasma and tumor samples. RESULTS Assessment of T790M in tumor biopsy tissue was successful in 81% of patients; 49% had confirmed T790M results (tumor or plasma) for ASTRIS. Plasma testing in this companion study yielded T790M results in 97% of patients; 62% had T790M-positive results, 36% had negative results, and 2% had indeterminate results. Of 38 patients with negative or indeterminate biopsy results, 55% had positive plasma T790M results, increasing the proportion with T790M-positive results to 73%. Sensitivity of plasma T790M testing was 75%. Overall concordance between tissue and plasma was 64%, and concordance among laboratories was 90.3%. Response to osimertinib and duration of therapy were similar irrespective of testing method (overall response rate, 62.5% for tissue, 66.7% for plasma, and 70.6% for both). CONCLUSION This multicenter validation study demonstrates that plasma EGFR T790M testing can identify significantly more patients than biopsy alone who may benefit from targeted therapy.
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Affiliation(s)
| | | | | | | | - Aly Karsan
- BC Cancer, Vancouver, British Columbia, Canada
| | - Tong Zhang
- University Health Network, Toronto, Ontario, Canada
| | | | | | | | - Geoffrey Liu
- University Health Network, Toronto, Ontario, Canada
| | - Scott Owen
- McGill University Health Center, Montreal, Quebec, Canada
| | | | | | | | - Alan Spatz
- Lady Davis Institute and OPTILAB-McGill University Health Center, Montreal, Quebec, Canada
| | - Léon C van Kempen
- Lady Davis Institute and OPTILAB-McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - Lisa W Le
- University Health Network, Toronto, Ontario, Canada
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17
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Rudin CM, Awad MM, Navarro A, Gottfried M, Peters S, Csőszi T, Cheema PK, Rodriguez-Abreu D, Wollner M, Yang JCH, Mazieres J, Orlandi FJ, Luft A, Gümüş M, Kato T, Kalemkerian GP, Luo Y, Ebiana V, Pietanza MC, Kim HR. Pembrolizumab or Placebo Plus Etoposide and Platinum as First-Line Therapy for Extensive-Stage Small-Cell Lung Cancer: Randomized, Double-Blind, Phase III KEYNOTE-604 Study. J Clin Oncol 2020; 38:2369-2379. [PMID: 32468956 DOI: 10.1200/jco.20.00793] [Citation(s) in RCA: 371] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Pembrolizumab monotherapy has shown antitumor activity in patients with small-cell lung cancer (SCLC). The randomized, double-blind, phase III KEYNOTE-604 study compared pembrolizumab plus etoposide and platinum (EP) with placebo plus EP for patients with previously untreated extensive-stage (ES) SCLC. METHODS Eligible patients were randomly assigned 1:1 to pembrolizumab 200 mg once every 3 weeks or saline placebo for up to 35 cycles plus 4 cycles of EP. Primary end points were progression-free survival (PFS; RECIST version 1.1, blinded central review) and overall survival (OS) in the intention-to-treat population. Objective response rate (ORR) and duration of response were secondary end points. Prespecified efficacy boundaries were one-sided P = .0048 for PFS and .0128 for OS. RESULTS Of the 453 participants, 228 were randomly assigned to pembrolizumab plus EP and 225 to placebo plus EP. Pembrolizumab plus EP significantly improved PFS (hazard ratio [HR], 0.75; 95% CI, 0.61 to 0.91; P = .0023). Twelve-month PFS estimates were 13.6% with pembrolizumab plus EP and 3.1% with placebo plus EP. Although pembrolizumab plus EP prolonged OS, the significance threshold was not met (HR, 0.80; 95% CI, 0.64 to 0.98; P = .0164). Twenty-four-month OS estimates were 22.5% and 11.2%, respectively. ORR was 70.6% in the pembrolizumab plus EP group and 61.8% in the placebo plus EP group; the estimated proportion of responders remaining in response at 12 months was 19.3% and 3.3%, respectively. In the pembrolizumab plus EP and placebo plus EP groups, respectively, any-cause adverse events were grade 3-4 in 76.7% and 74.9%, grade 5 in 6.3% and 5.4%, and led to discontinuation of any drug in 14.8% and 6.3%. CONCLUSION Pembrolizumab plus EP significantly improved PFS compared with placebo plus EP as first-line therapy for patients with ES-SCLC. No unexpected toxicities were seen with pembrolizumab plus EP. These data support the benefit of pembrolizumab in ES-SCLC.
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Affiliation(s)
| | | | - Alejandro Navarro
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Tibor Csőszi
- Hetényi Géza Kórház Onkológiai Központ, Szolnok, Hungary
| | - Parneet K Cheema
- William Osler Health System, University of Toronto, Brampton, Ontario, Canada
| | - Delvys Rodriguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - James Chih-Hsin Yang
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Julien Mazieres
- Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | - Mahmut Gümüş
- Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | | | | | | | | | - Hye Ryun Kim
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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18
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Moldaver D, Hurry M, Evans WK, Cheema PK, Sangha R, Burkes R, Melosky B, Tran D, Boehm D, Venkatesh J, Walisser S, Orava E, Grima D. Development, validation and results from the impact of treatment evolution in non-small cell lung cancer (iTEN) model. Lung Cancer 2019; 139:185-194. [PMID: 31812889 DOI: 10.1016/j.lungcan.2019.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Treatment of advanced NSCLC (aNSCLC) is rapidly evolving, as new targeted and immuno-oncology (I-O) treatments become available. The iTEN model was developed to predict the cost and survival benefits of changing aNSCLC treatment patterns from a Canadian healthcare system perspective. This report describes iTEN model development and validation. MATERIALS & METHODS A discrete event patient simulation of aNSCLC was developed. A modified Delphi process using Canadian clinical experts informed the development of treatment sequences that included commonly used, Health Canada approved treatments of aNSCLC. Treatment efficacy and the timing of progression and death were estimated from published Kaplan-Meier progression free and overall survival data. Costs (2018 CDN$) included were: drug acquisition and administration, imaging, monitoring, adverse events, physician visits, best supportive care, and end-of-life. RESULTS AND CONCLUSION Clinical validity of the iTEN model was assessed by comparing model survival predictions to published real-world evidence (RWE). Four RWE studies that reported the overall survival of patients treated with a broad sampling of common aNSCLC treatment patterns were used for validation. The validation coefficient of determination was R2 = 0.95, with the model generally producing estimates that were neither optimistic nor conservative. The model estimated that current Canadian practice patterns yield a median survival of almost 13 months, a five-year survival rate of 3% and a life-time per-treated-patient cost of $110,806. Cost and survival estimates are presented and were found to vary by aNSCLC subtype. In conclusion, the iTEN model is a reliable tool for forecasting the impact on cost and survival of new treatments for aNSCLC.
