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Meersseman C, Grolleau E, Freymond N, Wallet F, Gilbert T, Locatelli-Sanchez M, Gérinière L, Perrot E, Souquet PJ, Fontaine-Delaruelle C, David JS, Couraud S. High flow nasal oxygen in frail COVID-19 patients hospitalized in intermediate care units and non-eligible to invasive mechanical ventilation. Respir Med Res 2023; 84:101026. [PMID: 37717386 PMCID: PMC10195878 DOI: 10.1016/j.resmer.2023.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND In COVID-19 patients, older age (sixty or older), comorbidities, and frailty are associated with a higher risk for mortality and invasive mechanical ventilation (IMV) failure. It therefore seems appropriate to suggest limitations of care to older and vulnerable patients with severe COVID-19 pneumonia and a poor expected outcome, who would not benefit from invasive treatment. HFNO (high flow nasal oxygen) is a non-invasive respiratory support device already used in de novo acute respiratory failure. The main objective of this study was to evaluate the survival of patients treated with HFNO outside the ICU (intensive care unit) for a severe COVID-19 pneumonia, otherwise presenting limitations of care making them non-eligible for IMV. Secondary objectives were the description of our cohort and the identification of prognostic factors for HFNO failure. METHODS We conducted a retrospective cohort study. We included all patients with limitations of care making them non-eligible for IMV and treated with HFNO for a severe COVID-19 pneumonia, hospitalized in a COVID-19 unit of the pulmonology department of Lyon Sud University Hospital, France, from March 2020 to March 2021. Primary outcome was the description of the vital status at day-30 after HFNO initiation, using the WHO (World Health Organization) 7-points ordinal scale. RESULTS Fifty-six patients were included. Median age was 83 years [76.3-87.0], mean duration for HFNO was 7.5 days, 53% had a CFS score (Clinical Frailty Scale) >4. At day-30, 73% of patients were deceased, one patient (2%) was undergoing HFNO, 9% of patients were discharged from hospital. HFNO failure occurred in 66% of patients. Clinical signs of respiratory failure before HFNO initiation (respiratory rate >30/min, retractions, and abdominal paradoxical breathing pattern) were associated with mortality (p = 0.001). CONCLUSIONS We suggest that HFNO is an option in non-ICU skilled units for older and frail patients with a severe COVID-19 pneumonia, otherwise non-suitable for intensive care and mechanical ventilation. Observation of clinical signs of respiratory failure before HFNO initiation was associated with mortality.
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Affiliation(s)
- Corentin Meersseman
- Lyon-Est Medical School, Claude Bernard Lyon 1 University, Villeurbanne, France; Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France.
| | - Emmanuel Grolleau
- Lyon-Est Medical School, Claude Bernard Lyon 1 University, Villeurbanne, France; Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Nathalie Freymond
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Florent Wallet
- Anesthesia and Critical Care Medicine Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Thomas Gilbert
- Department of Geriatric Medicine, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Myriam Locatelli-Sanchez
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Laurence Gérinière
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Emilie Perrot
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Pierre-Jean Souquet
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Clara Fontaine-Delaruelle
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Jean-Stéphane David
- Anesthesia and Critical Care Medicine Department, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Sébastien Couraud
- Department of Respiratory Diseases, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France; Lyon Center for Innovation in Cancerology, Lyon-Sud Medical School, Claude Bernard Lyon 1 University, Oullins, France
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Wolf J, Souquet PJ, Goto K, Cortot A, Baik C, Heist R, Kim TM, Han JY, Neal JW, Mansfield AS, Gilloteau I, Nwana N, Waldron-Lynch M, Davis KL, Giovannini M, Awad MM. Improved Survival Outcomes in Patients With MET-Dysregulated Advanced NSCLC Treated With MET Inhibitors: Results of a Multinational Retrospective Chart Review. Clin Lung Cancer 2023; 24:641-650.e2. [PMID: 37741716 DOI: 10.1016/j.cllc.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND We evaluated the disease and patient characteristics, treatment, and MET testing patterns, predictive biomarkers and survival outcomes in patients with MET-dysregulated metastatic non-small-cell lung cancer (NSCLC) in a real-world setting. PATIENTS AND METHODS This was a multinational, retrospective, noninterventional chart review study. Data from medical records of patients with advanced/metastatic EGFR wild-type, MET-dysregulated NSCLC (December 2017-September 2018) were abstracted into electronic data collection forms. RESULTS Overall, 211 patient charts were included in this analysis; 157 patients had MET exon 14 skipping mutations (METex14; with or without concomitant MET amplification) and 54 had MET amplification only. All patients were tested for METex14, whereas MET amplification was evaluated in 168 patients. No overlap was reported between MET dysregulation and ALK, ROS1 or RET rearrangements, or HER2 exon 20 insertions. Overall, 56 of 211 patients (26.5%) received MET inhibitor (METi) therapy in any treatment-line setting (31.2% in the METex14 cohort; 13% in the MET-amplified only cohort). In the METex14 cohort, median OS in patients receiving METi was 25.4 months versus 10.7 months in patients who did not (HR [95% CI]: 0.532 [0.340-0.832]; P = .0055). In the MET-amplified only cohort, median OS was 20.6 months in patients treated with METi compared with 7.6 months in those without METi (HR [95% CI]: 0.388 [0.152-0.991]; P = .0479). CONCLUSIONS MET alterations in NSCLC typically occur in the absence of other oncogenic driver mutations and are associated with poor survival outcomes. Notably, METi therapies are associated with improved survival outcomes in patients with MET-dysregulated NSCLC.
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Affiliation(s)
- Jürgen Wolf
- Department of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany.
| | | | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Alexis Cortot
- Department of Thoracic Oncology, University of Lille, CHU Lille, CNRS, Inserm, Institut Pasteur De Lille, UMR9020-U1277-CANTHER, Lille, France
| | - Christina Baik
- Thoracic, Head and Neck Medical Oncology, University of Washington, Seattle, WA
| | | | - Tae Min Kim
- Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Youn Han
- Center for Lung Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Joel W Neal
- Medical Oncology, Stanford University Medical Center, Stanford, CA
| | | | | | | | | | | | | | - Mark M Awad
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
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Grange C, Rioufol C, Souquet PJ, Assaad S. Anti-coagulant Treatment of Cancer-Associated Thrombosis in Frail Patients: Impact of Frailties on the Management of Drug-Drug Interactions. Clin Pharmacokinet 2023; 62:1523-1531. [PMID: 37824026 PMCID: PMC10582124 DOI: 10.1007/s40262-023-01298-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 10/13/2023]
Abstract
Low molecular weight heparins (LMWH) and anti-Xa direct oral anti-coagulants (DOACs) are recommended for the long-term treatment of cancer-associated thrombosis (CAT) based on well-documented randomised controlled trials. Anti-Xa DOACs are viewed as a first choice for the treatment of patients with CAT. A large number of drug-drug interactions have been reported between DOACs and chemotherapy drugs, modifying circulating levels of DOAC leading to fears of increased bleeding risks or thrombotic recurrence. Progresses in anti-neoplastic therapies have improved the prognosis and the survival, thus increasing the prevalence of frail patients with cancer. However, since frailties tend to be excluded from large trials due to multiple co-morbidities, current guidelines are not fully applicable to this population. The management of these frail patients with CAT is particularly complex and requires a risk assessment on a case-by-case basis with specific focus on cancer, patient-related risk factors and drug-drug interactions. In this brief review we have identified age, co-morbidities and co-medications as key factors of frailty that require careful attention and we have developed a therapeutic decision algorithm to help clinicians optimising the use of anti-coagulants in patients with cancer with CAT, especially in case of anti-Xa DOACs concomitant medications. With the evaluation of the bleeding risk according to the type of cancer, and anticipating drug-drug interactions intensity, taking into account patient frailties allows the optimisation of the anti-coagulant choice. A systematic collaboration between oncologists, vascular pathology specialists and pharmacists is warranted to ensure an optimal patient management. Clinical studies are needed to determine the real impact of these interactions.
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Affiliation(s)
- Claire Grange
- Service de Médecine Interne-Médecine Vasculaire, Hospices Civils de Lyon, CH Lyon Sud, Lyon, France.
| | - Catherine Rioufol
- Hospices Civils de Lyon, CH Lyon Sud, Service de Pharmacie, UCBL1-EA 3738 CICLY, Lyon, France
| | - Pierre-Jean Souquet
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Lyon, France
| | - Souad Assaad
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France
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Plessala I, Cawston H, Cortes J, Ajjouri R, Le Lay K, Souquet PJ, Chouaid C. Cost-effectiveness analysis of atezolizumab as adjuvant treatment of patients with stage II-IIIA non-small cell lung cancer, PD-L1+≥50% of tumor cells in France: A modeling study. Lung Cancer 2023; 184:107316. [PMID: 37562344 DOI: 10.1016/j.lungcan.2023.107316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The objective of this study was to assess the cost-effectiveness of atezolizumab versus best supportive care (BSC) as adjuvant treatment following resection and platinum-based chemotherapy for patients with stage II-IIIA non-small cell lung cancer (NSCLC) whose tumours have a programmed death-ligand 1 (PD-L1) expression ≥ 50% of tumour cells and excluding those with ALK/EGFR mutations, from a French collective perspective. MATERIAL AND METHODS A five state Markov model over a 20-year time horizon was considered, including disease-free survival (DFS1) from IMpower010 trial, three progression states (locoregional recurrence, first and second-line metastatic recurrence) and death. Utilities, quality-adjusted life year (QALY) decrements associated to adverse events, costs, resource use, and transition probabilities were considered in the model. These inputs were sourced from IMpower010 trial, literature, and clinical experts' opinion. Model uncertainty was assessed through deterministic, probabilistic sensitivity analyses and scenario analyses. RESULTS Atezolizumab was associated with a QALY gain of 1.662, mainly driven by additional time spent in the DFS state, and a life-year gain of 2.112 years. The incremental cost-effectiveness ratio (ICER) for atezolizumab versus BSC was €21,348/QALY gained. The sensitivity analyses highlighted that uncertainty within the model had limited impact on results. Changing the DFS survival curves to other plausible distributions produced ICERs below €20,000/QALY. Introducing an increasing proportion of cured patients (91.5%) from year two to year five reduced the ICER to €13,083/QALY, while including a loss of efficacy at year two in the atezolizumab treatment arm increased the ICER to €33,755/QALY. DISCUSSION Atezolizumab as adjuvant treatment in stage II-IIIA NSCLC resected patients with PDL1 ≥ 50% and without ALK/EGFR mutations has a lower ICER than other oncology drugs in France and a similar ICER to other adjuvant treatment in oncology.
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Affiliation(s)
| | - Hélène Cawston
- Amaris, Health Economics and Market Access, Paris, France
| | - Justine Cortes
- Amaris, Health Economics and Market Access, Paris, France
| | | | | | | | - Christos Chouaid
- Service de Pneumologie, CHI Créteil, 5 Inserm U955, UPEC, IMRB, Créteil, France
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Phelip JM, Souquet PJ, Hacini M, Chehimi M, Bourgeois V, Bennoune R, Tredan O. G-CSF filgrastim biosimilar-Sandoz reduces the incidence of febrile neutropenia in patients receiving chemotherapy regimens with rest periods not exceeding 14 days: A French, multicenter, prospective, non-interventional study. Cancer Treat Res Commun 2023; 35:100690. [PMID: 36780734 DOI: 10.1016/j.ctarc.2023.100690] [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: 12/08/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The objective of this study was to describe filgrastim biosimilar-Sandoz modalities of use in patients receiving cytotoxic chemotherapy regimens with a rest period of ≤14 days and to investigate the incidence of febrile neutropenia (FN) in routine clinical practice. METHODS This was a French, multicenter, prospective and descriptive, non-interventional study including patients with breast, lung, gastrointestinal cancer or a lymphoma initiating filgrastim biosimilar-Sandoz treatment and in the context of cytotoxic chemotherapy with a rest period not exceeding 14 days. Data were collected during two routine clinical visits on the modalities of use of filgrastim biosimilar-Sandoz, on the incidence of neutropenia events and on adverse events. RESULTS Between November 2015 and June 2018, 1080 patients were enrolled in the study in 129 centers. Overall, 941 patients were evaluable for efficacy and 937 for safety. Of the 941 patients, 84.8% had a solid tumor and 15.2% had a lymphoid hemopathy. Filgrastim biosimilar-Sandoz was prescribed as primary prophylaxis in 74.0% of the patients and as secondary prophylaxis in 22.4% of the patients. FN was reported in 1.5% of patients with a solid tumor and 12.6% of patients with a lymphoma. A chemotherapy relative dose intensity of over 85% with regard to the reference dose was achieved by more than 80% of the patients in all tumor localizations. CONCLUSIONS The study showed that filgrastim biosimilar-Sandoz is safe to use and effective in preventing FN and in allowing to maintain the dose intensity of chemotherapy.
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Affiliation(s)
- Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Pierre-Jean Souquet
- Department of Thoracic Cancer, University Hospital of Lyon, Institut de Cancérologie des Hospices Civils de Lyon, Lyon 69002, France
| | - Maya Hacini
- Department of Hematology, Centre Hospitalier de Chambéry, Chambery 73000, France
| | - Mohamad Chehimi
- Department of Medical Oncology and Hematology, Centre Hospitalier Saint Quentin Cedex, 02321 Saint-Quentin, France
| | - Vincent Bourgeois
- Department of Oncology, Centre Hospitalier de Boulogne sur mer, 62321 Boulogne-sur-mer, France
| | - Ryma Bennoune
- Medical Department, Oncology, Sandoz SAS, 92593 Levallois-Perret Cedex, France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, 28 rue Laennec, 69373, Lyon Cedex, France.
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Westeel V, Foucher P, Scherpereel A, Domas J, Girard P, Trédaniel J, Wislez M, Dumont P, Quoix E, Raffy O, Braun D, Derollez M, Goupil F, Hermann J, Devin E, Barbieux H, Pichon E, Debieuvre D, Ozenne G, Muir JF, Dehette S, Virally J, Grivaux M, Lebargy F, Souquet PJ, Freijat FA, Girard N, Courau E, Azarian R, Farny M, Duhamel JP, Langlais A, Morin F, Milleron B, Zalcman G, Barlesi F. Chest CT scan plus x-ray versus chest x-ray for the follow-up of completely resected non-small-cell lung cancer (IFCT-0302): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:1180-1188. [DOI: 10.1016/s1470-2045(22)00451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/09/2023]
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7
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Beaurain M, Rioufol C, Vantard N, Teixeira A, Baudouin A, Herledan C, Souquet PJ, Couraud S, Ranchon F. Intravenous route for folate supplementation in a patient with celiac disease treated by pemetrexed-based chemotherapy for non-small-cell lung cancer. J Oncol Pharm Pract 2022; 29:750-754. [PMID: 35918825 DOI: 10.1177/10781552221117734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Oral folic acid supplementation is essential for patients treated with pemetrexed, to prevent the risk of severe hematologic toxicity. In case of intestinal absorption disorder, no recommendations exist for intravenous folic acid supplementation. CASE REPORT We describe a 74-year-old patient with multimetastatic non-small-cell lung adenocarcinoma, receiving first-line chemotherapy with carboplatin AUC5, pemetrexed 500 mg/m2 and pembrolizumab 200 mg intravenously every 3 weeks. The patient presented neglected celiac disease, resulting in malabsorption syndrome with iron and folic acid deficiency. The question was how to administer folic acid supplementation during the pemetrexed-based chemotherapy. MANAGEMENT AND OUTCOMES Intravenous injection of 200 mg levoleucovorin on day 1 of cycle 1 of pemetrexed-based chemotherapy was administered and well tolerated. During the second cycle, the levoleucovorin perfusion was not renewed by omission. The patient was hospitalized for 7 days because of febrile aplasia. Piperacillin-tazobactam was started, and then switched to amoxicillin-clavulanate plus ciprofloxacin. After this episode of post-chemotherapy febrile aplasia, it was decided to systematically supplement the patient with intravenous levoleucovorin, with blood folate concentration monitoring at each cycle. At 16 months after start of treatment, the patient was in complete remission, indicating that the immune-chemotherapy was effective, with no further febrile neutropenia. DISCUSSION/CONCLUSION This case report highlights intravenous levoleucovorin supplementation as an alternative to oral folic acid if needed during pemetrexed-antifolate-based chemotherapy.