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Affiliation(s)
| | | | | | | | | | | | | | - Diana Tran
- Cornerstone Research Group, Burlington, Ontario, Canada
| | - Darryl Boehm
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Jaya Venkatesh
- Saskatchewan Cancer Agency, Regina, Saskatchewan, Canada
| | - Susan Walisser
- BC Cancer (Retired), Vancouver, British Columbia, Canada
| | - Erik Orava
- AstraZeneca Canada, Mississauga, Ontario, Canada
| | - Daniel Grima
- Cornerstone Research Group, Burlington, Ontario, Canada.
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19
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Marinis FD, Wu YL, de Castro G, Chang GC, Chen YM, Cho BC, Freitas HC, Jiang L, Kim SW, Martin C, Metro G, Provencio M, Vansteenkiste J, Vicente D, Zhou Q, Miranda MF, Bakker NA, Rigas JR, Cheema PK. ASTRIS: a global real-world study of osimertinib in >3000 patients with EGFR T790M positive non-small-cell lung cancer. Future Oncol 2019; 15:3003-3014. [PMID: 31339357 DOI: 10.2217/fon-2019-0324] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Aim: Osimertinib is a third-generation, irreversible, oral EGFR tyrosine kinase inhibitor. We report real-world effectiveness and safety data. Patients & methods: EGFR T790M positive advanced non-small-cell lung cancer adults, who received ≥1 prior EGFR tyrosine kinase inhibitor, received osimertinib 80 mg daily. Primary effectiveness outcome: overall survival. Secondary effectiveness outcomes included: investigator-assessed clinical response, progression-free survival, time-to-treatment discontinuation. Results: At data cutoff, 3015 patients had enrolled: 57.1% had investigator-assessed response (95% CI: 55.2-58.9). Median progression-free survival: 11.1 months (95% CI: 11.0-12.0) and median time-to-treatment discontinuation: 13.5 months (95% CI: 12.6-13.9). Interstitial lung disease/pneumonitis-like events reported in 28 (1%) patients. Conclusion: Osimertinib demonstrated clinical effectiveness similar to efficacy observed in the clinical trial program with no new safety signals.
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Affiliation(s)
- Filippo de Marinis
- Department of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Yi-Long Wu
- Department of Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, & Guangdong Academy of Medical Sciences, Guangzhou, PR China
| | - Gilberto de Castro
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Gee-Chen Chang
- Department of Internal Medicine, Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, & School of Medicine, National Yang-Ming Medical University, Taipei, Taiwan
| | - Byoung Chul Cho
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Helano C Freitas
- Department of Medical Oncology, AC Camargo Cancer Center, São Paulo, Brazil
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Sang-We Kim
- Department of Oncology, Brain Tumor Center, Center for Personalized Cancer Medicine, Lung Cancer Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Claudio Martin
- Department of Oncology, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Giulio Metro
- Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Mariano Provencio
- Department of Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, IDHIPSA, Universidad Autónoma de Madrid, Spain
| | - Johan Vansteenkiste
- Department of Respiratory Diseases, Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - David Vicente
- Department of Clinical Oncology, H.U.V. Macarena, Seville, Spain
| | - Qing Zhou
- Department of Oncology, Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, & Guangdong Academy of Medical Sciences, Guangzhou, PR China
| | | | | | - James R Rigas
- AstraZeneca, GMA Oncology TA, Gaithersburg, MD 20878, USA
| | - Parneet K Cheema
- William Osler Health System, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
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20
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Abstract
The use of real-world evidence (rwe) through real-world data (rwd) is becoming increasingly prevalent in health care around the globe. [...]
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Affiliation(s)
- P K Cheema
- Faculty of Medicine, University of Toronto, Toronto, and William Osler Health System, Brampton, ON
| | - S Kuruvilla
- Faculty of Medicine, Western University, and London Health Sciences Centre, London, ON
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21
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Higenell V, Fajzel R, Batist G, Cheema PK, McArthur HL, Melosky B, Morris D, Petrella TM, Sangha R, Savard MF, Sridhar SS, Stagg J, Stewart DJ, Verma S. A network approach to developing immuno-oncology combinations in Canada. Curr Oncol 2019; 26:73-79. [PMID: 31043804 PMCID: PMC6476440 DOI: 10.3747/co.26.4393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Immune checkpoint inhibitors have revolutionized care for many cancer indications, with considerable effort now being focused on increasing the rate, depth, and duration of patient response. One strategy is to combine immune strategies (for example, ctla-4 and PD-1/L1-directed agents) to harness additive or synergistic efficacy while minimizing toxicity. Despite encouraging results with such combinations in multiple tumour types, numerous clinical challenges remain, including a lack of biomarkers that reliably predict outcome, the emergence of therapeutic resistance, and optimal management of immune-related toxicities. Furthermore, the selection of ideal combinations from the myriad of immune, systemic, and locoregional therapies has yet to be determined. A longitudinal network-based approach could offer advantages in addressing those critical questions, including long-term follow-up of patients beyond individual trials. The molecular cancer registry Personalize My Treatment, managed by the Networks of Centres of Excellence nonprofit organization Exactis Innovation, is uniquely positioned to accelerate Canadian immuno-oncology (io) research efforts throughout its national network of cancer sites. To gain deeper insight into how a pan-Canadian network could advance research in io combinations, Exactis invited preeminent clinical and scientific advisors from across Canada to a roundtable event in November 2017. The present white paper captures the expert advice provided: leverage longitudinal patient data collection; facilitate network collaboration and assay harmonization; synergize with existing initiatives, networks, and biobanks; and develop an io combination trial based on Canadian discoveries.