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Affiliation(s)
- Marie Beaurain
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.,Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Alexandre Teixeira
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Chloe Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Pierre-Jean Souquet
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Sebastien Couraud
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France.,Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.,Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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Barlesi F, Tomasini P, Karimi M, Michiels S, Raimbourg J, Daniel C, Janicot H, Madroszyk A, Audigier-Valette C, Quoix E, Mazieres J, Moro-Sibilot D, Dansin E, Molinier O, Morel H, Pichon E, Cortot A, Otto J, Chomy FO, Souquet PJ, Cloarec N, Giroux Leprieur E, Bieche I, Lacroix L, Boyault S, Attignon V, Soubeyran I, Morel A, Tran-Dien A, Jacquet A, Dall'Olio FG, Jimenez M, Soria JC, Besse B. Comprehensive genome profiling in patients with metastatic non-small cell lung cancer: the precision medicine phase 2 randomized SAFIR02-Lung trial. Clin Cancer Res 2022; 28:4018-4026. [PMID: 35802649 DOI: 10.1158/1078-0432.ccr-22-0371] [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] [Received: 02/06/2022] [Revised: 04/20/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Targeted therapies (TT) and immune checkpoint blockers (ICB) have revolutionized the approach to non-small cell lung cancer (NSCLC) treatment in the era of precision medicine. Their impact as switch maintenance therapy based on molecular characterization is unknown. EXPERIMENTAL DESIGN SAFIR02-Lung was an open-label, randomized, phase 2 trial, involving 33 centers in France. We investigated eight TT (substudy-1) and one ICB (substudy-2), compared to standard-of-care as a maintenance strategy in advanced EGFR, ALK wild-type (wt) NSCLC patients without progression after first line chemotherapy, based on high-throughput genome analysis. The primary outcome was progression-free survival (PFS). RESULTS Among the 175 patients randomized in substudy-1, 116 received TT (selumetinib, vistusertib, capivasertib, AZD4547, AZD8931, vandetanib, olaparib, savolitinib) and 59 standard-of-care. Median PFS was 2.7 months (95% CI 1.6-2.9) with TT vs. 2.7 months (1.6-4.1) with standard-of-care (HR 0.97, 0.7-1.36; p=0.87). There were no significant differences in PFS within any molecular subgroup. In substudy-2, 183 patients were randomized, 121 received durvalumab and 62 standard-of-care. Median PFS was 3.0 months (2.3-4.4) with durvalumab versus 3.0 months (2.0-5.1) with standard-of-care (HR=0.86; 0.62-1.20; p=0.38). Preplanned subgroup analysis showed an enhanced benefit with durvalumab in patients with PD-L1 Tumor Proportion Score (TPS) ≥ 1%, (n=29, HR=0.29; 0.11-0.75) as compared to PD-L1 <1% (n=31, HR=0.71, 0.31-1.60, interaction p= 0.036). CONCLUSIONS Molecular profiling can feasibly be implemented to guide treatment choice for the maintenance strategy in EGFR/ALK wt NSCLC; in the current study it did not lead to substantial treatment benefits beyond durvalumab for PD-L1 ≥ 1 patients.
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Affiliation(s)
- Fabrice Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Pascale Tomasini
- Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | | | | | | | | | - Henri Janicot
- CHU - Hopital Gabriel Montpied, Clermont-Ferrand, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alain Morel
- Institut de Cancérologie de l'Ouest, Angers, France
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Molinier O, Besse B, Barlesi F, Audigier-Valette C, Friard S, Monnet I, Jeannin G, Mazières J, Cadranel J, Hureaux J, Hilgers W, Quoix E, Coudert B, Moro-Sibilot D, Fauchon E, Westeel V, Brun P, Langlais A, Morin F, Souquet PJ, Girard N. IFCT-1502 CLINIVO: real-world evidence of long-term survival with nivolumab in a nationwide cohort of patients with advanced non-small-cell lung cancer. ESMO Open 2021; 7:100353. [PMID: 34953398 PMCID: PMC8764511 DOI: 10.1016/j.esmoop.2021.100353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Immunotherapy using inhibitors targeting immune checkpoint programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) is currently the standard of care in patients with advanced non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS We carried out a nationwide cohort retrospective study of consecutive patients with advanced, refractory NSCLC who received nivolumab as second to later lines of treatment as part of the expanded access program. Key objectives were to assess the efficacy and safety of nivolumab and the efficacy of first post-nivolumab treatment. RESULTS Nine hundred and two patients were enrolled: 317 (35%) with squamous cell carcinoma and 585 (65%) with non-squamous cell carcinoma. Median age was 64 years; there were 630 (70%) men, 795 (88%) smokers, 723 (81%) patients with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0/1, 197 (22%) patients with brain metastases, and 212 (27%) with liver metastases. Best response was partial response for 16.2% and stable disease (SD) for 30.5%. Progression-free survival and overall survival (OS) rates at 2, 3, and 5 years were 8% and 25%, 6% and 16%, and 4% and 10%, respectively. At multivariate analysis, ECOG PS ≥2 [hazard ratio (HR) = 2.13, 95% confidence interval (95% CI) 1.78-2.55, P < 0.001], squamous histology (HR = 1.17, 95% CI 1.01-1.36, P = 0.04), and presence of central nervous system metastases (HR = 1.29, 95% CI 1.08-1.54, P = 0.005) were significantly associated with lower OS. Four hundred and ninety-two patients received at least one treatment after discontinuation of nivolumab, consisting of systemic therapies in 450 (91%). Radiation therapy was delivered to 118 (24%) patients. CONCLUSION The CLINIVO cohort represents the largest real-world evidence cohort with the use of immune checkpoint inhibitor in advanced, metastatic NSCLC after failure of first-line chemotherapy, with long-term follow-up and analysis of subsequent therapies. Our data confirm the efficacy of nivolumab in a cohort larger than that reported in landmark clinical trials and identify prognostic factors, which reinforces the need for accurate selection of patients for treatment with immune checkpoint inhibitors. Our data indicate that oligoprogression is frequent after nivolumab exposure and provide a unique insight into the long-term survival.
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Affiliation(s)
- O Molinier
- Pneumology, Centre Hospitalier Du Mans, Le Mans, France
| | - B Besse
- Cancer Medicine Department, Gustave Roussy, Villejuif, France; Paris-Saclay University, Orsay, France
| | - F Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France; Gustave Roussy Cancer Campus, Villejuif, France
| | - C Audigier-Valette
- Pneumology Department, Centre Hospitalier Toulon Sainte-Musse, Toulon, France
| | - S Friard
- Hopital Foch, Chest Department, Suresnes, France
| | - I Monnet
- Pneumology Service, CHI Créteil, Créteil, France
| | - G Jeannin
- Pneumology Service, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - J Mazières
- Pneumology Service, Centre Hospitalier Universitaire de Toulouse, Hôpital Larrey, Pôle Voies Respiratoires, Toulouse, France
| | - J Cadranel
- Pneumology Service, Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, GRC n04, Theranoscan, Paris, France
| | - J Hureaux
- Pôle Hippocrate, CHU d'Angers, Angers, France
| | - W Hilgers
- Medical Oncology, Sainte Catherine Cancer Institute, Avignon Provence, France
| | - E Quoix
- Pneumology Service, Hôpitaux Universitaires de Strasbourg-Unistra, Strasbourg, France
| | - B Coudert
- Medical Oncology Department, Centre Georges-François Leclerc, Dijon, France
| | - D Moro-Sibilot
- Pneumology and Thoracic Oncology Department, CHU Grenoble-Alpes, La Tronche, France
| | - E Fauchon
- Pneumology Service, CHI, Saint-Julien-en-Genevois, France
| | - V Westeel
- Pneumology Service, Centre Hospitalier Régional Universitaire de Besançon, Hôpital Jean Minjoz, Besançon, France
| | - P Brun
- Pneumology Service, CH de Valence, Valence, France
| | - A Langlais
- Biostatistic Department, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - F Morin
- Clinical Research Unit, French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - P J Souquet
- Pneumology Service, Centre hospitalier Lyon-Sud, Pierre-Bénite, France
| | - N Girard
- Paris-Saclay University, Orsay, France; Institut du Thorax Curie-Montsouris, Institut Curie, Paris, France.
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10
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Souquet PJ, Audigier-Valette C, Molinier O, Cortot A, Margery J, Moreau L, Gervais R, Barlesi F, Pichon E, Zalcman G, Dumont P, Girard N, Poudenx M, Mazières J, Cadranel J, Debieuvre D, Dauba J, Langlais A, Morin F, Moro-Sibilot D, Westeel V, Pérol M. Tailoring maintenance chemotherapy upon response to induction chemotherapy as compared with pemetrexed continuation maintenance in advanced non-squamous NSCLC patients: Results of the IFCT-GFPC-1101 multicenter randomized phase III trial. Lung Cancer 2021; 164:84-90. [PMID: 35051725 DOI: 10.1016/j.lungcan.2021.11.014] [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: 08/30/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Benefit from maintenance in advanced non-squamous non-small cell lung cancer (NS-NSCLC) might favor switch maintenance after disease stabilization (SD) and continuation after objective response (OR). This trial assessed a maintenance strategy conditioned by response to cisplatin-gemcitabine (CG) with G continuation for patients with OR or switch to pemetrexed (P) for patients with SD as compared with a control arm based on the Paramount regimen. METHODS Eligibility criteria: age 18-70 years, ECOG PS 0-1, untreated stage IV NS-NSCLC without EGFR or ALK alteration, ineligibility to bevacizumab. Patients were randomized 1:1 to receive either CG (4 cycles) followed by G maintenance in case of OR followed by P at progression, or switch to P for patients with SD, or 4 cycles of CP followed by P (control arm). Primary endpoint: overall Survival. RESULTS Between 2012 and 2016, 932 patients were randomized (CG: 467, CP: 465) with well-balanced characteristics. 257 patients (56.7%) in the CG arm received maintenance (G: 142, P: 113) versus 277 patients (59.7%) in the CP arm. Median number of maintenance cycles was 5 for G and P (CG induction) and 4 for P (CP induction). OS adjusted HR was 0.97 (95% CI 0.84, 1.13; p = 0.71) with a median of 10.9 months (CG) versus 10.4 (CP). HR for PFS was 0.95 (95% CI 0.83, 1.09; p = 0.45) with a median of 4.8 months for CG versus 4.5 for CP. Safety profile was as expected. CONCLUSIONS Adapting maintenance strategy according to response to induction chemotherapy does not improve patient outcome. CLINICAL TRIAL INFORMATION NCT01631136.
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Affiliation(s)
| | | | - Olivier Molinier
- Service des Maladies Respiratoires, Centre Hospitalier Général - Le Mans, France
| | - Alexis Cortot
- Thoracic Oncology Department, CHU Lille, Univ. Lille, Siric ONCOLille, CNRS UMR8161, Lille F-59000, France
| | - Jacques Margery
- Department of Pneumology, Hôpital D'Instruction des Armées Percy, Clamart, France
| | - Lionel Moreau
- Department of Pneumology, Hôpital Louis Pasteur, Hôpitaux Civils de Colmar, Colmar, France
| | - Radj Gervais
- Department of Pneumology, Centre François Baclesse, Caen, France
| | - Fabrice Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, APHM, Campus Timone, CHU NORD, Chemin des Bourrely, Marseille 13915, France; Gustave Roussy cancer campus - Villejuif, France
| | - Eric Pichon
- Department of Pneumology, CHRU Bretonneau, Tours, France
| | - Gérard Zalcman
- University Hospital Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris-Diderot University Paris, France
| | | | - Nicolas Girard
- Institut Curie Montsouris Thorax, Institut Curie, Paris, France
| | | | | | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris and GRC 04 Theranoscan Sorbonne Université, Paris, France
| | | | - Jérôme Dauba
- Departement of Oncology, Hôpital Mont de Marsan - Mont-de-Marsan, France
| | | | - Franck Morin
- Intergroupe Francophone de Cancérologie Thoracique - Paris, France
| | - Denis Moro-Sibilot
- Thoracic Oncology Unit, PTV, CHU Grenoble-Alpes CS10217, 38043 Grenoble, France
| | - Virginie Westeel
- Université de Bourgogne-Franche Comté, INSERM UMR 1098, University Hospital Jean Minjoz, Department of Pneumology, Besançon, France
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11
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Darrason M, Souquet PJ, Couraud S. Standardized vs peer-played patients for learning how to break bad news in lung cancer: A prospective crossover study. Respir Med Res 2021; 80:100856. [PMID: 34481303 DOI: 10.1016/j.resmer.2021.100856] [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: 04/11/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Residents in respiratory medicine are often confronted with breaking bad news to patients. In communication skill training, a recurring question is whether to use standardized or peer-played patients for simulation METHODS: In this prospective single-center crossover study in pulmonology residents, a range of scenarios were performed during training sessions using standardized or peer-played patients. The aim was to assess whether patient type did alter the quality of the role-play. The residents completed post-scenario questionnaires about the role-play of each scenario, but also pre- and post-session questionnaires about their perception of the effectiveness of both modalities, and pre- and post-testing questionnaires about the psychological impact of the training. RESULTS Collectively, 4 scenarios were performed 52 times and evaluated 208 times by 52 residents. The use of standardized patients appeared to improve the quality of the patient role (8.8 ± 1.0 vs. 8.3 ± 1.1; p = 0.001) and the general quality of role-play (8.8 ± 1.0 vs. 8.2 ± 0.9; p = 0.008), without affecting the quality of the physician role played by the resident. There were no significant differences between standardized and peer-played patients regarding learning interest or psychological impact. Regardless of the modality, the training sessions did appear to significantly affect the residents' evaluations of their ability to break bad news to patients (5.7 ± 1.1 vs. 7.4 ± 1.1; p < 10-4). CONCLUSION Our results did not point to a superiority of either of these modalities for learning how to break bad news. Both may be used, depending on the local resources.
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Affiliation(s)
- Marie Darrason
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Institut de Recherches Philosophiques de Lyon, Université Lyon 3, Lyon, France.
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue et Cancérologie Thoracique, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France; Plateforme Lyon Sud de Simulation en Santé (PL3S), Faculté de médecine et de maïeutique Lyon Sud, Université de Lyon, Lyon, France
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12
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Grolleau E, Fonteille V, Lebourgeois C, Darrason M, Michel P, Ragonnet D, Freyer G, Deculty A, Gippet C, Leclercq C, Neugnot C, Malek R, Perdriolat O, Rigaud M, Torrecillas S, Barral MC, Souquet PJ, Fassier JB, Tanguy L, Rolland B, Couraud S. Tobacco use and related behaviors among staff and students in a university hospital: A large cross-sectional survey. Tob Prev Cessat 2021; 7:49. [PMID: 34268457 PMCID: PMC8265395 DOI: 10.18332/tpc/137670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/14/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking prevalence in the overall population in France was 27% in 2017. There are few data about smoking prevalence in hospital workers. The aim of this study was to assess prevalence of current smoking in student and staff populations at Lyon University Hospital. Secondary objectives were to identify main variables associated with current smoking and willingness to quit. METHODS We designed a single center, cross-sectional survey, using printed questionnaires. During one day, all registered staff and students were surveyed. We used optical reading to extract information from questionnaires. We performed univariate and multivariate analysis adjusted on most relevant factors. RESULTS We analyzed 9712 questionnaires. The participating rates were high: 40.6% in the student cohort and 51.5% in the staff cohort. The proportion of current cigarette users was 26% in students and 25% in staff. In multivariate analysis, current smoking was significantly associated with: younger age, male sex, occupation type (e.g. logistical staff, and paramedical students), overnight work, and e-cigarette use. Among smokers, 53% reported a willingness to quit. In multivariate analysis, number of quit attempts, and feeling symptoms from tobacco were associated with willingness to quit. CONCLUSIONS Current smoking is less frequent in our cohorts of hospital staff and students than in the general French population. However, there are deep disparities in current smoking prevalence underlining a heterogeneous population. Among smokers, the majority reported a willingness to quit and some predictive factors may help to target this audience.
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Affiliation(s)
- Emmanuel Grolleau
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Véronique Fonteille
- Equipe de Liaison en Addictologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Caroline Lebourgeois
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.,Direction de la Performance et du Contrôle de Gestion, Hospices Civils de Lyon, Lyon, France
| | - Marie Darrason
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Philippe Michel
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, Lyon, France.,Direction de l'Organisation, de la Qualité des Soins et des Relations avec les Usagers Hospices Civils de Lyon, Lyon, France
| | - Delphine Ragonnet
- Service d'Addictologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Gilles Freyer
- Institut de Cancérologie des Hospices Civils de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Amélie Deculty
- Centre de Coordination en Cancérologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Carine Gippet
- Centre de Coordination en Cancérologie, Hospices Civils de Lyon, Lyon, France
| | - Céline Leclercq
- Centre de Coordination en Cancérologie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | - Carole Neugnot
- Centre de Coordination en Cancérologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Radoudja Malek
- Centre de Coordination en Cancérologie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Odile Perdriolat
- Unité de Tabacologie, Service de Maternité, Hôpital Femme-Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Michele Rigaud
- Centre de Coordination en Cancérologie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
| | - Séverine Torrecillas
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Centre de Coordination en Cancérologie, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Maud-Catherine Barral
- Unité de Tabacologie, Service de Maternité, Hôpital Femme-Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Jean-Baptiste Fassier
- Service de Médecine et Santé au Travail, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Lénaïck Tanguy
- Institut de Cancérologie des Hospices Civils de Lyon, Hospices Civils de Lyon, Lyon, France.,Direction de la Coopération et des Stratégies, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Rolland
- Equipe de Liaison en Addictologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France.,Service d'Addictologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Service Universitaire d'Addictologie de Lyon, Centre Hospitalier du Vinatier, Bron, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Centre hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.,Equipe IBISCUS, Centre d'Innovation en Cancérologie de Lyon (CICLY), Faculté de Médecine Lyon Sud, Oullins, France
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13
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de la Bruyère CL, Souquet PJ, Dalle S, Corbaux P, Boespflug A, Duruisseaux M, Kiakouama-Maleka L, Reverdy T, Maugeais M, Sahin G, Maillet D, Péron J. Investigating the Impact of Immune-Related Adverse Events, Glucocorticoid Use and Immunotherapy Interruption on Long-Term Survival Outcomes. Cancers (Basel) 2021; 13:cancers13102365. [PMID: 34068892 PMCID: PMC8156819 DOI: 10.3390/cancers13102365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/20/2021] [Accepted: 05/08/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Immunotherapy has modified our clinical practices for the treatment of various solid cancers. Many studies have been done but it remains unclear whether adverse events induced by immunotherapy and the corticoids used for their management could impact long-term outcomes in patients treated by immunotherapy. A data collection of 828 patients was made to assess the impact of adverse events, immunotherapy interruption and the use of corticoids in long-term outcomes. In this cohort, we did not find any association between adverse events and survival outcomes. However, corticoid use was associated with a significantly shorter time before disease progression. Immunotherapy interruption was associated with a significantly shorter time before progression and survival. The impact of severe adverse events related to immunotherapy reported in other studies might be explained by their management. The use of corticoids must be careful, and resuming immunotherapy after adverse events may be important for long-term prognosis and should be considered as often as possible. Abstract It remains unclear whether immune-related adverse events (irAEs) and glucocorticoid use could impact long-term outcomes in patients treated for solid tumors with immune checkpoint inhibitors (ICI). All patients treated with a single-agent ICI for any advanced cancer were included in this retrospective unicentric study. The objectives were to assess the impact of grade ≥3 irAEs, glucocorticoid use and the interruption of immunotherapy on progression-free survival (PFS) and overall survival (OS). In this 828-patient cohort, the first occurrence of grade ≥3 irAEs had no significant impact on PFS or OS. Glucocorticoid administration for the irAEs was associated with a significantly shorter PFS (adjusted HR 3.0; p = 0.00040) and a trend toward shorter OS. ICI interruption was associated with a significantly shorter PFS (adjusted HR 3.5; p < 0.00043) and shorter OS (HR 4.5; p = 0.0027). Glucocorticoid administration and ICI interruption were correlated. In our population of patients treated with single agent ICI, grade ≥3 irAEs did not impact long-term outcomes. However, the need for glucocorticoids and the interruption of immunotherapy resulted in poorer long-term outcomes. The impact of grade ≥3 irAEs reported in other studies might then be explained by the management of the irAEs.
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Affiliation(s)
- Charline Lafayolle de la Bruyère
- Cancer Research Center of Lyon, Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (P.C.); (T.R.); (M.M.); (D.M.); (J.P.)
- Correspondence:
| | - Pierre-Jean Souquet
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.-J.S.); (S.D.); (A.B.); (M.D.); (L.K.-M.)
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
- Cancer Research Center of Lyon, Department of Respiratory Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Stéphane Dalle
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.-J.S.); (S.D.); (A.B.); (M.D.); (L.K.-M.)
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
- Cancer Research Center of Lyon, Dermatology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Pauline Corbaux
- Cancer Research Center of Lyon, Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (P.C.); (T.R.); (M.M.); (D.M.); (J.P.)
| | - Amélie Boespflug
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.-J.S.); (S.D.); (A.B.); (M.D.); (L.K.-M.)
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
- Cancer Research Center of Lyon, Dermatology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France
| | - Michaël Duruisseaux
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.-J.S.); (S.D.); (A.B.); (M.D.); (L.K.-M.)
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
- Department of Respiratory Medicine, Groupement Hospitalier Est, Hôpital Louis-Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Lize Kiakouama-Maleka
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.-J.S.); (S.D.); (A.B.); (M.D.); (L.K.-M.)
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
- Department of Respiratory Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thibaut Reverdy
- Cancer Research Center of Lyon, Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (P.C.); (T.R.); (M.M.); (D.M.); (J.P.)
| | - Madeleine Maugeais
- Cancer Research Center of Lyon, Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (P.C.); (T.R.); (M.M.); (D.M.); (J.P.)
| | - Gulsum Sahin
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
| | - Denis Maillet
- Cancer Research Center of Lyon, Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (P.C.); (T.R.); (M.M.); (D.M.); (J.P.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.-J.S.); (S.D.); (A.B.); (M.D.); (L.K.-M.)
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
| | - Julien Péron
- Cancer Research Center of Lyon, Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (P.C.); (T.R.); (M.M.); (D.M.); (J.P.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; (P.-J.S.); (S.D.); (A.B.); (M.D.); (L.K.-M.)
- ImmuCare (Immunology Cancer Research) Institut de Cancérologie des Hospices Civils de Lyon, 69229 Lyon, France;
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100 Villeurbanne, France
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14
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Espi M, Teuma C, Novel-Catin E, Maillet D, Souquet PJ, Dalle S, Koppe L, Fouque D. Renal adverse effects of immune checkpoints inhibitors in clinical practice: ImmuNoTox study. Eur J Cancer 2021; 147:29-39. [PMID: 33607383 DOI: 10.1016/j.ejca.2021.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Acute Kidney Injury (AKI), induced by Checkpoint Inhibitors therapies (CPI-induced AKI), is an uncommon but severe Immune-Related Adverse Event (IRAE). The aim was to describe the epidemiology, risks factors, clinical, and laboratory characteristics of these renal adverse events (AEs) in a real-life cohort treatment. DESIGN/PARTICIPANTS Consecutive patients undergoing a checkpoint inhibitor (CPI) therapy at the Hôpital Lyon Sud from January 2015 to July 2017 were included. A systematic retrospective analysis of medical files was performed, monthly serum creatinine levels, associated treatments, and occurrence of other IRAEs data were collected. AKI episodes explained by classic AKI aetiologies (prerenal, obstructive, septic) were excluded from the analysis. RESULTS CPI-induced AKI incidence was 3.7% (13/352) and appeared to be time-dependent (7.7% (11/143) for patients with >3 months of CPI exposure), ranging from 1 to 16 months. All cases with available histology were acute tubulointerstitial nephritis (ATIN), with poor urinary sediment. The severity of AKI was mild (stage 1 in 50% of cases), with no need for renal-replacement therapy. Although CPI-induced AKI patients had more frequently other IRAEs (77% versus 39%), this was not associated with a greater risk of AKI. Pre-existing chronic kidney disease (defined as an estimated glomerular filtration rate (eGFR) <60 ml/min) was not associated with a greater risk of CPI-induced AKI. Treatments of CPI-induced AKI were heterogeneous, with discontinuation of CPIs, and inconstant systemic corticosteroid therapy. CONCLUSION The monitoring of renal function and early identification of AKI during CPIs treatment is essential. The optimal management of CPI-induced AKI remains unclear and requires a close collaboration between the oncology and nephrology departments. CLINICAL RELEVANCY STATEMENT Immune checkpoint inhibitors (CPIs) have dramatically improved patient outcomes in different malignant contexts such as melanoma, non-small cell lung cancers (NSCLC) and urologic cancers. Usually well-tolerated, CPIs are however associated with immune-related adverse events (IRAEs). Among them, acute kidney injury (AKI) is uncommon, and not well-described. Following the exponential increase in the prescription of CPIs, previously uncommon cases of IRAEs (such as AKI) have become common occurrence in referral centres. Data regarding the epidemiology, risk factors, or management of CPI-induced AKI are currently lacking or can be discordant. Data regarding CPI-induced AKI, in a large real-life cohort were reported herein.
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Affiliation(s)
- M Espi
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France.
| | - C Teuma
- Service de Néphrologie, Hôpital Nord Ouest, 69400, Gleizé, France
| | - E Novel-Catin
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - D Maillet
- Service D'Oncologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - P J Souquet
- Service de Pneumologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - S Dalle
- Service de Dermatologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - L Koppe
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; Univ. Lyon, CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, F-69621, Villeurbanne, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - D Fouque
- Service de Néphrologie, Hôpital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Bénite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
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15
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Paz-Ares L, Ciuleanu TE, Cobo M, Schenker M, Zurawski B, Menezes J, Richardet E, Bennouna J, Felip E, Juan-Vidal O, Alexandru A, Sakai H, Lingua A, Salman P, Souquet PJ, De Marchi P, Martin C, Pérol M, Scherpereel A, Lu S, John T, Carbone DP, Meadows-Shropshire S, Agrawal S, Oukessou A, Yan J, Reck M. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in patients with non-small-cell lung cancer (CheckMate 9LA): an international, randomised, open-label, phase 3 trial. Lancet Oncol 2021; 22:198-211. [PMID: 33476593 DOI: 10.1016/s1470-2045(20)30641-0] [Citation(s) in RCA: 667] [Impact Index Per Article: 222.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND First-line nivolumab plus ipilimumab has shown improved overall survival in patients with advanced non-small-cell lung cancer (NSCLC). We aimed to investigate whether the addition of a limited course (two cycles) of chemotherapy to this combination would further enhance the clinical benefit. METHODS This randomised, open-label, phase 3 trial was done at 103 hospitals in 19 countries. Eligible patients were aged 18 years or older with treatment-naive, histologically confirmed stage IV or recurrent NSCLC, and an Eastern Cooperative Oncology Group performance status of 0-1. Patients were randomly assigned (1:1) by an interactive web response system via permuted blocks (block size of four) to nivolumab (360 mg intravenously every 3 weeks) plus ipilimumab (1 mg/kg intravenously every 6 weeks) combined with histology-based, platinum doublet chemotherapy (intravenously every 3 weeks for two cycles; experimental group), or chemotherapy alone (every 3 weeks for four cycles; control group). Randomisation was stratified by tumour histology, sex, and PD-L1 expression. The primary endpoint was overall survival in all randomly assigned patients. Safety was analysed in all treated patients. Results reported here are from a pre-planned interim analysis (when the study met its primary endpoint) and an exploratory longer-term follow-up analysis. This study is active but no longer recruiting patients, and is registered with ClinicalTrials.gov, number NCT03215706. FINDINGS Between Aug 24, 2017, and Jan 30, 2019, 1150 patients were enrolled and 719 (62·5%) randomly assigned to nivolumab plus ipilimumab with two cycles of chemotherapy (n=361 [50%]) or four cycles of chemotherapy alone (n=358 [50%]). At the pre-planned interim analysis (median follow-up 9·7 months [IQR 6·4-12·8]), overall survival in all randomly assigned patients was significantly longer in the experimental group than in the control group (median 14·1 months [95% CI 13·2-16·2] vs 10·7 months [9·5-12·4]; hazard ratio [HR] 0·69 [96·71% CI 0·55-0·87]; p=0·00065). With 3·5 months longer median follow-up (median 13·2 months [IQR 6·4-17·0]), median overall survival was 15·6 months (95% CI 13·9-20·0) in the experimental group versus 10·9 months (9·5-12·6) in the control group (HR 0·66 [95% CI 0·55-0·80]). The most common grade 3-4 treatment-related adverse events were neutropenia (in 24 [7%] patients in the experimental group vs 32 [9%] in the control group), anaemia (21 [6%] vs 50 [14%]), diarrhoea (14 [4%] vs two [1%]), increased lipase (22 [6%] vs three [1%]), and asthenia (tjree [1%] vs eight [2%]). Serious treatment-related adverse events of any grade occurred in 106 (30%) patients in the experimental group and 62 (18%) in the control group. Seven (2%) deaths in the experimental group (acute kidney failure, diarrhoea, hepatotoxicity, hepatitis, pneumonitis, sepsis with acute renal insufficiency, and thrombocytopenia; one patient each) and six (2%) deaths in the control group (anaemia, febrile neutropenia, pancytopenia, pulmonary sepsis, respiratory failure, and sepsis; one patient each) were treatment related. INTERPRETATION Nivolumab plus ipilimumab with two cycles of chemotherapy provided a significant improvement in overall survival versus chemotherapy alone and had a favourable risk-benefit profile. These data support this regimen as a new first-line treatment option for patients with advanced NSCLC. FUNDING Bristol Myers Squibb.
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Affiliation(s)
- Luis Paz-Ares
- Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Unit, Universidad Complutense & CiberOnc, Madrid, Spain.
| | - Tudor-Eliade Ciuleanu
- Institutul Oncologic Prof Dr Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Manuel Cobo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | | | | | | | - Jaafar Bennouna
- Thoracic Oncology Unit, University Hospital of Nantes and INSERM, CRCINA, Nantes, France
| | - Enriqueta Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Aurelia Alexandru
- Institute of Oncology Prof Dr Alexandru Trestioreanu Bucha, Bucharest, Romania
| | | | - Alejo Lingua
- Instituto Medico Rio Cuarto SA, Córdoba, Argentina
| | - Pamela Salman
- Fundacion Arturo Lopez Perez, Santiago, Metropolitana, Chile
| | | | | | | | | | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology, University of Lille, CHU Lille, INSERM U1189, OncoThAI, Lille, France
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China
| | | | - David P Carbone
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | | | | | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany
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16
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Herbreteau G, Langlais A, Greillier L, Audigier-Valette C, Uwer L, Hureaux J, Moro-Sibilot D, Guisier F, Carmier D, Madelaine J, Otto J, Souquet PJ, Gounant V, Merle P, Molinier O, Renault A, Rabeau A, Morin F, Denis MG, Pujol JL. Circulating Tumor DNA as a Prognostic Determinant in Small Cell Lung Cancer Patients Receiving Atezolizumab. J Clin Med 2020; 9:E3861. [PMID: 33261056 PMCID: PMC7760916 DOI: 10.3390/jcm9123861] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The IFCT-1603 trial evaluated atezolizumab in small cell lung cancer (SCLC). The purpose of the present study was to determine whether circulating tumor DNA (ctDNA), prospectively collected at treatment initiation, was associated with the prognosis of SCLC, and whether it identified patients who benefited from atezolizumab. METHODS 68 patients were included in this study: 46 patients were treated with atezolizumab and 22 with conventional chemotherapy. Circulating DNA was extracted from plasma and NGS (Next Generation Sequencing) looked for mutations in the TP53, RB1, NOTCH1, NOTCH2, and NOTCH3 genes. ctDNA was detectable when at least one somatic mutation was identified, and its relative abundance was quantified by the variant allele fraction (VAF) of the most represented mutation. RESULTS We found that 49/68 patients (70.6%) had detectable baseline ctDNA. The most frequently identified mutations were TP53 (32/49; 65.3%) and RB1 (25/49; 51.0%). Patients with detectable ctDNA had a significantly lower disease control rate at week 6 compared with patients with no detectable ctDNA, regardless of the nature of the treatment. Detection of ctDNA was associated with a poor OS prognosis. The detection of ctDNA at a relative abundance greater than the median value was significantly associated with poor overall survival (OS) and progression free survival (PFS). Interestingly, the benefit in overall survival (OS) associated with low ctDNA was more pronounced in patients treated with atezolizumab than in patients receiving chemotherapy. Among patients whose relative ctDNA abundance was below the median, those treated with atezolizumab tended to have higher OS than those in the chemotherapy arm. CONCLUSION ctDNA is strongly associated with the prognosis of SCLC patients treated with second-line immunotherapy. Its analysis seems justified for future SCLC clinical trials.
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Affiliation(s)
- Guillaume Herbreteau
- Department of Biochemistry, Nantes University Hospital, 9 quai Moncousu, 44093 Nantes, France;
| | - Alexandra Langlais
- IFCT Intergroupe Francophone de Cancérologie Thoracique, 10 Rue de la Grange Batelière, 75009 Paris, France; (A.L.); (F.M.)