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Affiliation(s)
- V Higenell
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - R Fajzel
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - G Batist
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
- Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - P K Cheema
- William Osler Health System, University of Toronto, Toronto, ON
| | - H L McArthur
- Division of Hematology Oncology, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, U.S.A
| | - B Melosky
- Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - D Morris
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - T M Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - R Sangha
- Department of Oncology, Cross Cancer Institute, Edmonton, AB
| | - M F Savard
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - S S Sridhar
- Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Stagg
- Faculty of Pharmacy, University of Montreal, Montreal, QC
| | - D J Stewart
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, ON
| | - S Verma
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
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22
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Cheema PK, Rothenstein J, Melosky B, Brade A, Hirsh V. Perspectives on treatment advances for stage III locally advanced unresectable non-small-cell lung cancer. Curr Oncol 2019; 26:37-42. [PMID: 30853796 PMCID: PMC6380636 DOI: 10.3747/co.25.4096] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
For more than a decade, there has been no improvement in outcomes for patients with unresectable locally advanced (la) non-small-cell lung cancer (nsclc). The standard treatment in that setting is definitive concurrent chemotherapy and radiation (ccrt). Although the intent of treatment is curative, most patients rapidly progress, and their prognosis is poor, with a 5-year overall survival (os) rate in the 15%-25% range. Those patients therefore represent a critical unmet need, warranting expedited approval of, and access to, new treatments that can improve outcomes. The pacific trial, which evaluated durvalumab consolidation therapy after ccrt in unresectable la nsclc, demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (pfs) and a significant improvement in os. Durvalumab thus fills a critical unmet need in the setting of unresectable la nsclc and provides a new option for patients treated with curative intent. Here, we review the treatment of unresectable la nsclc, with a focus on the effect of the clinical data for durvalumab.
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Affiliation(s)
- P K Cheema
- William Osler Health System, Brampton/Toronto, and University of Toronto, Toronto, ON
| | - J Rothenstein
- R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, and Queen's University, Kingston, ON
| | - B Melosky
- BC Cancer-Vancouver and University of British Columbia, Vancouver, BC
| | - A Brade
- Peel Regional Cancer Centre, Mississauga, and University of Toronto, Toronto, ON
| | - V Hirsh
- Royal Victoria Hospital and McGill University, Montreal, QC
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23
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Laurie SA, Banerji S, Blais N, Brule S, Cheema PK, Cheung P, Daaboul N, Hao D, Hirsh V, Juergens R, Laskin J, Leighl N, MacRae R, Nicholas G, Roberge D, Rothenstein J, Stewart DJ, Tsao MS. Canadian consensus: oligoprogressive, pseudoprogressive, and oligometastatic non-small-cell lung cancer. ACTA ACUST UNITED AC 2019; 26:e81-e93. [PMID: 30853813 DOI: 10.3747/co.26.4116] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Little evidence has been generated for how best to manage patients with non-small-cell lung cancer (nsclc) presenting with rarer clinical scenarios, including oligometastases, oligoprogression, and pseudoprogression. In each of those scenarios, oncologists have to consider how best to balance efficacy with quality of life, while maximizing the duration of each line of therapy and ensuring that patients are still eligible for later options, including clinical trial enrolment. Methods An expert panel was convened to define the clinical questions. Using case-based presentations, consensus practice recommendations for each clinical scenario were generated through focused, evidence-based discussions. Results Treatment strategies and best-practice or consensus recommendations are presented, with areas of consensus and areas of uncertainty identified. Conclusions In each situation, treatment has to be tailored to suit the individual patient, but with the intent of extending and maximizing the use of each line of treatment, while keeping treatment options in reserve for later lines of therapy. Patient participation in clinical trials examining these issues should be encouraged.
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Affiliation(s)
- S A Laurie
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - S Banerji
- Manitoba: Rady Faculty of Health Sciences, University of Manitoba, and Medical Oncology, CancerCare Manitoba, Winnipeg
| | - N Blais
- Quebec: CHUM Cancer Centre, Université de Montréal, Montreal (Blais); Centre intégré de cancérologie de la Montérégie, Hôpital Charles-LeMoyne, and Université de Sherbrooke, Greenfield Park (Daaboul); Department of Oncology, McGill University, and Thoracic Oncology, McGill University Health Centre, Montreal (Hirsh); Centre hospitalier de l'Université de Montréal, Montreal (Roberge)
| | - S Brule
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - P K Cheema
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - P Cheung
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - N Daaboul
- Quebec: CHUM Cancer Centre, Université de Montréal, Montreal (Blais); Centre intégré de cancérologie de la Montérégie, Hôpital Charles-LeMoyne, and Université de Sherbrooke, Greenfield Park (Daaboul); Department of Oncology, McGill University, and Thoracic Oncology, McGill University Health Centre, Montreal (Hirsh); Centre hospitalier de l'Université de Montréal, Montreal (Roberge)
| | - D Hao
- Alberta: Tom Baker Cancer Centre and Department of Oncology, University of Calgary, Calgary
| | - V Hirsh
- Quebec: CHUM Cancer Centre, Université de Montréal, Montreal (Blais); Centre intégré de cancérologie de la Montérégie, Hôpital Charles-LeMoyne, and Université de Sherbrooke, Greenfield Park (Daaboul); Department of Oncology, McGill University, and Thoracic Oncology, McGill University Health Centre, Montreal (Hirsh); Centre hospitalier de l'Université de Montréal, Montreal (Roberge)
| | - R Juergens
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - J Laskin
- British Columbia: Medical Oncology, BC Cancer, Vancouver
| | - N Leighl
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - R MacRae
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - G Nicholas
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - D Roberge
- Quebec: CHUM Cancer Centre, Université de Montréal, Montreal (Blais); Centre intégré de cancérologie de la Montérégie, Hôpital Charles-LeMoyne, and Université de Sherbrooke, Greenfield Park (Daaboul); Department of Oncology, McGill University, and Thoracic Oncology, McGill University Health Centre, Montreal (Hirsh); Centre hospitalier de l'Université de Montréal, Montreal (Roberge)