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Assistance Publique—Hôpitaux de Marseille, Aix Marseille University, 13015 Marseille, France;
| | - Clarisse Audigier-Valette
- Department of Thoracic Oncology, 54 Rue Henri Sainte Claire Deville, CHITS CH Sainte Musse, 83000 Toulon, France;
| | - Lionel Uwer
- Institut de Cancérologie de Lorraine Alexis Vautrin, 6 Avenue de Bourgogne, 54519 Vandoeuvre-les-Nancy, France;
| | - José Hureaux
- Pôle Hippocrate, Angers University Hospital, 49933 Angers, France;
| | | | - Florian Guisier
- Department of Pneumology, Thoracic Oncology and Respiratory Intensive Care, Rouen University Hospital, 76000 Rouen, France;
| | - Delphine Carmier
- Service de Pneumologie CHRU Hôpitaux de Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000 Tours, France;
| | - Jeannick Madelaine
- Service de Pneumologie, CHU Caen Normandie, Av de La Côte de Nacre, 14000 Caen, France;
| | - Josiane Otto
- Pôle Médecine, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06100 Nice, France;
| | - Pierre-Jean Souquet
- Service de Pneumologie Aiguë Spécialisée et Cancérologie Thoracique, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310 Pierre-Benite, France;
| | - Valérie Gounant
- Department of Thoracic Oncology, Bichat Claude Bernard Hospital, 75018 Paris, France;
| | - Patrick Merle
- Service de Pneumologie, 58 Rue Montalembert, CHU G Montpied, 63000 Clermont Ferrand, France;
| | - Olivier Molinier
- Service de Pneumologie, Centre Hospitalier, 194 Avenue Rubillard, 72037 Le Mans, France;
| | - Aldo Renault
- Service de Pneumologie, Centre Hospitalier, 4 Boulevard Hauterive, 64000 Pau, France;
| | - Audrey Rabeau
- Service de Pneumologie, Centre Hospitalier, Université Paul Sabatier, 31300 Toulouse, France;
| | - Franck Morin
- IFCT Intergroupe Francophone de Cancérologie Thoracique, 10 Rue de la Grange Batelière, 75009 Paris, France; (A.L.); (F.M.)
| | - Marc G Denis
- Department of Biochemistry, Nantes University Hospital, 9 Quai Moncousu, 44093 Nantes, France;
| | - Jean-Louis Pujol
- Department of Thoracic Oncology, Montpellier Regional University Hospital, 34090 Montpellier, France
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17
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Quoix E, Audigier-Valette C, Lavolé A, Molinier O, Westeel V, Barlesi F, Le Treut J, Pichon E, Dauba J, Otto J, Moreau L, Madelaine J, Dumont P, Margery J, Debieuvre D, Renault PA, Pujol JL, Langlais A, Morin F, Moro-Sibilot D, Souquet PJ. Switch maintenance chemotherapy versus observation after carboplatin and weekly paclitaxel doublet chemotherapy in elderly patients with advanced non-small cell lung cancer: IFCT-1201 MODEL trial. Eur J Cancer 2020; 138:193-201. [PMID: 32898792 DOI: 10.1016/j.ejca.2020.07.034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Maintenance chemotherapy is a reasonable choice for patients with metastatic non-small cell lung carcinoma (NSCLC) not progressing after induction therapy with a platinum-based doublet. Nevertheless, there have been no studies dedicated to elderly patients. PATIENTS AND METHODS We conducted a randomised trial in patients aged 70-89 years, with advanced NSCLC (with neither EGFR mutation nor ALK rearrangement), who had not progressed after four cycles of monthly carboplatin and weekly paclitaxel in order to compare maintenance with either pemetrexed (500 mg/m2 d1, 22) in patients with non-squamous cell carcinoma or gemcitabine (1,150 mg/m2 d1, 8, 22) in squamous cell carcinoma to simple observation. The patients were required to have a performance status (PS) 0-2, mini-mental score >23, and creatinine clearance ≥45 mL/min. The primary end-point was overall survival (OS). RESULTS 632 patients were enrolled from May 2013 to October 2016. Of the 328 (52.3%) patients randomised after induction therapy, 166 patients were assigned to the observation arm, versus 162 to the switch maintenance arm, 119 of whom received pemetrexed and 43 gemcitabine. The median OS from randomisation was 14.1 months (95% confidence interval [CI]: 12.0-17.0) in the observation arm and 14 months (95% CI: 10.9-16.9) in the maintenance arm (p = 0.72). The median progression-free survival (PFS) from randomisation was 2.7 months (95% CI: 2.6-3.1) in the observation arm versus 5.7 months (95% CI: 4.8-7.1) in the maintenance arm (p < 0.001). CONCLUSION Switch maintenance therapy significantly prolonged PFS but not OS and, thus, should not be proposed to elderly patients with advanced NSCLC.
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Affiliation(s)
- Elisabeth Quoix
- Department of Pneumology, University Hospital of Strasbourg, Strasbourg, France.
| | | | | | | | - Virginie Westeel
- Department of Pneumology, University Hospital of Besançon, Besançon, France
| | - Fabrice Barlesi
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Jacques Le Treut
- Department of Pneumology, Pays D'Aix Hospital, Aix-en-Provence, France
| | - Eric Pichon
- Department of Pneumology, University Hospital of Tours, Tours, France
| | - Jérôme Dauba
- Department of Medical Oncology, Hospital Layné, Mont-de-Marsan, France
| | | | - Lionel Moreau
- Department of Pneumology, Louis Pasteur Hospital, Colmar, France
| | - Jeannick Madelaine
- Department of Pneumology, University Hospital of Caen Normandie, Caen, France
| | - Patrick Dumont
- Department of Pneumology, Hospital of Chauny, Chauny, France
| | - Jacques Margery
- Department of Pneumology, Hôpital D'Instruction des Armées Percy, Clamart, France
| | - Didier Debieuvre
- Department of Pneumology, GHRMSA, Emile Miller Hospital, Mulhouse, France
| | | | - Jean-Louis Pujol
- Department of Thoracic Oncology, Montpellier Regional University Hospital, Montpellier, France
| | | | - Franck Morin
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
| | - Denis Moro-Sibilot
- Thoracic Oncology Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre-Jean Souquet
- Department of Pneumology and Thoracic Oncology, Hospital of Lyon Sud, Lyon, France
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18
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Wolf J, Seto T, Han JY, Reguart N, Garon EB, Groen HJM, Tan DSW, Hida T, de Jonge M, Orlov SV, Smit EF, Souquet PJ, Vansteenkiste J, Hochmair M, Felip E, Nishio M, Thomas M, Ohashi K, Toyozawa R, Overbeck TR, de Marinis F, Kim TM, Laack E, Robeva A, Le Mouhaer S, Waldron-Lynch M, Sankaran B, Balbin OA, Cui X, Giovannini M, Akimov M, Heist RS. Capmatinib in MET Exon 14-Mutated or MET-Amplified Non-Small-Cell Lung Cancer. N Engl J Med 2020; 383:944-957. [PMID: 32877583 DOI: 10.1056/nejmoa2002787] [Citation(s) in RCA: 468] [Impact Index Per Article: 117.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Among patients with non-small-cell lung cancer (NSCLC), MET exon 14 skipping mutations occur in 3 to 4% and MET amplifications occur in 1 to 6%. Capmatinib, a selective inhibitor of the MET receptor, has shown activity in cancer models with various types of MET activation. METHODS We conducted a multiple-cohort, phase 2 study evaluating capmatinib in patients with MET-dysregulated advanced NSCLC. Patients were assigned to cohorts on the basis of previous lines of therapy and MET status (MET exon 14 skipping mutation or MET amplification according to gene copy number in tumor tissue). Patients received capmatinib (400-mg tablet) twice daily. The primary end point was overall response (complete or partial response), and the key secondary end point was response duration; both end points were assessed by an independent review committee whose members were unaware of the cohort assignments. RESULTS A total of 364 patients were assigned to the cohorts. Among patients with NSCLC with a MET exon 14 skipping mutation, overall response was observed in 41% (95% confidence interval [CI], 29 to 53) of 69 patients who had received one or two lines of therapy previously and in 68% (95% CI, 48 to 84) of 28 patients who had not received treatment previously; the median duration of response was 9.7 months (95% CI, 5.6 to 13.0) and 12.6 months (95% CI, 5.6 to could not be estimated), respectively. Limited efficacy was observed in previously treated patients with MET amplification who had a gene copy number of less than 10 (overall response in 7 to 12% of patients). Among patients with MET amplification and a gene copy number of 10 or higher, overall response was observed in 29% (95% CI, 19 to 41) of previously treated patients and in 40% (95% CI, 16 to 68) of those who had not received treatment previously. The most frequently reported adverse events were peripheral edema (in 51%) and nausea (in 45%); these events were mostly of grade 1 or 2. CONCLUSIONS Capmatinib showed substantial antitumor activity in patients with advanced NSCLC with a MET exon 14 skipping mutation, particularly in those not treated previously. The efficacy in MET-amplified advanced NSCLC was higher in tumors with a high gene copy number than in those with a low gene copy number. Low-grade peripheral edema and nausea were the main toxic effects. (Funded by Novartis Pharmaceuticals; GEOMETRY mono-1 ClinicalTrials.gov number, NCT02414139.).
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Affiliation(s)
- Jürgen Wolf
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Takashi Seto
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Ji-Youn Han
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Noemi Reguart
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Edward B Garon
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Harry J M Groen
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Daniel S W Tan
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Toyoaki Hida
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Maja de Jonge
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Sergey V Orlov
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Egbert F Smit
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Pierre-Jean Souquet
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Johan Vansteenkiste
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Maximilian Hochmair
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Enriqueta Felip
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Makoto Nishio
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Michael Thomas
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Kadoaki Ohashi
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Ryo Toyozawa
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Tobias R Overbeck
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Filippo de Marinis
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Tae-Min Kim
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Eckart Laack
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Anna Robeva
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Sylvie Le Mouhaer
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Maeve Waldron-Lynch
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Banu Sankaran
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - O Alejandro Balbin
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Xiaoming Cui
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Monica Giovannini
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Mikhail Akimov
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
| | - Rebecca S Heist
- From the Department I of Internal Medicine, Center for Integrated Oncology, University Hospital Cologne and University of Cologne, Cologne (J.W.), Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg, Heidelberg (M.T.), the Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen (T.R.O.), and Hämato-Onkologie Hamburg, Hamburg (E.L.) - all in Germany; the National Hospital Organization Kyushu Cancer Center, Fukuoka (T.S.), Aichi Cancer Center, Nagoya (T.H.), the Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo (M.N.), the Department of Respiratory Medicine, Okayama University Hospital, Okayama (K.O.), and the National Kyushu Cancer Center, Fukuoka (R.T.) - all in Japan; the National Cancer Center, Gyeonggi-do (J.-Y.H.), and the Department of Internal Medicine, Seoul National University Hospital, Seoul (T.-M.K.) - both in South Korea; the Hospital Clinic of Barcelona (N.R.), Translational Genomic and Targeted Therapeutics in Solid Tumors (IDIBAPS) (N.R.), and Vall d'Hebron University Hospital-Vall d'Hebron Institute of Oncology (E.F.), Barcelona; David Geffen School of Medicine at UCLA, Los Angeles (E.B.G.); the University of Groningen and University Medical Center Groningen, Groningen (H.J.M.G.), Erasmus MC Cancer Institute, Rotterdam (M.J.), and the Netherlands Cancer Institute, Amsterdam (E.F.S.) - all in the Netherlands; the National Cancer Centre Singapore, Singapore (D.S.W.T.); St. Petersburg Pavlov State Medical University, St. Petersburg, Russia (S.V.O.); University Hospital of Lyon-Sud, Lyon (P.-J.S.), and Novartis Pharma, Rueil-Malmaison (S.L.M.) - both in France; the Respiratory Oncology Unit, University Hospitals KU Leuven, Leuven, Belgium (J.V.); the Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Vienna (M.H.); the Thoracic Oncology Division, European Institute of Oncology, IRCCS, Milan (F.M.); Novartis Pharmaceuticals, East Hanover, NJ (A.R., M.G.); Novartis Pharma, Basel, Switzerland (M.W.-L., M.A.); and Novartis Institutes for BioMedical Research, Cambridge (B.S., O.A.B., X.C.), and Massachusetts General Hospital, Boston (R.S.H.) - both in Massachusetts
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Garon EB, Heist RS, Seto T, Han JY, Reguart N, Groen HJ, Tan DSW, Hida T, de Jonge MJ, Orlov SV, Smit EF, Souquet PJ, Vansteenkiste J, Mouhaer SL, Robeva A, Waldron-Lynch M, Giovannini M, Wolf J. Abstract CT082: Capmatinib in METex14-mutated (mut) advanced non-small cell lung cancer (NSCLC): Results from the phase II GEOMETRY mono-1 study, including efficacy in patients (pts) with brain metastases (BM). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct082] [Citation(s) in RCA: 5] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Capmatinib is a highly selective and potent MET inhibitor that crosses the blood-brain barrier. In the GEOMETRY mono-1 study, capmatinib showed clinically meaningful response rates in pts with advanced NSCLC harboring METex14 skipping mutations, including activity in pts with baseline BM, and also demonstrated manageable safety. Here, we present efficacy and safety data, including an efficacy analysis in METex14 skipping mutated NSCLC pts with baseline BM. Methods: The phase 2, multi-cohort, multicenter GEOMETRY mono-1 study (NCT02414139) is evaluating capmatinib in adult pts with ECOG PS 0-1, ALK and EGFR-wt, METex14-mut/MET-amplified stage IIIB/IV NSCLC, including pts with neurologically stable/asymptomatic BM. Pts were assigned to Cohorts 4 (pretreated, 2/3L) and 5b (treatment-naive) and received capmatinib 400 mg BID. Primary endpoint: overall response rate (ORR) by BIRC per RECIST v1.1. Key secondary endpoint: duration of response (DOR) by BIRC. The retrospective analyses on brain lesions were based on modified RECIST v1.1 as assessed by BIRC neuro-radiologic assessments of all Cohorts 4 and 5b pts with baseline BM. Results: As of April 15, 2019, 97 pts (Cohort 4: 69 pts; Cohort 5b: 28 pts) were evaluable for efficacy. BIRC results for cohorts 4 and 5b, respectively, were (i) ORR (95%CI): 40.6% (28.9-53.1) and 67.9% (47.6-84.1), (ii) median DOR (95%CI): 9.72 (5.55-12.98) and 11.14 (5.55-NE) months (mos), and (iii) median progression-free survival (95%CI): 5.42 (4.17-6.97) and 9.69 (5.52-13.86) mos. There were 13 pts with evaluable baseline BM by BIRC [3.3 brain lesions/pt (range 1−8)]. 7 of the 13 pts (54%) had intracranial response of which 4 pts had complete resolution of all brain lesions. The other 3 responders had (i) complete resolution in 3 lesions, −50% reduction in 1 lesion, stabilization in remaining 4 lesions (total 7 lesions), (ii) complete resolution in 2 lesions, stabilization in 1 remaining lesion (total 3 lesions), and (iii) complete resolution in 1 lesion, stabilization in 3 remaining lesions (total 4 lesions). Intracranial disease control was achieved in 12/13 pts. Intracranial responses were as fast as systemic responses. 3/7 responders had prior brain radiotherapy; 5/7 responders had either signs of progression in the existing brain lesion(s) or new BM at study entry. Most common tx-related adverse events (≥15%, all grades) across all cohorts (N=334) were peripheral edema (41.6%), nausea (33.2%), increased blood creatinine (19.5%), and vomiting (18.9%). Conclusion: BIRC neuro-radiologist review of 13 pts with evaluable baseline BM suggested that capmatinib has anti-tumor efficacy in the brain. Capmatinib also showed deep and durable responses in pts with METex14-mut advanced NSCLC regardless of line of therapy and demonstrated a manageable safety profile.
Citation Format: Edward B. Garon, Rebecca S. Heist, Takashi Seto, Ji-Youn Han, Noemi Reguart, Harry J. Groen, Daniel SW Tan, Toyoaki Hida, Maja J. de Jonge, Sergey V. Orlov, Egbert F. Smit, Pierre-Jean Souquet, Johan Vansteenkiste, Sylvie Le Mouhaer, Anna Robeva, Maeve Waldron-Lynch, Monica Giovannini, Juergen Wolf. Capmatinib in METex14-mutated (mut) advanced non-small cell lung cancer (NSCLC): Results from the phase II GEOMETRY mono-1 study, including efficacy in patients (pts) with brain metastases (BM) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT082.