| | - J Rothenstein
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - D J Stewart
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
| | - M S Tsao
- Ontario: The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa (Laurie); Division of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa (Brule); University of Toronto, Toronto, and William Osler Health System, Brampton (Cheema); Sunnybrook Odette Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto (Cheung); McMaster University, Juravinski Cancer Centre, Hamilton (Juergens); Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); University of Ottawa, The Ottawa Hospital, Ottawa (MacRae); University of Ottawa, Ottawa (Nicholas); R.S. McLaughlin Durham Regional Cancer Centre, Lakeridge Health, Oshawa, and Queen's University, Kingston (Rothenstein); The Ottawa Hospital, The Ottawa Hospital Research Institute, and Division of Medical Oncology, University of Ottawa, Ottawa (Stewart); University Health Network, Princess Margaret Cancer Centre, and University of Toronto, Toronto (Tsao)
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24
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Planchard D, Boyer MJ, Lee JS, Dechaphunkul A, Cheema PK, Takahashi T, Gray JE, Tiseo M, Ramalingam SS, Todd A, McKeown A, Rukazenkov Y, Ohe Y. Postprogression Outcomes for Osimertinib versus Standard-of-Care EGFR-TKI in Patients with Previously Untreated EGFR-mutated Advanced Non-Small Cell Lung Cancer. Clin Cancer Res 2019; 25:2058-2063. [PMID: 30659024 DOI: 10.1158/1078-0432.ccr-18-3325] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/26/2018] [Accepted: 01/16/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE In the phase III FLAURA study, third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) osimertinib significantly improved progression-free survival (PFS) versus standard-of-care (SoC) EGFR-TKI (gefitinib or erlotinib) in patients with previously untreated EGFR (exon 19 deletion or L858R) mutation-positive advanced non-small cell lung cancer (NSCLC). Interim overall survival (OS) data were encouraging, but not formally statistically significant at current maturity (25%). Here we report exploratory postprogression outcomes. PATIENTS AND METHODS Patients were randomized 1:1 to receive osimertinib (80 mg orally, once daily) or SoC EGFR-TKI (gefitinib 250 mg or erlotinib 150 mg, orally, once daily). Treatment beyond disease progression was allowed if the investigator judged ongoing clinical benefit. Patients receiving SoC EGFR-TKI could cross over to receive osimertinib after independently confirmed objective disease progression with documented postprogression T790M-positive mutation status. RESULTS At data cutoff (June 12, 2017), 138 of 279 (49%) and 213 of 277 (77%) patients discontinued osimertinib and SoC EGFR-TKI, respectively, of whom 82 (59%) and 129 (61%), respectively, started a subsequent treatment. Median time to discontinuation of any EGFR-TKI or death was 23.0 months [95% confidence interval (CI), 19.5-not calculable (NC)] in the osimertinib arm and 16.0 months (95% CI, 14.8-18.6) in the SoC EGFR-TKI arm. Median second PFS was not reached (95% CI, 23.7-NC) in the osimertinib arm and 20.0 months (95% CI, 18.2-NC) in the SoC EGFR-TKI arm [hazard ratio (HR), 0.58; 95% CI, 0.44-0.78; P = 0.0004]. CONCLUSIONS All postprogression endpoints showed consistent improvement with osimertinib versus SoC EGFR-TKI, providing further confidence in the interim OS data.
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Affiliation(s)
- David Planchard
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.
| | - Michael J Boyer
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jong-Seok Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Arunee Dechaphunkul
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Parneet K Cheema
- Faculty of Medicine and Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Toshiaki Takahashi
- Division of Thoracic Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan
| | - Jhanelle E Gray
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia
| | - Alexander Todd
- Global Medicines Development, AstraZeneca, Cambridge, United Kingdom
| | - Astrid McKeown
- Global Medicines Development, AstraZeneca, Cambridge, United Kingdom
| | - Yuri Rukazenkov
- Global Medicines Development, AstraZeneca, Cambridge, United Kingdom
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
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Cheema PK, Doherty M, Tsao MS. A Case of Invasive Mucinous Pulmonary Adenocarcinoma with a CD74-NRG1 Fusion Protein Targeted with Afatinib. J Thorac Oncol 2018; 12:e200-e202. [PMID: 29169524 DOI: 10.1016/j.jtho.2017.07.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Parneet K Cheema
- Division of Medical Oncology/Hematology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Mark Doherty
- Division of Medical Oncology/Hematology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Department of Pathology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
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Cheema PK, Thawer A, Leake J, Cheng SY, Khanna S, Charles Victor J. Multi-disciplinary proactive follow-up algorithm for patients with advanced NSCLC receiving afatinib. Support Care Cancer 2018; 27:1029-1039. [PMID: 30116943 DOI: 10.1007/s00520-018-4392-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 07/31/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Afatinib is a standard first-line therapy for advanced EGFR-positive NSCLC. We implemented a pharmacist-led proactive follow-up algorithm to identify and manage early afatinib-related adverse events (AEs). METHODS We conducted a retrospective chart review of all patients treated with afatinib after implementation of the algorithm at the Sunnybrook Odette Cancer Centre (Toronto, ON, Canada) from April 1, 2015 to July 31, 2016. Our in-house algorithm involved consultations in person and proactive pharmacist-led callbacks on days 5, 10, and 17. All AEs were graded and documented in real time and management based on toxicity grade was standardized. This study evaluated the impact of our algorithm on real-world AEs. RESULTS AND DISCUSSION Thirty-three patients were identified and reviewed. Median follow-up was 248 days. All patients experienced at least one drug-related AE; 18.2% were grade 3/4. The most common AEs were diarrhea 87.9%, rash 81.8%, stomatitis 57.6%, and paronychia 45.5%. Median dose of afatinib was 40 mg daily; 51.5% of patients had ≥ 1 dose reduction and 6.3% discontinued afatinib due to AEs. Proactive calls by the pharmacist identified 36.5% of all drug-related AEs, 33.3% of grade 3/4 AEs, 58.1% of first drug-related AEs and identified two patients that were non-compliant. Only 3.2% of AEs were identified by an emergency room/urgent clinic visit. CONCLUSIONS This proactive multi-disciplinary AE management algorithm resulted in a low rate of urgent assessments and discontinuation due to toxicity while maintaining afatinib at ideal dose, thus providing a useful tool for centers prescribing afatinib.