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Affiliation(s)
| | | | - Takashi Seto
- 3National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Ji-Youn Han
- 4National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Noemi Reguart
- 5University Hospital Clinic of Barcelona, Barcelona, Spain
| | - Harry J. Groen
- 6University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Daniel SW Tan
- 7National Cancer Centre Singapore, Singapore, Singapore
| | | | | | - Sergey V. Orlov
- 10St Petersburg Pavlov State Medical University, St Petersburg, Russian Federation
| | | | | | | | | | - Anna Robeva
- 15Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Juergen Wolf
- 17Center for Integrated Oncology, University Hospital Cologne, Cologne, Germany
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Ruppert AM, Beau-Faller M, Debieuvre D, Ouafik L, Westeel V, Rouquette I, Mazières J, Bringuier PP, Monnet I, Escande F, Ricordel C, Merlio JP, Janicot H, Lemoine A, Foucher P, Poudenx M, Morin F, Langlais A, Souquet PJ, Barlesi F, Wislez M. Outcomes of Patients With Advanced NSCLC From the Intergroupe Francophone de Cancérologie Thoracique Biomarkers France Study by KRAS Mutation Subtypes. JTO Clin Res Rep 2020; 1:100052. [PMID: 34589947 PMCID: PMC8474404 DOI: 10.1016/j.jtocrr.2020.100052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction KRAS mutations are detected in 20% to 30% of NSCLC. However, KRAS mutation subtypes may differently influence the outcome of patients with advanced NSCLC. Methods In the Biomarkers France study, 4894 KRAS mutations (26.2%) were detected in 4634 patients from the 17,664 enrolled patients with NSCLC. Survival and treatment data on noncurative stage III to IV NSCLC were available for 901 patients. First- and second-line treatment effects on progression-free survival and overall survival were analyzed according to the KRAS mutations subtype. Results Over 95% of patients with KRAS mutation were smokers or former smokers who were white (99.5%), presenting with adenocarcinoma (82.5%). The most common KRAS mutation subtype was G12C (374 patients; 41.5%), followed by G12V (168; 18.6%), G12D (131; 14.5%), G12A (62; 6.9%), G13C (45; 5.0%), G13D (31; 3.4%), and others (10; 1%). Approximately 21% of patients had transition mutation and 68.2% had a transversion mutation. G12D and transition mutations were predominant in never-smokers. The median overall survival for patients with KRAS-mutated NSCLC was 8.1 months (95% confidence interval [CI]: 7.5-9.5), without any differences according to the different KRAS subtypes mutations. The median progression-free survival was 4.6 months (95% CI: 4.2-5.1) for first-line treatment and 4.8 months (95% CI: 4.3-6.8) for second-line treatment, without any differences according to the different KRAS subtypes mutations. Conclusions KRAS mutation subtypes influenced neither treatment responses nor outcomes. The KRAS G12C mutation was detected in 41.5% of patients, who are now eligible for potent and specific G12C inhibitors.
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Affiliation(s)
- Anne-Marie Ruppert
- GRC n°04, Theranoscan, AP-HP, Groupe Hospitalier Sorbonne Université, Hôpital Tenon, Paris, France.,Department of Pneumology, AP-HP, Groupe Hospitalier Sorbonne Université, Hôpital Tenon, Paris, France
| | - Michèle Beau-Faller
- Laboratory of Biochemistry and Molecular Biology, Centre Hospitalier Universitaire de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.,IRFAC UMR-S1113, Inserm, Université de Strasbourg, Strasbourg, France
| | - Didier Debieuvre
- Department of Pneumology, GHRMSA, Emile Muller Hospital, Mulhouse, France
| | - L'Houcine Ouafik
- Aix Marseille Univ, CNRS, INP, Inst Neurophysiopathol, Marseille, France.,Aix Marseille Univ, APHM, CHU Nord, Department of Tumor Biology, Marseille, France
| | - Virginie Westeel
- Centre Hospitalier Régional Universitaire de Besançon, Hôpital Jean Minjoz, Department of Pneumology, Besançon, France.,INSERM UMR 1098, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Isabelle Rouquette
- Pathology Department, Centre Hospitalier Universitaire de Toulouse Institut Universitaire du Cancer de Toulouse, Oncopôle, Toulouse, France
| | - Julien Mazières
- Department of Pneumology, CHU de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Pierre-Paul Bringuier
- Institut de Pathologie Multisite des Hospices Civils de Lyon Site Est and Université Claude Bernard Lyon 1, Lyon, France
| | - Isabelle Monnet
- Department of Pneumology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Fabienne Escande
- Laboratory of Biochemistry and Molecular Biology, CHRU Lille, Lille, France
| | - Charles Ricordel
- Unité COSS INSERM U1242 - CEM - Université de Rennes, Rennes, France.,Department of Pneumology, CHU Rennes, Rennes, France
| | - Jean-Philippe Merlio
- Department of Tumor Biology, CHU and University of Bordeaux, INSERM U1053, Bordeaux, France
| | - Henri Janicot
- Department of Pneumology, CHU Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Antoinette Lemoine
- Department of Oncogenetics, AP-HP, Groupe Hospitalier APHP.Univeristé Pars-Saclay, Hôpital Paul Brousse, INSERM UMR-S 1193, Paris, France
| | - Pascal Foucher
- Department of Thoracic Oncology, University hospital Dijon-Bourgogne, Dijon, France
| | - Michel Poudenx
- Departement of Oncology, MédicaleCentre Antoine Lacassagne, Nice, France
| | - Franck Morin
- French Cooperative Thoracic Intergroup, Paris, France
| | | | - Pierre-Jean Souquet
- Department of Pneumology and Thoracic Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Fabrice Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Department, Aix Marseille University, INSERM, CNRS, CRCM, APHM, Marseille, France
| | - Marie Wislez
- Department of Pneumology, Thoracic Oncology Unit, AP-HP, Groupe Hospitalier HUPC, Hôpital Cochin, Paris, France.,Centre de Recherche des Cordeliers, Université Paris Descartes, UMRS1138 « Complement, Inflammation and Cancer », Paris, France
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21
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Mazieres J, Barlesi F, Rouquette I, Molinier O, Besse B, Monnet I, Audigier-Valette C, Toffart AC, Renault PA, Fraboulet S, Hiret S, Mennecier B, Debieuvre D, Westeel V, Masson P, Madroszyk-Flandin A, Pichon E, Cortot AB, Amour E, Morin F, Zalcman G, Moro-Sibilot D, Souquet PJ. Randomized Phase II Trial Evaluating Treatment with EGFR-TKI Associated with Antiestrogen in Women with Nonsquamous Advanced-Stage NSCLC: IFCT-1003 LADIE Trial. Clin Cancer Res 2020; 26:3172-3181. [DOI: 10.1158/1078-0432.ccr-19-3056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 11/16/2022]
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22
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Moro-Sibilot D, Cozic N, Pérol M, Mazières J, Otto J, Souquet PJ, Bahleda R, Wislez M, Zalcman G, Guibert SD, Barlési F, Mennecier B, Monnet I, Sabatier R, Bota S, Dubos C, Verriele V, Haddad V, Ferretti G, Cortot A, De Fraipont F, Jimenez M, Hoog-Labouret N, Vassal G. Crizotinib in c-MET- or ROS1-positive NSCLC: results of the AcSé phase II trial. Ann Oncol 2019; 30:1985-1991. [PMID: 31584608 DOI: 10.1093/annonc/mdz407] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [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: 12/16/2022] Open
Abstract
BACKGROUND In 2013, the French National Cancer Institute initiated the AcSé program to provide patients with secure access to targeted therapies outside of their marketed approvals. Efficacy and safety was then assessed using a two-stage Simon phase II trial design. When the study design was designed, crizotinib was approved only as monotherapy for adults with anaplastic lymphoma kinase plus non-small-cell lung cancers (NSCLC). PATIENTS AND METHODS Advanced NSCLC patients with c-MET ≥6 copies, c-MET-mutated, or ROS-1-translocated tumours were enrolled in one of the three cohorts. Patients were treated with crizotinib 250 mg twice daily. Efficacy was assessed using the objective response rate (ORR) after two cycles of crizotinib as primary outcome. Secondary outcomes included disease control rate at four cycles, best ORR, progression-free survival, overall survival, and drug tolerance. RESULTS From August 2013 to March 2018, 5606 patients had their tumour tested for crizotinib targeted molecular alterations: 252 patients had c-MET ≥6 copies, 74 c-MET-mutation, and 78 ROS-1-translocated tumour. Finally, 25 patients in the c-MET ≥6 copies cohort, 28 in the c-MET-mutation cohort, and 37 in the ROS-1-translocation cohort were treated in the phase II trial. The ORR was 16% in the c-MET ≥6 copies cohort, 10.7% in the mutated, and 47.2% in the ROS-1 cohort. The best ORR during treatment was 32% in the c-MET-≥6 copies cohort, 36% in the c-MET-mutated, and 69.4% in the ROS-1-translocation cohort. Safety data were consistent with that previously reported. CONCLUSIONS Crizotinib activity in patients with ROS1-translocated tumours was confirmed. In the c-MET-mutation and c-MET ≥6 copies cohorts, despite insufficient ORR after two cycles of crizotinib, there are signs of late response not sufficient to justify the development of crizotinib in this indication. The continued targeting of c-MET with innovative therapies appears justified. CLINICAL TRIAL NUMBER NCT02034981.
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Affiliation(s)
- D Moro-Sibilot
- Thoracic Oncology Unit, Grenoble-Alpes University Hospital, Grenoble; Intergroupe Francophone de Cancérologie Thoracique (IFCT), Paris.
| | - N Cozic
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, ESP, Paris-Saclay and Paris-Sud Universities, Villejuif
| | - M Pérol
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon
| | - J Mazières
- Pneumology Department, Toulouse University Hospital and Paul Sabatier University, Toulouse
| | - J Otto
- Department of Medicine, Antoine Lacassagne Cancer Centre, Nice
| | - P J Souquet
- Department of Pneumology and Thoracic Oncology, Lyon Sud Hospital Center, Hospices Civils de Lyon, Pierre Bénite
| | - R Bahleda
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif
| | - M Wislez
- Pneumology Department, Tenon Hospital, AP-HP and "Pierre and Marie Curie" University, Paris
| | - G Zalcman
- Thoracic Oncology Department-CIC INSERM 1425, Bichat University Hospital, AP-HP, Paris; Paris-Diderot University, Paris
| | | | - F Barlési
- Multidisciplinary Oncology & Therapeutic Innovations Department, APHM and Aix Marseille University, INSERM, CNRS, CRCM, Marseille
| | - B Mennecier
- Pneumology Department, Strasbourg University Hospital, Strasbourg
| | - I Monnet
- Pneumology Department, CHIC Creteil, Créteil
| | - R Sabatier
- Department of Medical Oncology, Inserm 1068, CNRS UMR7258, CRCM, Paoli-Calmettes Institute and Aix-Marseille University, Marseille
| | - S Bota
- Pneumology Department, Charles Nicolle Hospital, Rouen University Hospital, Rouen
| | - C Dubos
- Pneumology Department, François Baclesse Cancer Centre, Caen
| | - V Verriele
- Anatomy and Pathological Cytologies Department, Paul Papin Cancer Centre, ICO, Angers
| | - V Haddad
- Department of Tumour Biology, Léon Bérard Cancer Centre, Lyon
| | - G Ferretti
- Radiology and Medical Imaging Department, Grenoble-Alpes University Hospital, Grenoble
| | - A Cortot
- Department of Thoracic Oncology, Lille University Hospital and University of Lille, Lille
| | - F De Fraipont
- Molecular Genetic Unit: Hereditary Diseases and Oncology, Grenoble-Alpes University Hospital, Grenoble
| | - M Jimenez
- Research and Development UNICANCER, Paris
| | | | - G Vassal
- Clinical Research Division, Gustave Roussy Cancer Campus, Villejuif, France
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Chebib N, Nesme P, Freymond N, Argaud L, Rimmelé T, Bohé J, Devouassoux G, Souquet PJ, Guérin C. Acute Respiratory Failure in Obesity-Hypoventilation Syndrome Managed in the ICU. Respir Care 2019; 64:1545-1554. [PMID: 31506342 DOI: 10.4187/respcare.06901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Obesity-hypoventilation syndrome (OHS) is defined as the combination of obesity (body mass index ≥ 30 kg/m2) and daytime arterial hypercapnia (PaCO2 > 45 mm Hg) in the absence of other causes of hypoventilation, and can lead to acute hypercapnic respiratory failure in the ICU. Our objective was to describe the ventilatory management and outcomes of subjects with OHS who were admitted to the ICU for acute hypercapnic respiratory failure. METHODS We retrospectively built a cohort of subjects with OHS who were admitted for acute hypercapnic respiratory failure in 4 ICUs of the university teaching hospital in Lyon, France, between 2013 and 2017. The main end point was the rate of success of noninvasive ventilation (NIV). Secondary end points were survival from OHS diagnosis to the last follow-up and risk factors for ICU admission and long-term survival. RESULTS One hundred fifteen subjects with OHS were included. Thirty-seven subjects (32.1%) were admitted to the ICU for acute hypercapnic respiratory failure. Congestive heart failure was the leading cause of acute hypercapnic respiratory failure (54%). At ICU admission, pH before NIV use was median (range) 7.26 (7.22-7.31) and PaCO2 was 70 (61-76) mm Hg. NIV was used as first-line ventilatory support in 36 subjects (97.2%) and was successful in 33 subjects (91.7%). ICU mortality was low (2.7%). The subjects admitted to the ICU were significantly older and had a lower FEV1 and vital capacity at the time of an OHS diagnosis. The difference in the restricted mean survival time was 663 d in favor of subjects not admitted to the ICU. Multivariate analysis showed that lower vital capacity at an OHS diagnosis was significantly associated with a higher risk of ICU admission. No factor was independently associated with long-term overall mortality in multivariate analysis. CONCLUSIONS Acute hypercapnic respiratory failure in subjects with OHS was generally responsive to NIV and was frequently associated with congestive heart failure.
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Affiliation(s)
- Nader Chebib
- Réanimation Médicale Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France. .,Claude Bernard Lyon 1 University, University of Lyon, Lyon, France
| | - Pascale Nesme
- Pneumologie Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Nathalie Freymond
- Pneumologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Laurent Argaud
- Claude Bernard Lyon 1 University, University of Lyon, Lyon, France.,Réanimation Médicale Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Rimmelé
- Claude Bernard Lyon 1 University, University of Lyon, Lyon, France.,Anesthésie et Réanimation Médicale Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Julien Bohé
- Claude Bernard Lyon 1 University, University of Lyon, Lyon, France.,Réanimation Médicale Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gilles Devouassoux
- Claude Bernard Lyon 1 University, University of Lyon, Lyon, France.,Pneumologie Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Jean Souquet
- Pneumologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Claude Guérin
- Réanimation Médicale Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, University of Lyon, Lyon, France.,IMRB (Institut Mondor de Recherche Biomédicale) INSERM (Institut National de la Santé et de la Recherche Médicale) 955 Créteil and Médecine Intensive et Réanimation, Centre Hospitalier Universitaire Grenoble, Grenoble, France
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24
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Souquet PJ, Couraud S. Immune checkpoint inhibitors: a game changer for metastatic non-small-cell lung cancer. Lancet Oncol 2019; 20:1334-1335. [PMID: 31422027 DOI: 10.1016/s1470-2045(19)30508-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Pierre-Jean Souquet
- Service de Cancérologie Thoracique, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, Lyon 69002, France; Intergroupe Francophone de Cancérologie Thoracique, Paris, France.
| | - Sébastien Couraud
- Service de Cancérologie Thoracique, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, Lyon 69002, France; EMR 3738 Ciblage Thérapeutique en oncologie, Faculté de médecine Lyon Sud, Université Lyon, Lyon, France
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25
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Antoun S, Morel H, Souquet PJ, Surmont V, Planchard D, Bonnetain F, Foucher P, Egenod T, Krakowski I, Gaudin H, Debieuvre D. Staging of nutrition disorders in non-small-cell lung cancer patients: utility of skeletal muscle mass assessment. J Cachexia Sarcopenia Muscle 2019; 10:782-793. [PMID: 30932365 PMCID: PMC6711412 DOI: 10.1002/jcsm.12418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 02/04/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND An international consensus proposed in 2011 a definition and classification system for cachexia (CAX), mainly based on weight loss, sarcopenia [skeletal muscle mass (SMM) loss], inflammation, and anorexia. The aim of this study was to stage CAX in non-small-cell lung cancer (NSCLC) patients by using a classification based on the Fearon criteria and supported by quantifiable parameters. METHODS This was a cross-sectional and non-interventional multicentre study. SMM was assessed by analysing L3 computed tomography-scan images. Patients completed the anorexia/CAX subscale of the Functional Assessment of Anorexia/Cachexia Therapy, EORTC QLQ-C30 quality of life (QoL) and International Physical Activity Questionnaire (IPAQ). RESULTS Patients were recruited in 56 sites. The analysis population comprised 531 patients, and SMM was assessed in 312 patients. Male patients were 66.5%, with a mean (SD) age of 65.2 (10.0) years, 79.9% were PS 0-1, and the tumour stage was mainly IIIB-IV (87.3%). Overall, 38.7% of patients had CAX, 33.8% pre-CAX, and 0.9% refractory CAX. Molecular tumour profiles were significantly associated with the presence of CAX: 23.9% in EGFR, ALK, ROS1, BRAF, or HER2+ patients, 41.4% in K-RAS+, and 43.2% in patients with no molecular abnormality (P = 0.003). The more advanced the CAX stage, the poorer the scores of functional items of the QoL (P < 0.001) and International Physical Activity Questionnaire (P < 0.001). Sarcopenia was present in 66.7% of CAX and 68.5% of pre-CAX patients. Overall, 43.8% of pre-CAX patients had only sarcopenia with limited weight loss (≤2%) and no anorexia. CONCLUSIONS This is the first study to show the distribution of CAX in a population of NSCLC patients and an association between molecular abnormality in NSCLC and CAX. The original Fearon classification for CAX stages was supported by the associated functional QoL scores and physical activity levels, resulting in a clinically relevant system for detection of early stages of CAX.
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Affiliation(s)
- Sami Antoun
- Emergency Unit, Gustave Roussy, Paris Saclay University, Villejuif, France
| | - Hugues Morel
- Pneumology Department, Centre Hospitalier Régional d'Orleans, Orleans, France
| | | | - Veerle Surmont
- Thoracic Oncology Unit, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - David Planchard
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit (EA 3181), Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Pascal Foucher
- Department of Thoracic Oncology, Centre Hospitalier Universitaire Dijon Bourgogne, Dijon Cedex, France
| | - Thomas Egenod
- Thoracic and Skin Oncology Unit, Centre Hospitalier Universitaire De Limoges Dupuytren, Limoges, France
| | - Ivan Krakowski
- Interdisciplinary Department of Supportive care in Oncology (DISSPO-CARE), French-Speaking Association of Supportive Care in Cancer (AFSOS), Institut Bergonié, Bordeaux, France
| | - Hélène Gaudin
- Chugai Pharma France, Tour Franklin - Arche Sud, Paris, France
| | - Didier Debieuvre
- GHRMSA, Pneumology Department, French College of General Hospital Respiratory Physicians (CPHG), Hôpital Emile Muller, Mulhouse, France
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26
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Couraud S, Barlesi F, Fontaine-Deraluelle C, Debieuvre D, Merlio JP, Moreau L, Beau-Faller M, Veillon R, Mosser J, Al Freijat F, Bringuier PP, Léna H, Ouafik L, Westeel V, Morel A, Audigier-Valette C, Missy P, Langlais A, Morin F, Souquet PJ, Planchard D. Clinical outcomes of non-small-cell lung cancer patients with BRAF mutations: results from the French Cooperative Thoracic Intergroup biomarkers France study. Eur J Cancer 2019; 116:86-97. [PMID: 31181537 DOI: 10.1016/j.ejca.2019.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/17/2019] [Accepted: 04/10/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Patients with stage IV non-small-cell lung cancer (NSCLC) and BRAF V600 mutations may benefit from targeted therapies. Chemotherapy outcomes are little known in this population. METHODS The French Cooperative Thoracic Intergroup (IFCT) Biomarkers France study was a national prospective cohort study aiming to describe the molecular characteristics and clinical outcome of all consecutive NSCLC patients (N = 17,664) screened for molecular alterations. We used this data set to set up a case-control analysis. Cases had stage IV BRAF-mutated (BRAF-MT) NSCLC, whereas controls had NSCLC that was wild-type for EGFR, KRAS, HER2, BRAF, PIK3CA and ALK. Each case was matched for sex, age at diagnosis and smoking status to two controls randomly selected. RESULTS Overall, 83 cases with BRAF mutant disease (66.3% V600E) were matched to 166 controls. Five cases received tyrosine kinase inhibition in the first-line and 16 in the second-line. All others were treated with standard chemotherapy. There was no significant difference in first-line and second-line progression-free survival (PFS) between the groups, as well as in the disease control rate, BRAF mutation was not found to be prognostic of overall survival. We found no significant difference in outcome between the treatment types used in first-line or second-line in patients with BRAF-MT disease compared with controls nor between BRAF V600E or non-V600E compared with controls. CONCLUSIONS BRAF mutation is not a strong prognostic factor in NSCLC. Although taxan-based therapy shows poorest PFS in first-line, no chemotherapy regimen was associated with prognosis.
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Affiliation(s)
- Sébastien Couraud
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France; EMR3738 Ciblage Thérapeutique en Oncologie, Programme CIRCAN (CIRculating CANcer), Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Lyon 1, Université de Lyon, Oullins, France
| | - Fabrice Barlesi
- Aix Marseille University, Predictive Oncology Laboratory, Centre de Recherche en Cancérologie de Marseille, Inserm UMR1068, CNRS UMR7258, Marseille France; Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Dpt, Marseille, France
| | - Clara Fontaine-Deraluelle
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Didier Debieuvre
- Chest Department, Hôpital Emile Muller - GHRMSA, Mulhouse, France
| | - Jean-Philippe Merlio
- CHU and University Bordeaux, Hôpital Haut-Lévêque, Department of Pathology and Tumor Biology, Pessac, France
| | - Lionel Moreau
- Service de Pneumologie, Hôpital Louis Pasteur, Hôpitaux Civils de Colmar, Colmar, France
| | - Michèle Beau-Faller
- Laboratoire de Biochimie et de Biologie Moléculaire, Hôpitaux Universitaires de Strasbourg, Plate-forme de Génomique des Cancers d'Alsace, Laboratoire d'Onco-biologie, Institut Régional du Cancer d'Alsace, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France; INSERM IRFAC UMR-S1113, Université de Strasbourg, Strasbourg, France
| | - Rémi Veillon
- Service des Maladies Respiratoires, CHU Bordeaux, Hôpital du Haut Lévêque, Pessac, France
| | - Jean Mosser
- Centre Hospitalier Universitaire de Rennes, Département de Génomique et Génétique Moléculaire, Rennes, France
| | - Faraj Al Freijat
- Centre Hospitalier de Belfort-Montbéliard, Service de Pneumologie, Belfort, France
| | - Pierre-Paul Bringuier
- Department of Biology and Pathology, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Hervé Léna
- Hôpital Pontchaillou, Service de Pneumologie, Centre Hospitalier Universitaire, Rennes, France
| | - L'Houcine Ouafik
- Aix Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, Marseille, France; Faculté de Médecine Secteur Nord, Service de Transfert d'Oncologie Biologique, Marseille, France
| | - Virginie Westeel
- Service de Pneumologie, Centre Hospitalier Régional Universitaire de Besançon, Hôpital Jean Minjoz, Besançon, France
| | - Alain Morel
- CRCINA, INSERM, Université d'Angers et Institut de Cancérologie de l'Ouest, Nantes Angers, France
| | | | - Pascale Missy
- French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | | | - Franck Morin
- French Cooperative Thoracic Intergroup (IFCT), Paris, France
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - David Planchard
- Department of Medical Oncology, Thoracic Unit, Gustave Roussy, Villejuif, France.
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Swalduz A, Souquet PJ, Pérol M, Moro-Sibilot D, Schiffler C, Chabaud S, Fayet Y, Rogasik M, Labrosse H, Farsi F, Brun P, Decroisette C, Bombaron P, Bringuier PP, Haddad V, Forest F, Peoc’h M, Lantuejoul S, de Fraipont F, Ray-Coquard I, Fournel P. Compliance to regional recommendations for molecular analyses and management of advanced lung cancer patients. Future Oncol 2019; 15:2139-2149. [DOI: 10.2217/fon-2018-0943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: We performed a clinical audit of the management of patients with EGFR mutations, 1 year after the introduction of EGFR tyrosine kinase inhibitor ( EGFR-TKI) in first-line treatment. Methods: Compliance was defined by tumor molecular profiling for stage IIIB and IV non-small-cell lung cancer and first-line treatment as recommended by the French guidelines. Results: Among the 169 EGFR-mutated patients, compliance was 76.4%. The most common noncompliance criterion was chemotherapy given in first-line treatment instead of EGFR-TKI. No dedicated multidisciplinary meeting and type of institutions were independent unfavorable predictors for compliance. Compliance to guidelines was significantly correlated with time-to-first subsequent treatment improvement (2.5 vs 9.1 months; p < 0.0001). Conclusion: Implementation of new standards of care is challenging. Our results reinforce the role of multidisciplinary meetings to provide a better access to innovating therapeutics.
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Affiliation(s)
- Aurélie Swalduz
- Department of Chest Diseases & Thoracic Oncology, University Hospital of Saint-Étienne, 42270, Saint Priest en Jarez, France
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
| | - Pierre-Jean Souquet
- Department of Respiratory Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Maurice Pérol
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
| | - Denis Moro-Sibilot
- Pulmonology & Thoracic Oncology Department, Grenoble University Hospital, 38700, Grenoble, France
- Medicine Faculty, Joseph Fourrier University, 38043, La Tronche, France
| | - Camille Schiffler
- Department of Biostatistics, Centre Léon Bérard, 69008, Lyon, France
| | - Sylvie Chabaud
- Department of Biostatistics, Centre Léon Bérard, 69008, Lyon, France
| | - Yohan Fayet
- Équipe Évaluation Médicales et Sarcome (EMS), Centre Léon Bérard, 69008 Lyon, France
| | - Muriel Rogasik
- Équipe Évaluation Médicales et Sarcome (EMS), Centre Léon Bérard, 69008 Lyon, France
| | | | - Fadila Farsi
- Réseau Espace Santé Cancer Rhône-Alpes, 69008, Lyon, France
| | - Philippe Brun
- Department of Respiratory Medicine, Valence Hospital, 26953, Valence, France
| | - Chantal Decroisette
- Department of Respiratory Medicine, Annecy Genevois Hospital, 74370, Metz-Tessy, France
| | - Pierre Bombaron
- Department of Respiratory Medicine, Mermoz Private Hospital, 69008, Lyon, France
| | - Pierre-Paul Bringuier
- Molecular Diagnostics Laboratory, Edouard-Herriot Hospital, Hospices Civils de Lyon, 69003, Lyon, France
| | - Véronique Haddad
- Department of Biopathology, Centre Léon Bérard, 69008, Lyon, France
| | - Fabien Forest
- Department of Pathology, University Hospital of Saint Étienne, 42270, Saint Priest en Jarez, France
| | - Michel Peoc’h
- Department of Pathology, University Hospital of Saint Étienne, 42270, Saint Priest en Jarez, France
| | - Sylvie Lantuejoul
- Medicine Faculty, Joseph Fourrier University, 38043, La Tronche, France
- Department of Biopathology, Centre Léon Bérard, 69008, Lyon, France
| | - Florence de Fraipont
- Institue of Biology & Pathology, Grenoble University Hospital, 38043, Grenoble, France
| | - Isabelle Ray-Coquard
- Department of Medicine, Centre Léon Bérard, 69008, Lyon, France
- Université Claude Bernard Lyon 1, 69008, Lyon, France
| | - Pierre Fournel
- Department of Medical Oncology, Institut Lucien Neuwirth, 42270, Saint-Priest-en-Jarez, France
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Garcia J, Wozny AS, Geiguer F, Delherme A, Barthelemy D, Merle P, Tissot C, Jones FS, Johnson C, Xing X, Xu Z, Edelstein DL, Brevet M, Souquet PJ, Rodriguez-Lafrasse C, Payen L, Couraud S. Profiling of circulating tumor DNA in plasma of non-small cell lung cancer patients, monitoring of epidermal growth factor receptor p.T790M mutated allelic fraction using beads, emulsion, amplification, and magnetics companion assay and evaluation in future application in mimicking circulating tumor cells. Cancer Med 2019; 8:3685-3697. [PMID: 31112372 PMCID: PMC6866744 DOI: 10.1002/cam4.2244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 12/12/2022] Open
Abstract
Cell-free plasma DNA (cfDNA) and mimicking circulating tumor cells (mCTCs) have demonstrated tremendous potential for molecular diagnosis of cancer and have been rapidly implemented in specific settings. However, widespread clinical adoption still faces some obstacles. The purpose was to compare the performance of a BEAMing (beads, emulsion, amplification, and magnetics) assay (OncoBEAM™-epidermal growth factor receptor [EGFR] [Sysmex Inostics]) and a next-generation sequencing assay (NGS; 56G Oncology panel kit, Swift Bioscience) to detect the p.T790M EGFR mutation in cfDNA of non-small cell lung cancer (NSCLC) patients. CfDNA samples (n = 183) were collected within our hospital from patients having a known EGFR sensitizing mutation, and presenting disease progression while under first-line therapy. EGFR mutations were detected using NGS in 42.1% of samples during progression in cfDNA. Testing using the OncoBEAM™-EGFR assay enabled detection of the p.T790M EGFR mutation in 40/183 NSCLC patients (21.8%) versus 20/183 (10.9%), using the NGS assay. Samples that were only positive with the OncoBEAM™-EGFR assay had lower mutant allelic fractions (Mean = 0.1304%; SD ± 0.1463%). In addition, we investigated the detection of p.T790M in mCTCs using H1975 cells. These cells spiked into whole blood were enriched using the ClearCellFX1 microfluidic device. Using the OncoBEAM™-EGFR assay, p.T790M was detected in as few as 1.33 tumoral cells/mL. Overall, these findings highlight the value of using the OncoBEAM™-EGFR to optimize detection of the p.T790M mutation, as well as the complementary clinical value that each of the mutation detection assay offers: NGS enabled the detection of mutations in other oncogenes that may be relevant to secondary resistance mechanisms, whereas the OncoBEAM™-EGFR assay achieved higher sensitivity for detection of clinically actionable mutations.