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Affiliation(s)
- Parneet K Cheema
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada.
| | - Alia Thawer
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Joanne Leake
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Susanna Y Cheng
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - Suneil Khanna
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
| | - J Charles Victor
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
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Steenrod A, Orme M, MacGilchrist KS, Rosenthal R, Schaefer J, Smoljanovic V, Mitry E, Cheema PK. Abstract 1642: Alectinib in treatment-naïve anaplastic lymphoma kinase-positive ( ALK+) metastatic non-small-cell lung cancer (mNSCLC): Systematic literature review (SLR) and network meta-analysis (NMA). Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-1642] [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: 11/16/2022]
Abstract
Abstract
Background: The standard of care for treatment-naïve ALK+ mNSCLC patients (pts) is an ALK tyrosine kinase inhibitor (TKI). Pts treated with crizotinib generally experience disease progression within 1 year, often within the central nervous system (CNS). As such, there is a high unmet need for CNS-active ALK TKIs. Phase III data from 2 ALK TKIs, alectinib and ceritinib, showed improved efficacy vs crizotinib and chemotherapy, respectively; however, no studies have directly compared these TKIs. We report a NMA to compare the efficacy/safety of these therapies.
Methods: A SLR was conducted to identify ALK+ mNSCLC randomized controlled trials (RCTs) in treatment-naïve pts. Efficacy/safety endpoints were extracted and the feasibility of using the data in a NMA was assessed. Data were analyzed using a fixed effect analysis in WinBUGs following NICE guidelines.
Results: 1194 citations were identified, of which 4 RCTs were in treatment-naïve pts (ALEX [NCT02075840], ASCEND-4 [NCT01828099], PROFILE 1014 [NCT01154140] and PROFILE 1029 [NCT01639001]). All were open-label, phase III RCTs and pts were similar in terms of age, ECOG PS, disease stage, sex and smoking status. More pts had baseline CNS metastasis (mets) in ALEX (40%) vs the other trials (26-32%). PROFILE 1029 was conducted in East Asian pts and only included in a sensitivity analysis. Chemotherapy arms differed in that pemetrexed maintenance was included in ASCEND-4 but not in the PROFILE studies. Key efficacy/safety results are shown in the Table. Data from the sensitivity analyses were similar.
Conclusion: Alectinib significantly improved progression-free survival compared with other treatments in the ITT population including in pts with baseline CNS mets. Alectinib showed significantly fewer grade 3-4 AEs than ceritinib. The difference in chemotherapy arms of the 2 trials may have impacted the NMA efficacy results.
Table. NMA results in treatment-naïve ALK+ mNSCLC patientsComparisonEfficacy/Safety Endpoints PFS by IRC* HR (95% CrI)Subgroup CNS Mets at Baseline* PFS by IRC HR (95% CrI)OS* HR (95% CrI)Grade 3 or 4 AEs§OR (95% CrI)Alectinib vs chemotherapy0.23 (0.15-0.34)0.21 (0.10-0.44)0.63 (0.34-1.15)0.81 (0.44-1.52)Alectinib vs crizotinib0.50 (0.36-0.70)0.37 (0.22-0.63)0.76 (0.49-1.20)0.65 (0.41-1.04)Alectinib vs ceritinib0.41 (0.25-0.67)0.31 (0.13-0.71)0.85 (0.42-1.73)0.36 (0.17-0.79)Crizotinib vs chemotherapy0.45 (0.35-0.58)0.57 (0.35-0.93)0.82 (0.54-1.24)1.24 (0.81-1.91)Ceritinib vs chemotherapy0.55 (0.42-0.72)0.70 (0.44-1.11)0.73 (0.50-1.06)2.25 (1.42-3.61)Ceritinib vs crizotinib1.22 (0.84-1.79)1.22 (0.62-2.43)0.90 (0.52-1.57)1.82 (0.96-3.44)Statistically significant differences indicated in bold based on 95% CrI; *Hazard ratio <1 indicates lower hazard (higher likelihood of PFS or OS) compared with control; §Odds ratio <1 indicates lower odds of an event compared with control. AEs, adverse events; CNS, central nervous system; CrI, credible interval; HR, hazard ratio; IRC, independent review committee; Mets, metastases; OR, odds ratio; OS, overall survival; PFS, progression-free survival
Citation Format: Anna Steenrod, Michelle Orme, Katherine S. MacGilchrist, Rachel Rosenthal, Juliane Schaefer, Vlatka Smoljanovic, Emmanuel Mitry, Parneet K. Cheema. Alectinib in treatment-naïve anaplastic lymphoma kinase-positive (ALK+) metastatic non-small-cell lung cancer (mNSCLC): Systematic literature review (SLR) and network meta-analysis (NMA) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1642.
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Affiliation(s)
| | | | | | | | | | | | | | - Parneet K. Cheema
- 4William Osler Health System, University of Toronto, Toronto, Ontario, Canada
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28
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Camidge DR, Peters S, Mok T, Gadgeel SM, Cheema PK, Pavlakis N, De Marinis F, Stroyakovskiy DL, Cho BC, Zhang L, Moro-Sibilot D, Zeaiter AH, Mitry E, Balas B, Müller B, Shaw A. Updated efficacy and safety data from the global phase III ALEX study of alectinib (ALC) vs crizotinib (CZ) in untreated advanced ALK+ NSCLC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9043] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Solange Peters
- Centre Hospitalier Universitaire Vaudois - CHUV, Lausanne, Switzerland
| | - Tony Mok
- Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Nick Pavlakis
- Northern Cancer Institute, St Leonards, Sydney, Australia
| | | | - Daniil L. Stroyakovskiy
- Moscow City Oncology Hospital №62 of Moscow Department of Health, Moscow, Russian Federation
| | | | - Li Zhang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | | | | | | | | | | | - Alice Shaw
- Massachusetts General Hospital, Boston, MA
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29
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Stockley T, Souza CA, Cheema PK, Melosky B, Kamel-Reid S, Tsao MS, Spatz A, Karsan A. Evidence-based best practices for EGFR T790M testing in lung cancer in Canada. ACTA ACUST UNITED AC 2018; 25:163-169. [PMID: 29719432 DOI: 10.3747/co.25.4044] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) are recommended as first-line systemic therapy for patients with non-small-cell lung cancer (nsclc) having mutations in the EGFR gene. Resistance to tkis eventually occurs in all nsclc patients treated with such drugs. In patients with resistance to tkis caused by the EGFR T790M mutation, the third-generation tki osimertinib is now the standard of care. For optimal patient management, accurate EGFR T790M testing is required. A multidisciplinary working group of pathologists, laboratory medicine specialists, medical oncologists, a respirologist, and a thoracic radiologist from across Canada was convened to discuss best practices for EGFR T790M mutation testing in Canada. The group made recommendations in the areas of the testing algorithm and the pre-analytic, analytic, and post-analytic aspects of clinical testing for both tissue testing and liquid biopsy circulating tumour dna testing. The recommendations aim to improve EGFR T790M testing in Canada and to thereby improve patient care.
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Affiliation(s)
- T Stockley
- Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network; and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - C A Souza
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON
| | - P K Cheema
- William Osler Health System, Brampton; and Department of Medicine, University of Toronto, Toronto, ON
| | - B Melosky
- Department of Oncology, BC Cancer, Vancouver, BC
| | - S Kamel-Reid
- Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network; and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON.,Department of Medical Biophysics, University of Toronto, Toronto, ON
| | - M S Tsao
- Department of Pathology, University Health Network; and Princess Margaret Cancer Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - A Spatz
- Lady Davis Institute for Medical Research; McGill University Health Centre; and Department of Pathology, McGill University, Montreal, QC
| | - A Karsan
- Centre for Clinical Genomics, Michael Smith Genome Sciences Centre, BC Cancer Research Centre; and Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
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30
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De Marinis F, Cho BC, Kim DW, Kim SW, Hochmair MJ, Metro G, Vansteenkiste JF, Vicente D, Solomon BJ, Cheema PK, Freitas HC, Provencio M, Chen YM, Wu YL, Milner A, Rigas JR. ASTRIS: A real world treatment study of osimertinib in patients (pts) with EGFR T790M positive non-small cell lung cancer (NSCLC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.9036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9036 Background: Osimertinib is an oral, irreversible, central nervous system (CNS) active EGFR tyrosine kinase inhibitor (TKI) selective for both EGFR-TKI sensitizing and T790M resistance mutations. We report results from the first predefined interim analysis of the ongoing ASTRIS study (NCT02474355). Methods: Pts received osimertinib 80 mg once daily. Eligible pts had Stage IIIB-IV NSCLC harbouring a T790M mutation determined by local validated molecular test (not restricted by sample type), received prior EGFR-TKI therapy, WHO performance status (PS) 0−2, acceptable organ and bone marrow function and no history of interstitial lung disease (ILD) or QTc prolongation. Asymptomatic, stable CNS metastases were permitted. The primary efficacy outcome was overall survival; other outcomes included investigator-assessed response rate (RR), progression-free survival and time to treatment discontinuation. Safety data are also reported. Results: From study start (18 Sept 2015) to data cut-off (DCO; 3 Nov 2016), 1217 pts received osimertinib from 120 sites with a median follow-up of 4.1 mths ( < 1−14 mths), median age 64 yrs (27–92 yrs), 67% female, 61% White, 37% Asian, 87% WHO PS 0/1, 44% prior chemotherapy, 45% prior radiotherapy. All pts tested positive for T790M, identified from tissue in 682 pts (56%), plasma ctDNA in 433 pts (36%) and from other specimens in 102 pts (8%). At DCO, 317 pts (26%) had discontinued treatment, 900 pts (74%) were ongoing, median duration of exposure 3.8 mths ( < 1–13.2 mths), 168 pts (14%) had disease progression and 156 pts (13%) had died. In pts evaluable for response, the investigator-assessed RR was 64% (569/886; 95% CI 61, 67). Adverse events (AEs) leading to dose modification and treatment discontinuation were reported in 122 (10%) and 54 pts (4%), respectively. Serious AEs were reported in 165 pts (14%) and AEs leading to death in 30 pts (2%). ILD/pneumonitis-like events were reported in 25 pts (2%), and QTc prolongation in 9 pts (1%). Conclusions: ASTRIS, the largest reported clinical study of osimertinib in T790M-positive NSCLC, demonstrates clinical activity similar to that observed in the osimertinib clinical trial program with no new safety signals. Clinical trial information: NCT02474355.
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Affiliation(s)
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Maximilian J. Hochmair
- Respiratory Oncology Unit, Department of Respiratory and Critical Care Medicine, Otto Wagner Hospital, Vienna, Austria
| | - Giulio Metro
- Clinical Oncology, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | - Yuh-Min Chen
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital and Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital (GGH) and Guangdong Academy of Medical Sciences, Guangzhou, China
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31
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Cheema PK, Raphael S, El-Maraghi R, Li J, McClure R, Zibdawi L, Chan A, Victor JC, Dolley A, Dziarmaga A. Rate of EGFR mutation testing for patients with nonsquamous non-small-cell lung cancer with implementation of reflex testing by pathologists. ACTA ACUST UNITED AC 2017; 24:16-22. [PMID: 28270720 DOI: 10.3747/co.24.3266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Testing for mutation of the EGFR (epidermal growth factor receptor) gene is a standard of care for patients with advanced nonsquamous non-small-cell lung cancer (nsclc). To improve timely access to EGFR results, a few centres implemented reflex testing, defined as a request for EGFR testing by the pathologist at the time of a nonsquamous nsclc diagnosis. We evaluated the impact of reflex testing on EGFR testing rates. METHODS A retrospective observational review of the Web-based AstraZeneca Canada EGFR Database from 1 April 2010 to 31 March 2014 found centres within Ontario that had requested EGFR testing through the database and that had implemented reflex testing (with at least 2 years' worth of data, including the pre- and post-implementation period). RESULTS The 7 included centres had requested EGFR tests for 2214 patients. The proportion of pathologists requesting EGFR tests increased after implementation of reflex testing (53% vs. 4%); conversely, the proportion of medical oncologists requesting tests decreased (46% vs. 95%, p < 0.001). After implementation of reflex testing, the mean number of patients having EGFR testing per centre per month increased significantly [12.6 vs. 4.9 (range: 4.5-14.9), p < 0.001]. Before reflex testing, EGFR testing rates showed a significant monthly increase over time (1.37 more tests per month; 95% confidence interval: 1.19 to 1.55 tests; p < 0.001). That trend could not account for the observed increase with reflex testing, because an immediate increase in EGFR test requests was observed with the introduction of reflex testing (p = 0.003), and the overall trend was sustained throughout the post-reflex testing period (p < 0.001). CONCLUSIONS Reflex EGFR testing for patients with nonsquamous nsclc was successfully implemented at multiple centres and was associated with an increase in EGFR testing.