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Affiliation(s)
- Jessica Garcia
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, CNRS UMR5286, Claude Bernard University, University of Lyon, Lyon, France.,CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France.,Laboratoire Commun de Recherche Hospices Civils de Lyon - BioMérieux, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Anne-Sophie Wozny
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France
| | - Florence Geiguer
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France.,Laboratoire Commun de Recherche Hospices Civils de Lyon - BioMérieux, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Aurélia Delherme
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France.,Laboratoire Commun de Recherche Hospices Civils de Lyon - BioMérieux, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - David Barthelemy
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, CNRS UMR5286, Claude Bernard University, University of Lyon, Lyon, France.,CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France.,Laboratoire Commun de Recherche Hospices Civils de Lyon - BioMérieux, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Patrick Merle
- Service de Pneumologie et oncologie thoracique, CHU G Montpied, Clermont-Ferrand, France
| | - Claire Tissot
- Service de Pneumologie et Cancérologie Thoracique, CHU Saint Etienne, Saint-Priest-en-Jarez, France
| | | | | | - Xiaobin Xing
- SOPHiA GENETICS SA, Headquarters, Saint Sulpice, Switzerland
| | - Zhenyu Xu
- SOPHiA GENETICS SA, Headquarters, Saint Sulpice, Switzerland
| | | | - Marie Brevet
- Cancer Research Center of Lyon, INSERM U1052, CNRS UMR5286, Claude Bernard University, University of Lyon, Lyon, France.,CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France.,Institut de pathologie multisites des HCL-Site Est, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Jean Souquet
- Service de Pneumologie aigue spécialisée et cancérologie thoracique, Groupement hospitalier sud, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France
| | - Claire Rodriguez-Lafrasse
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,UMR CNRS 5822/IN2P3, IPNL, PRISME, Laboratoire de Radiobiologie Cellulaire et Moléculaire, Faculté de Médecine Lyon-Sud, Université Lyon 1, Lyon, France
| | - Léa Payen
- Laboratoire de Biochimie et Biologie Moléculaire, Groupe Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,Cancer Research Center of Lyon, INSERM U1052, CNRS UMR5286, Claude Bernard University, University of Lyon, Lyon, France.,CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France.,Laboratoire Commun de Recherche Hospices Civils de Lyon - BioMérieux, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Couraud
- CIRculating CANcer (CIRCAN) program, Hospices Civils de Lyon Cancer institute, Lyon, France.,Service de Pneumologie aigue spécialisée et cancérologie thoracique, Groupement hospitalier sud, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France.,EMR 3738 Ciblage Thérapeutique en Oncologie, Faculté de médecine Lyon Sud, Université Lyon 1, Université de Lyon, Lyon, France
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Corbaux P, Fontaine-Delaruelle C, Souquet PJ, Couraud S, Morel H, Tronc F, Eker E, Peron J, Raynard B. Is Nutritional Screening of Patients with Lung Cancer Optimal? An Expert Opinion Survey of French Physicians and Surgeons. Nutr Cancer 2019; 71:971-980. [DOI: 10.1080/01635581.2019.1595051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Pauline Corbaux
- Department of Medical Oncology, Centre Hospitalier Lyon-Sud, Institut de Cancérologie des Hospices Civils de Lyon-IC-HCL, University of Lyon 1, Pierre-Bénite, France
| | - Clara Fontaine-Delaruelle
- Department of Respiratory Medicine, Centre Hospitalier Lyon-Sud, University of Lyon 1, Pierre-Bénite, France
| | - Pierre-Jean Souquet
- Department of Respiratory Medicine, Centre Hospitalier Lyon-Sud, University of Lyon 1, Pierre-Bénite, France
| | - Sébastien Couraud
- Department of Respiratory Medicine, Centre Hospitalier Lyon-Sud, University of Lyon 1, Pierre-Bénite, France
| | - Hugues Morel
- Department of Respiratory Medicine, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - François Tronc
- Department of Thoracic Surgery, Hôpital Louis Pradel, University of Lyon 1, Bron, France
| | - Elife Eker
- Department of Radiotherapy, Centre Hospitalier Lyon Sud, University of Lyon 1, Pierre-Bénite, France
| | - Julien Peron
- Department of Medical Oncology, Centre Hospitalier Lyon-Sud, Institut de Cancérologie des Hospices Civils de Lyon-IC-HCL, University of Lyon 1, Pierre-Bénite, France
- Centre National de la Recherche Scientifique, Unités Mixtes de Recherche 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Department of Biostatistics, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Bruno Raynard
- Transversal Unit of Dietetics and Nutrition, Institut Gustave Roussy, University of Paris Sud, Villejuif, France
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Drareni K, Dougkas A, Giboreau A, Laville M, Souquet PJ, Bensafi M. Relationship between food behavior and taste and smell alterations in cancer patients undergoing chemotherapy: A structured review. Semin Oncol 2019; 46:160-172. [DOI: 10.1053/j.seminoncol.2019.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022]
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Pujol JL, Greillier L, Audigier-Valette C, Moro-Sibilot D, Uwer L, Hureaux J, Guisier F, Carmier D, Madelaine J, Otto J, Gounant V, Merle P, Mourlanette P, Molinier O, Renault A, Rabeau A, Antoine M, Denis MG, Bommart S, Langlais A, Morin F, Souquet PJ. A Randomized Non-Comparative Phase II Study of Anti-Programmed Cell Death-Ligand 1 Atezolizumab or Chemotherapy as Second-Line Therapy in Patients With Small Cell Lung Cancer: Results From the IFCT-1603 Trial. J Thorac Oncol 2019; 14:903-913. [PMID: 30664989 DOI: 10.1016/j.jtho.2019.01.008] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [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: 12/05/2018] [Revised: 01/02/2019] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This randomized phase II trial aimed at evaluating the engineered programmed cell death ligand 1 (PD-L1) antibody atezolizumab in SCLC progressing after first-line platinum-etoposide chemotherapy. METHODS Patients were randomized 2:1 to atezolizumab (1200 mg intravenously every 3 weeks) until progression or unacceptable toxicity, or conventional chemotherapy (up to 6 cycles of topotecan or re-induction of initial chemotherapy). Patients were not selected based on PD-L1 tissue expression. The primary endpoint was objective response rate at 6 weeks. A two-stage design with 2:1 randomization and O'Brien-Fleming stopping rules was used. The null hypothesis was rejected if more than 12 of 45 patients were responders. RESULTS Overall, 73 patients were randomized (atezolizumab n = 49; chemotherapy n = 24). At 6 weeks, 1 of 43 eligible atezolizumab patients achieved an objective response (2.3%, 95% confidence interval [CI]: 0.0-6.8), whereas 8 others had stable disease (20.9% disease control rate; 95% CI: 8.8-33.1). Among eligible chemotherapy patients (n = 20), 10% achieved an objective response (65% disease control rate). Median progression-free survival was 1.4 months (95% CI: 1.2-1.5) with atezolizumab and 4.3 months (95% CI: 1.5-5.9) with chemotherapy. Overall survival did not significantly differ between groups. Median overall survival was 9.5 months versus 8.7 months for the atezolizumab and the chemotherapy group, respectively (adjusted hazard ratioatezolizumab : 0.84, 95% CI: 0.45-1.58; p = 0.60). Two atezolizumab patients (4.2%) experienced grade 3 fatigue, and two others grade 1 dysthyroidism. Among 53 evaluable specimens, only 1 (2%) had positive immunohistochemical PD-L1 staining (SP142 clone). CONCLUSIONS Atezolizumab monotherapy in relapsed SCLC failed to show significant efficacy. No unexpected safety concerns were observed.
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Affiliation(s)
- Jean-Louis Pujol
- Department of Thoracic Oncology, Montpellier Regional University Hospital, Montpellier, France.
| | - Laurent Greillier
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Assistance Publique - Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | | | | | - Lionel Uwer
- Institut de Cancerologie de Lorraine Alexis Vautrin. 6 Avenue de Bourgogne, Vandoeuvre-les-Nancy, France
| | - José Hureaux
- Pôle Hippocrate, Angers University Hospital, Angers, France
| | - Florian Guisier
- Service de Pneumologie, Oncologie Thoracique et soins Intensifs Respiratoires, CHU de Rouen, Rouen, France
| | - Delphine Carmier
- Service de Pneumologie CHRU Hôpitaux de Tours, Hôpital Bretonneau, Tours, France
| | | | - Josiane Otto
- Pôle Médecine, Centre Antoine Lacassagne, Nice, France
| | - Valérie Gounant
- Department of Thoracic Oncology, Bichat Claude Bernard Hospital, Paris, France
| | - Patrick Merle
- Service de Pneumologie, Chu Gabriel-Montpied, Clermont-Ferrand, France
| | | | - Olivier Molinier
- Service de Pneumologie, Centre Hospitalier du Mans, Le Mans, France
| | - Aldo Renault
- Service de Pneumologie, Centre Hospitalier de Pau, Pau, France
| | - Audrey Rabeau
- Toulouse University Hospital, Université Paul Sabatier, Toulouse, France
| | - Martine Antoine
- Service d'Anatomo-pathologie, Hôpitaux Universitaires Est Parisien Site Tenon, Paris, France
| | - Marc G Denis
- Department of Biochemistry, Nantes University Hospital, Nantes, France
| | - Sebastien Bommart
- Department of radiology, Montpellier Regional University Hospital, Montpellier, France
| | | | - Franck Morin
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
| | - Pierre-Jean Souquet
- Service de Pneumologie Aiguë Spécialisée et Cancérologie Thoracique, Centre Hospitalier Lyon, Lyon, France
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Provoost J, Valour F, Gamondes D, Roux S, Freymond N, Perrot E, Souquet PJ, Kiakouama-Maleka L, Chidiac C, Lina G, Dumitrescu O, Sénéchal A, Ader F. A retrospective study of factors associated with treatment decision for nontuberculous mycobacterial lung disease in adults without altered systemic immunity. BMC Infect Dis 2018; 18:659. [PMID: 30547753 PMCID: PMC6295085 DOI: 10.1186/s12879-018-3559-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022] Open
Abstract
Background Nontuberculous mycobacteria (NTM) lung diseases are increasingly recognized as chronic opportunistic infections, occurring in individuals with a wide variety of underlying conditions. In the absence of systemic immunodeficiency, decision of NTM lung disease treatment must relies on a careful risk/benefit assessment, given the requirement of long-term administration of multidrug therapies supported by limited evidence. The primary objective was to identify the factors associated with anti-NTM treatment initiation. Clinical and radiological outcome upon treatment were studied. Methods This retrospective, single center study (2013–2016, 45 months) addressed the criteria supporting treatment decision among adults with NTM lung disease without systemic immunodeficiency at our institution, with the assigned goal to harmonize the practice. All patients matched the current international definitions of NTM lung disease according to the American Thoracic Society criteria. Factors associated with anti-NTM treatment were investigated by conditional logistic regression. Clinical and radiological outcomes of treated and untreated NTM-disease cases were examined. Mortality rate was assessed. An expert radiologist conducted a blinded computed tomography (CT)-scan review of the treated and untreated patients. Results Among 51 cases of NTM lung diseases, 25 (49%) received anti-NTM treatment. In univariate analysis, a body mass index (BMI) < 18 kg/m2 (odds ratio (OR), 4.2 [95% confidence interval (CI) 1.2–15.2]; p = 0.042), hemoptysis (OR, 11.8 [95% CI 1.35–12.9]; p = 0.026), excavation(s) (OR, 4.8 [95% CI 1.4–16.4], p = 0.012), prior anti-NTM treatment (OR, 5.65 [95% CI 1.06–29.9]; p = 0.042), Aspergillus spp. co-infection (OR, 6.3 [95% CI 1.8–22.2]; p = 0.004) were associated with treatment initiation. In multivariate analysis, Aspergillus spp. co-infection was the only independent determinant of treatment initiation (OR, 5.3 [95% CI 1.1–25.4]; p = 0.036). Twenty-one (81%) patients received ≥3 anti-NTM drugs. Median treatment duration and follow-up were 36.3 (interquartile range [IQR], 13.1–64.4) weeks and 17.1 (IQR, 8.7–27.1) months, respectively. Regarding radiological outcome, 85 CT-scans were reviewed, showing similar rates of regression or stabilization in treated and untreated patients. Overall mortality rate was not different in treated and untreated patients. Conclusion The most relevant variable associated with anti-NTM treatment initiation was Aspergillus spp. co-infection. Radiological regression or stabilization of pulmonary lesions was not different between the treated and untreated patients.
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Affiliation(s)
- Judith Provoost
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Florent Valour
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France.,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | | | - Sandrine Roux
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France
| | | | - Emilie Perrot
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Jean Souquet
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | | | - Christian Chidiac
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Gérard Lina
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Oana Dumitrescu
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Agathe Sénéchal
- Département de Pneumologie, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Département des Maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317, cedex 04, Lyon, France. .,CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007, Lyon, France. .,Université Claude Bernard Lyon 1, Lyon, France.
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Scherpereel A, Durand-Zaleski I, Cotté FE, Fernandes J, Debieuvre D, Blein C, Gaudin AF, Tournier C, Vainchtock A, Chauvin P, Souquet PJ, Westeel V, Chouaïd C. Access to innovative drugs for metastatic lung cancer treatment in a French nationwide cohort: the TERRITOIRE study. BMC Cancer 2018; 18:1013. [PMID: 30348130 PMCID: PMC6196460 DOI: 10.1186/s12885-018-4958-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 10/16/2018] [Indexed: 12/20/2022] Open
Abstract
Background Territorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence. Methods All incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data. Results Overall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs. Conclusion Although access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed.
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Affiliation(s)
- Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, CHU de Lille, Lille University, Lille, France
| | - Isabelle Durand-Zaleski
- URCEco Île-de-France, Hôtel-Dieu Hospital, Paris, France.,Department of Public Health, Henri-Mondor Hospital, Créteil, France
| | - François-Emery Cotté
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France.
| | | | - Didier Debieuvre
- Department of Chest Medicine, GHRMSA, Emile Muller Hospital, Mulhouse, France
| | | | - Anne-Françoise Gaudin
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
| | | | | | - Pierre Chauvin
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Sorbonne Universités, UPMC Université Paris 06, INSERM, Paris, France
| | - Pierre-Jean Souquet
- Department of Chest Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Virginie Westeel
- Department of Chest Medicine, Jean Minjoz University Hospital, Besançon, France
| | - Christos Chouaïd
- Department of Chest Medicine, Créteil University Hospital, Créteil, France
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Bennouna J, Barlesi F, Do P, Dumont P, Cadranel J, Debieuvre D, Hilgers W, Molinier O, Quoix E, Raimbourg J, Langlais A, Morin F, Souquet PJ. Phase II study assessing the benefit of cisplatin re-introduction (stop-and-go strategy) in patients with advanced non-squamous non-small cell lung cancer: the IFCT-1102 BUCiL study (a Better Use of Cisplatin in Lung cancer). ESMO Open 2018; 3:e000394. [PMID: 30094074 PMCID: PMC6069905 DOI: 10.1136/esmoopen-2018-000394] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/05/2023] Open
Abstract
Introduction This single-arm phase II trial aimed to evaluate a stop-and-go strategy with cisplatin-based chemotherapy and bevacizumab in advanced non-squamous non-small cell lung cancer (NSCLC). Methods Patients were initially treated with three cycles of pemetrexed, cisplatin plus bevacizumab (sequence 1) followed by bevacizumab maintenance and after progression, re-introduction of three cycles of pemetrexed, cisplatin plus bevacizumab (sequence 2) and pemetrexed plus bevacizumab maintenance. The primary endpoint was the proportion of patients with advanced non-squamous NSCLC receiving the complete sequence 2 without platinum dose reduction (hypothesis ≥75%). Results 120 patients with performance status ≤1 were included. Of 113 patients evaluable for efficacy, 65 (57.5%) entered in sequence 2 and 56 (86%) received the three planned cycles including 37 (56.9%, 95% CI 45.1 to 73.6) without platinum dose reduction. The median progression-free survival 1 (PFS1; inclusion to progression 1) was 5.6 months (95% CI 5.0 to 6.3) and median PFS2 (progression 1 to progression 2) was 6.8 months (95% CI 5.8 to 8.8). The median disease control duration (PFS1+PFS2; n=65) was 12.4 months (95% CI 11.2 to 14.9). The median overall survival was 17.7 months (95% CI 13.1 to 21.6) and 20.5 months (95% CI 16.9 to 26.9) for patients reaching the sequence 2 (n=65). Conclusion Although the stringent primary endpoint was not met, this stop-and-go strategy with platinum-based chemotherapy plus bevacizumab continuation beyond progression compares favourably with standard schedule, deserving to be further studied in advanced non-squamous NSCLC.
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Affiliation(s)
- Jaafar Bennouna
- Thoracic Oncology, Department of Pneumology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
| | - Fabrice Barlesi
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix Marseille University, Assistance Public Hôpitaux de Marseille, Marseille, France
| | - Pascal Do
- Centre François Baclesse, Caen, France
| | | | - Jacques Cadranel
- Assistance Publique Hôpitaux de Paris, Hôpital Tenon, service de Pneumologie and GRC 04 Theranoscan P&M Curie Université Paris 6, Paris, France
| | - Didier Debieuvre
- Service de Pneumologie, GHRMSA-Hôpital Emile Muller, Mulhouse, France
| | - Werner Hilgers
- Oncologie-Médecine interne, Institut Sainte Catherine, Avignon, France
| | | | - Elisabeth Quoix
- Service de Pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Judith Raimbourg
- Medical Oncology, Institut de cancérologie de l'Ouest-Centre René Gauducheau, St Herblain, France
| | | | - Franck Morin
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
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Veaudor M, Gérinière L, Souquet PJ, Druette L, Martin X, Vergnon JM, Couraud S. High-fidelity simulation self-training enables novice bronchoscopists to acquire basic bronchoscopy skills comparable to their moderately and highly experienced counterparts. BMC Med Educ 2018; 18:191. [PMID: 30086734 PMCID: PMC6081833 DOI: 10.1186/s12909-018-1304-1] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND We sought to determine whether a self-training program on a high-fidelity flexible bronchoscopy (FB) simulator would allow residents who were novices in bronchoscopy to acquire competencies similar to those of experienced bronchoscopists as concerns the visualization of the bronchial tree and the identification of its anatomical elements. METHODS We performed a prospective cohort study, categorizing bronchoscopists into three groups according to their experience level: novice (Group A, no FBs performed, n = 8), moderate (Group B, 30 ≤ FBs performed ≤200, n = 17) or high (Group C, > 200 FBs performed, n = 9). All were initially evaluated on their ability to perform on a high-fidelity FB simulator a complete visualization/identification of the bronchial tree in the least amount of time possible. The residents in Group A then completed a simulation-based self-training program and underwent a final evaluation thereafter. RESULTS The median total procedure time for Group A fell from 561 s (IQR = 134) in the initial evaluation to 216 s (IQR = 257) in the final evaluation (P = 0.002). The visualization and identification scores for Group A also improved significantly in the final evaluation. Resultantly, the overall performance score for Group A climbed from 5.9% (IQR = 5.1) before self-training to 25.5% (IQR = 26.3) after (P = 0.002), thus becoming comparable to the overall performance scores of Group B (25.3%, IQR = 13.8) and Group C (22.2%, IQR = 5.5). CONCLUSIONS Novice bronchoscopists who self-train on a high-fidelity simulator acquire basic competencies similar to those of moderately or even highly experienced bronchoscopists. High-fidelity simulation should be rapidly integrated within the learning curriculum and replace traditional, in-patient learning methods.