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Affiliation(s)
- P K Cheema
- Division of Medical Oncology and Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto
| | - S Raphael
- Department of Anatomic Pathology, North York General Hospital, Toronto
| | - R El-Maraghi
- Department of Medical Oncology/Hematology, Royal Victoria Regional Health Centre, Barrie
| | - J Li
- Department of Medical Oncology/Hematology, Michael Garron Hospital, Toronto
| | - R McClure
- Department of Anatomic Pathology, Health Sciences North, Sudbury
| | - L Zibdawi
- Department of Medical Oncology/Hematology, Southlake Regional Health Centre, Newmarket
| | - A Chan
- Department of Medical Oncology/Hematology, Thunder Bay Regional Health Sciences Centre, Thunder Bay
| | - J C Victor
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto; and
| | - A Dolley
- AstraZeneca Canada Inc., Mississauga, ON
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32
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Cheema PK, Menjak IB, Winterton-Perks Z, Raphael S, Cheng SY, Verma S, Muinuddin A, Freedman R, Toor N, Perera J, Anaka M, Victor JC. Impact of Reflex EGFR/ALK Testing on Time to Treatment of Patients With Advanced Nonsquamous Non–Small-Cell Lung Cancer. J Oncol Pract 2017; 13:e130-e138. [DOI: 10.1200/jop.2016.014019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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
Purpose: Optimal first-line systemic therapy for patients with advanced nonsquamous (nonsq) non–small-cell lung cancer (NSCLC) requires confirmation of EGFR/ ALK status, which can delay treatment. We evaluated the impact of reflex testing, defined as pathologists initiating EGFR/ ALK testing at the time of diagnosis of nonsq NSCLC, on time to treatment (TTT). Methods: We conducted a retrospective review of patients with nonsq NSCLC with medical oncology consultation at Sunnybrook Odette Cancer Centre between March 18, 2010 and April 30, 2014. Data were compared during routine and reflex testing. TTT was defined as the interval between the first medical oncology visit with advanced NSCLC and the initiation of systemic therapy. Results: A total of 306 patients were included (n = 232 for routine testing, n = 74 for reflex testing). There was a trend to improvement in median TTT with reflex testing (36 days [interquartile range {IQR}, 16 to 71 days v 26 days [IQR, 8 to 41 days], P = .071). Omitting patients with intentional delays in systemic therapy for low-volume disease, poor performance status, comorbidity management, and/or radiation therapy, median TTT improved (34 days [IQR, 15 to 67 days] v 22 days [IQR, 8 to 42 days], P = .049). Time to optimal first-line systemic therapy according to published guidelines improved (median, 36 days [IQR, 16 to 91 days] v 24 days [IQR, 8 to 43 days], P = .036). There was no impact on receipt of any first-line systemic therapy (55% v 59%, P = .66). The quality of biomarker testing improved, with fewer unsuccessful tests ( EGFR, 14% v 4%, P = .039; and ALK, 17% v 3%, P = .037). Conclusion: Reflex testing of EGFR/ ALK improved the time to optimal systemic therapy and the quality of biomarker testing for patients with advanced nonsq NSCLC.
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Affiliation(s)
- Parneet K. Cheema
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Ines B. Menjak
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Zoe Winterton-Perks
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Simon Raphael
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Susanna Y. Cheng
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Sunil Verma
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Ahmad Muinuddin
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Ryan Freedman
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Nevkeet Toor
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Joseph Perera
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Matthew Anaka
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - J. Charles Victor
- Sunnybrook Odette Cancer Centre; North York General Hospital, Toronto; Trillium Health Partners, Mississauga, Ontario; and Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Godman B, Finlayson AE, Cheema PK, Zebedin-Brandl E, Gutiérrez-Ibarluzea I, Jones J, Malmström RE, Asola E, Baumgärtel C, Bennie M, Bishop I, Bucsics A, Campbell S, Diogene E, Ferrario A, Fürst J, Garuoliene K, Gomes M, Harris K, Haycox A, Herholz H, Hviding K, Jan S, Kalaba M, Kvalheim C, Laius O, Lööv SA, Malinowska K, Martin A, McCullagh L, Nilsson F, Paterson K, Schwabe U, Selke G, Sermet C, Simoens S, Tomek D, Vlahovic-Palcevski V, Voncina L, Wladysiuk M, van Woerkom M, Wong-Rieger D, Zara C, Ali R, Gustafsson LL. Personalizing health care: feasibility and future implications. BMC Med 2013; 11:179. [PMID: 23941275 PMCID: PMC3750765 DOI: 10.1186/1741-7015-11-179] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/09/2013] [Indexed: 01/11/2023] Open
Abstract
Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer's perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- National Institute for Science and Technology on Innovation on Neglected Diseases, Centre for Technological Development in Health, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Alexander E Finlayson
- King’s Centre for Global Health, Global Health Offices, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Parneet K Cheema
- Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Eva Zebedin-Brandl
- Hauptverband der Österreichischen Sozialversicherungsträger, 21 Kundmanngasse, AT-1031, Wien, Austria
- Institute of Pharmacology and Toxicology, Department for Biomedical Sciences, University of Vienna, Vienna, Austria
| | - Inaki Gutiérrez-Ibarluzea
- Osteba Basque Office for HTA, Ministry of Health of the Basque Country, Donostia-San Sebastian 1, 01010, Vitoria-Gasteiz, Basque Country, Spain
| | - Jan Jones
- NHS Tayside, Kings Cross, Dundee DD3 8EA, UK
| | - Rickard E Malmström
- Department of Medicine, Clinical Pharmacology Unit, Karolinska Institutet, Karolinska University Hospital Solna, SE-17176, Stockholm, Sweden
| | - Elina Asola
- Pharmaceutical Pricing Board, Ministry of Social Affairs and Health, PO Box 33, FI-00023 Government, Helsinki, Finland
| | | | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Public Health & Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh EH12 9EB, UK
| | - Iain Bishop
- Public Health & Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh EH12 9EB, UK
| | - Anna Bucsics
- Hauptverband der Österreichischen Sozialversicherungsträger, 21 Kundmanngasse, AT-1031, Wien, Austria
| | - Stephen Campbell
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester M13 9PL, UK
| | - Eduardo Diogene
- Unitat de Coordinació i Estratègia del Medicament, Direcció Adjunta d'Afers Assistencials, Catalan Institute of Health, Barcelona, Spain
| | - Alessandra Ferrario
- London School of Economics and Political Science, LSE Health, Houghton Street, London WC2A 2AE, UK
| | - Jurij Fürst
- Health Insurance Institute, Miklosiceva 24, SI-1507, Ljubljana, Slovenia
| | - Kristina Garuoliene
- Medicines Reimbursement Department, National Health Insurance Fund, Europas a. 1, Vilnius, Lithuania
| | - Miguel Gomes
- INFARMED, Parque da Saúde de Lisboa, Avenida do Brasil 53, 1749-004, Lisbon, Portugal
| | - Katharine Harris
- King’s Centre for Global Health, Global Health Offices, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Alan Haycox
- Liverpool Health Economics Centre, University of Liverpool, Chatham Street, Liverpool L69 7ZH, UK
| | - Harald Herholz
- Kassenärztliche Vereinigung Hessen, 15 Georg Voigt Strasse, DE-60325, Frankfurt am Main, Germany
| | - Krystyna Hviding
- Norwegian Medicines Agency, Sven Oftedals vei 8, 0950, Oslo, Norway
| | - Saira Jan
- Clinical Programs, Pharmacy Management, Horizon Blue Cross Blue Shield of New Jersey, Newark, USA
| | - Marija Kalaba
- Republic Institute for Health Insurance, Jovana Marinovica 2, 11000, Belgrade, Serbia
| | | | - Ott Laius
- State Agency of Medicines, Nooruse 1, 50411, Tartu, Estonia
| | - Sven-Ake Lööv
- Department of Healthcare Development, Stockholm County Council, Stockholm, Sweden
| | - Kamila Malinowska
- HTA Consulting, Starowiślna Street, 17/3, 31-038, Cracow, Poland
- Public Health School, The Medical Centre of Postgraduate Education, Kleczewska Street, 61/63, 01-813, Warsaw, Poland
| | - Andrew Martin
- NHS Greater Manchester Commissioning Support Unit, Salford, Manchester, UK
| | - Laura McCullagh
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin 8, Ireland
| | - Fredrik Nilsson
- Dental and Pharmaceuticals Benefits Agency (TLV), PO Box 22520 Flemingatan 7, SE-104, Stockholm, Sweden
| | | | - Ulrich Schwabe
- University of Heidelberg, Institute of Pharmacology, D-69120, Heidelberg, Germany
| | - Gisbert Selke
- Wissenschaftliches Institut der AOK (WIDO), Rosenthaler Straße 31, 10178, Berlin, Germany
| | | | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium
| | - Dominik Tomek
- Faculty of Pharmacy, Comenius University and Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Vera Vlahovic-Palcevski
- Unit for Clinical Pharmacology, University Hospital Rijeka, Krešimirova 42, 51000, Rijeka, Croatia
| | - Luka Voncina
- Ministry of Health, Republic of Croatia, Ksaver 200a, Zagreb, Croatia
| | | | - Menno van Woerkom
- Dutch Institute for Rational Use of Medicines, 3527 GV, Utrecht, Netherlands
| | - Durhane Wong-Rieger
- Institute for Optimizing Health Outcomes, 151 Bloor Street West, Suite 600, Toronto, ON M5S 1S4, Canada
| | - Corrine Zara
- Barcelona Health Region, Catalan Health Service, Esteve Terrades 30, 08023, Barcelona, Spain
| | - Raghib Ali
- INDOX Cancer Research Network, Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
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Cheema PK, Zadeh S, Kukreti V, Reece D, Chen C, Trudel S, Mikhael J. Age 40 years and under does not confer superior prognosis in patients with multiple myeloma undergoing upfront autologous stem cell transmplant. Biol Blood Marrow Transplant 2009; 15:686-93. [PMID: 19450753 DOI: 10.1016/j.bbmt.2009.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 02/21/2009] [Indexed: 11/25/2022]
Abstract
Multiple myeloma (MM) rarely occurs in patients 40 years of age and younger. This young age has been reported to correlate with improved survival in patients with MM. The objective of this study is to describe presenting features and outcomes of patients < or =40 years of age with MM who undergo autologous stem cell transplantation (ASCT) as first-line treatment, and compare overall survival (OS) and progression free survival (PFS) to patients aged 41-65 years. We performed a retrospective institutional review of all patients < or =40 years of age and 41-65 years of age at the time of diagnosis of MM who had undergone upfront ASCT from January 1, 1990, to July 31, 2007. Thirty-eight patients < or =40 years of age and 608 patients aged 41-65 were identified. There was a high rate of plasma cell leukemia (PCL) in young patients at 11% compared to the reported rate of 2%-4%. At diagnosis, there was an increased rate of renal failure in the young cohort compared to patients aged 41-65 years at 25% versus 16% and Bence Jones proteinuria at 81% versus 51%. The rate of complete or partial response was similar between the groups at 79% and 83% in the young and older cohorts, respectively. Median PFS post-ASCT was 22.0 months (95% confidence interval [CI]: 16.1, 28.0), versus 26.9 months (95% CI: 24.0, 29.8) for patients aged 41-65 years (P = .66). Median OS from date of ASCT was also similar to those over 40 years: 68.1 months (95% CI: 39.0, 97.2) versus 80.7 months (95% CI: 68.1, 93.4); P = .90. Treatment-related mortality (TRM) was low at 2.6% and 2.3% in the young and older cohorts, respectively. Despite previous reports that young age is a positive prognostic marker, our study found OS post-ASCT is equivalent to those aged 41-65 years. This study emphasizes the importance of developing strategies to better the outcomes of young patients with MM.
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Affiliation(s)
- Parneet K Cheema
- Division of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale,AZ 85259, USA
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