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Affiliation(s)
- Martin Veaudor
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France
| | - Laurence Gérinière
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France
| | - Loïc Druette
- Stratégie d'Apprentissage des Métiers de Santé en Environnement Immersif, Université Lyon 1, 69008, Lyon, France
| | - Xavier Martin
- Stratégie d'Apprentissage des Métiers de Santé en Environnement Immersif, Université Lyon 1, 69008, Lyon, France
| | - Jean-Michel Vergnon
- Service de Pneumologie et oncologie thoracique, CHU St Etienne, Hôpital Nord, 42270, Saint-Priest en Jarez, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France.
- EMR 3738 Ciblage thérapeutique en oncologie, Faculté de médecine Lyon Sud Charles Mérieux, Université Lyon 1, 69600, Oullins, France.
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Armoiry X, Tsertsvadze A, Connock M, Royle P, Melendez-Torres GJ, Souquet PJ, Clarke A. Comparative efficacy and safety of licensed treatments for previously treated non-small cell lung cancer: A systematic review and network meta-analysis. PLoS One 2018; 13:e0199575. [PMID: 30044785 PMCID: PMC6059384 DOI: 10.1371/journal.pone.0199575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/13/2018] [Accepted: 06/08/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This systematic review with network meta-analysis compared the efficacy and safety of currently licensed second-line treatments in patients with late stage non-small cell lung cancer (NSCLC). METHODS Randomised controlled trials (RCTs) of participants with advanced/metastatic NSCLC receiving second/third line treatments were screened. We searched electronic databases (MEDLINE; EMBASE; Web of Science) from January, 2000 to July, 2017. Two reviewers screened bibliographic records, extracted data, and assessed risk of bias of included studies. The outcomes were overall survival (OS), progression-free survival (PFS), and drug-related grade 3-5 adverse-events (AEs). We pooled study-specific hazard ratios (HR; for OS and PFS) and risk ratios (RR; for AEs) using conventional and network-meta-analyses, and ranked interventions by the surface under the cumulative ranking curve. FINDINGS We included 11 RCTs (7,581 participants) comparing nine drugs. All drugs except for erlotinib significantly improved OS compared to docetaxel. Nivolumab was the highest ranking drug followed by atezolizumab and pembrolizumab. There was no significant difference in OS across these three drugs (HR = 0.98, 95% CI 0.79, 1.21 for nivolumab vs atezolizumab; HR = 0.98, 95% CI 0.77, 1.25 for nivolumab vs pembrolizumab). For PFS, ramucirumab + docetaxel and nivolumab were the drugs with the highest ranking. All interventions except ramucirumab + docetaxel had a reduced risk for severe drug-related AEs vs. docetaxel. Of the drugs with the highest ranking on AEs, nivolumab was significantly safer compared to atezolizumab (RR = 0.55, 95% CI 0.38, 0.79) or pembrolizumab (RR = 0.52, 95% CI 0.34, 0.81). IMPLICATIONS Nivolumab, pembrolizumab and atezolizumab exhibited superior benefit/risk balance compared to other licensed drugs used late stage NSCLC. Our results indicate that the use of immunotherapies in people diagnosed with non-specific late stage NSCLC should be promoted. The use of docetaxel may now be judged irrelevant as a comparator intervention for approval of new drugs for second line treatment of NSCLC. STUDY REGISTRATION NUMBER PROSPERO CRD42017065928.
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Affiliation(s)
- Xavier Armoiry
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - Alexander Tsertsvadze
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
- School of Epidemiology and Public Health, University of Ottawa, Ottawa Canada
| | - Martin Connock
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - Pamela Royle
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - G. J. Melendez-Torres
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
| | - Pierre-Jean Souquet
- Hospices Civils de Lyon, Groupement hospitalier Sud, Service de Pneumologie oncologique, Pierre-Bénite, France
| | - Aileen Clarke
- University of Warwick, Warwick Medical School, Division of Health Sciences, Coventry, England
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Confavreux CB, Pialat JB, Bellière A, Brevet M, Decroisette C, Tescaru A, Wegrzyn J, Barrey C, Mornex F, Souquet PJ, Girard N. Bone metastases from lung cancer: A paradigm for multidisciplinary onco-rheumatology management. Joint Bone Spine 2018; 86:185-194. [PMID: 29631067 DOI: 10.1016/j.jbspin.2018.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 03/14/2018] [Indexed: 12/15/2022]
Abstract
Bone is the third metastatic site after liver and lungs. Bone metastases occur in one out of three lung cancers and are usually of osteolytic aspect. Osteolytic bone metastases are responsible of long bone and vertebral fractures leading to restricted mobility, surgery and medullar compression that severely alter quality of life and that have a huge medico-economic impact. In the recent years, Bone Metastatic Multidisciplinary Tumour Board (BM2TB) have been developed to optimize bone metastases management for each patient in harmony with oncology program. In this review, we will go through all the different aspects of bone metastases management including diagnosis and evaluation (CT scan, Tc 99m-MDP bone scan, 18FDG-PET scan and biopsy for molecular diagnosis), systemic bone treatments (zoledronic acid and denosumab) and local treatments (interventional radiology and radiotherapy). Surgical strategies will be discussed elsewhere. Based on the last 2017-Lung Cancer South East French Guidelines, we present a practical decision tree to help the physicians for decision making in order to reach a personalized locomotor strategy for every patient.
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Affiliation(s)
- Cyrille B Confavreux
- Centre expert des métastases et oncologie osseuse secondaire-CEMOS, service de rhumatologie Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France.
| | - Jean-Baptiste Pialat
- Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France; Service de radiologie, centre hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Aurélie Bellière
- Centre régional de lutte contre le cancer Jean-Perrin, 63000 Clermont-Ferrand, France
| | - Marie Brevet
- Département d'anatomopathologie, groupement hospitalier Est, Hospices Civils de Lyon, 69500 Bron, France
| | - Chantal Decroisette
- Centre Hospitalier Annecy-Genevois, 1, boulevard de l'hôpital, 74370 Metz-Tessy, France
| | - Agnès Tescaru
- Service de médecine nucléaire, centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Julien Wegrzyn
- Centre expert des métastases et oncologie osseuse secondaire-CEMOS, service de rhumatologie Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université de Lyon, INSERM UMR 1033-Lyos, 69008 Lyon, France; Département de chirurgie orthopédique - Pavillon T, hôpital Edouard-Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - Cédric Barrey
- Département de neurochirurgie et chirurgie du Rachis, université Claude-Bernard Lyon I, hôpital Pierre-Wertheimer, Hospices Civils de Lyon, 69500 Bron, France; Laboratoire de biomécanique, ENSAM, Arts et Métiers Paris Tech, 75003 Paris, France
| | - Françoise Mornex
- Département de radiothérapie oncologie, centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Université Claude-Bernard Lyon 1-EMR 3738, 69921 Oullins, France
| | - Pierre-Jean Souquet
- Service de pneumologie, centre hospitalier Lyon-Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
| | - Nicolas Girard
- Université de Lyon, université Claude-Bernard Lyon 1, Lyon, France; Institut du Thorax Curie Montsouris, Institut Curie, 75005 Paris, France
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Chouaïd C, Debieuvre D, Durand-Zaleski I, Fernandes J, Scherpereel A, Westeel V, Blein C, Gaudin AF, Ozan N, Leblanc S, Vainchtock A, Chauvin P, Cotté FE, Souquet PJ. Survival inequalities in patients with lung cancer in France: A nationwide cohort study (the TERRITOIRE Study). PLoS One 2017; 12:e0182798. [PMID: 28841679 PMCID: PMC5571949 DOI: 10.1371/journal.pone.0182798] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/25/2017] [Indexed: 12/31/2022] Open
Abstract
The French healthcare system is a universal healthcare system with no financial barrier to access to health services and cancer drugs. The objective of the study is to investigate associations between, on the one hand, incidence and survival of patients diagnosed with lung cancer in France and, on the other, the socioeconomic deprivation and population density of their municipality of residence. A national, longitudinal analysis using data from the French National Hospital database crossed with the population density of the municipality and a social deprivation index based on census data aggregated at the municipality level. For lung cancer diagnosed at the metastatic stage, one-year and two-year survival was not associated with the population density of the municipality of residence. In contrast, mortality was higher for people living in very deprived, deprived and privileged areas compared to very privileged areas (hazard ratios at two years: 1.19 [1.13–1.25], 1.14 [1.08–1.20] and 1.10 [1.04–1.16] respectively). Similar associations are also observed in patients diagnosed with non-metastatic disease (hazard ratios at two years: 1.21 [1.13–1.30], 1.15 [1.08–1.23] and 1.10 [1.03–1.18] for people living in very deprived, deprived and privileged areas compared to very privileged areas). Despite a universal healthcare coverage, survival inequalities in patients with lung cancer can be observed in France with respect to certain socioeconomic indicators.
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Affiliation(s)
- Christos Chouaïd
- Department of Chest Medicine, Créteil University Hospital, Créteil, France
| | - Didier Debieuvre
- Department of Chest Medicine, Mulhouse University Hospital, Mulhouse, France
| | - Isabelle Durand-Zaleski
- URCEco Île-de-France, Hôtel-Dieu Hospital, Paris, France
- Department of Public Health, Henri-Mondor Hospital, Créteil, France
| | | | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, Lille University Hospital, Lille, France
| | - Virginie Westeel
- Department of Chest Medicine, Jean Minjoz University Hospital, Besançon, France
| | | | - Anne-Françoise Gaudin
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
| | - Nicolas Ozan
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
| | | | | | - Pierre Chauvin
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Paris, France
| | - François-Emery Cotté
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
- * E-mail:
| | - Pierre-Jean Souquet
- Department of Chest Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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Baudouin A, Fargier E, Cerruti A, Dubromel A, Vantard N, Ranchon F, Schwiertz V, Salles G, Souquet PJ, Thomas L, Bérard F, Nancey S, Freyer G, Trillet-Lenoir V, Rioufol C. Évolution du remboursement des anticancéreux inscrits sur la liste en sus : impact financier au sein d’un centre hospitalo-universitaire. Bull Cancer 2017; 104:538-551. [DOI: 10.1016/j.bulcan.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
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Maury JM, Girard N, Tabutin M, Grima R, Chalabreysse L, Pavlakovic I, Sayag-Beaujard A, Leroux C, Souquet PJ, Glehen O, Tronc F. Intra-Thoracic Chemo-Hyperthermia for pleural recurrence of thymoma. Lung Cancer 2017. [PMID: 28625619 DOI: 10.1016/j.lungcan.2017.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pleural recurrences are a hallmark of thymomas, and represent a challenge for multidisciplinary management. The purpose of this study was to assess the feasibility and the results in terms of morbidity, mortality and survival rates, of Intra-Thoracic Chemo-Hyperthermia (ITCH) for the treatment of pleural recurrences of thymomas. METHODS Retrospective analysis of 19 consecutives patients between 1997 and 2015 treated by surgical cytoreduction (pleurectomy) followed by ITCH with 25mg/m2 of mitomycin, and 50mg/m2 of Cisplatin. RESULTS There were 8 men and 11 women with a median age of 44 years. ITCH was combined with pleurectomy alone in 4 (22%) patients, pleurectomy and wedge resections in 14 (74%) patients; 1 (5%) patient had a pleuropneumonectomy. There were no perioperative deaths, and 5 patients (26%) presented with postoperative complication, including 3 (16%) cases related to chemotherapy (one case of reversible grade 2 bone marrow aplasia, and 2 cases of reversible, acute kidney failure). The median length of stay in intensive care unit and hospital were 1day and 10days, respectively. After a median follow-up period of 39 months (range 10-127 months), median disease-free survival was 42 months. Five patients (26%) died during follow-up. CONCLUSIONS Our data indicate that ITCH is a feasible option for selected patients with pleural recurrence of thymomas. ITCH clearly provides long local control, without major safety issues, and prolonged survival may be achieved in selected patients. This therapeutic option should be discussed at a multidisciplinary tumor board.
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Affiliation(s)
- Jean Michel Maury
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France; Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France
| | - Nicolas Girard
- Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France; Department of Respiratory Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France.
| | - Mayeul Tabutin
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France; Department of Surgery, Centre Léon-Berard, Cancer Research Center of Lyon 28, F-69008 Lyon, France
| | - Renaud Grima
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Lara Chalabreysse
- Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France; Department of Pathology, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Isabelle Pavlakovic
- Department of Anesthesiology and Reanimation, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Annie Sayag-Beaujard
- Department of Anesthesiology and Reanimation, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France
| | - Caroline Leroux
- Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France
| | - Pierre-Jean Souquet
- Department of Respiratory Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, F-69495 Pierre Benite, France
| | - Olivier Glehen
- Departement of General Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, F-69495 Pierre Benite, France
| | - François Tronc
- Department of Thoracic Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, F-69677 Lyon, France; Université de Lyon, Université Lyon 1, INRA, UMR754, UMS 3444, SFR BioSciences, F-69007 Lyon, France
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Fiteni F, Anota A, Bonnetain F, Oster JP, Pichon E, Wislez M, Dauba J, Debieuvre D, Souquet PJ, Bigay-Game L, Molinier O, Dansin E, Poudenx M, Milleron B, Morin F, Zalcman G, Quoix E, Westeel V. Health-related quality of life in elderly patients with advanced non-small cell lung cancer comparing carboplatin and weekly paclitaxel doublet chemotherapy with monotherapy. Eur Respir J 2016; 48:861-72. [DOI: 10.1183/13993003.01695-2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/26/2016] [Indexed: 11/12/2022]
Abstract
In the Intergroupe Francophone de Cancérologie Thoracique 0501 trial the carboplatin-paclitaxel chemotherapy increased toxicity (most frequent, decreased neutrophil count, asthenia). We longitudinally compared health-related quality of life (HRQoL) of the two treatment arms.In total, 451 patients aged 70–89 years with advanced non-small cell lung cancer (NSCLC) were randomly assigned to receive carboplatin plus paclitaxel or vinorelbine or gemcitabine. HRQoL was assessed by means of the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire at baseline, week 6 and week 18.Using a five-point decrease as the minimal clinically important difference, patients treated with the chemotherapy doublet exhibited a significant longer time until definitive deterioration (TUDD) for two HRQoL dimensions: physical functioning (median TUDD: 2.04 for the doublet versus 1.71 months for monotherapy; log-rank p=0.01) and nausea and vomiting (median: not reached versus 4.83, respectively; log-rank p=0.046). Cox multivariate analysis revealed the carboplatin and paclitaxel arm to be independently associated with longer TUDD for these two HRQoL dimensions. In addition, TUDD didn't significantly differ between the two arms for all the other HRQoL dimensions.The chemotherapy doublet did not reduce TUDD in elderly patients with advanced NSCLC. Moreover, TUDD was prolonged for two HRQoL dimensions, namely physical functioning and nausea and vomiting.
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Planchard D, Besse B, Groen HJM, Souquet PJ, Quoix E, Baik CS, Barlesi F, Kim TM, Mazieres J, Novello S, Rigas JR, Upalawanna A, D'Amelio AM, Zhang P, Mookerjee B, Johnson BE. Dabrafenib plus trametinib in patients with previously treated BRAF(V600E)-mutant metastatic non-small cell lung cancer: an open-label, multicentre phase 2 trial. Lancet Oncol 2016; 17:984-993. [PMID: 27283860 DOI: 10.1016/s1470-2045(16)30146-2] [Citation(s) in RCA: 570] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/06/2016] [Accepted: 05/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND BRAF mutations act as an oncogenic driver via the mitogen-activated protein kinase (MAPK) pathway in non-small cell lung cancer (NSCLC). BRAF inhibition has shown antitumour activity in patients with BRAF(V600E)-mutant NSCLC. Dual MAPK pathway inhibition with BRAF and MEK inhibitors in BRAF(V600E)-mutant NSCLC might improve efficacy over BRAF inhibitor monotherapy based on observations in BRAF(V600)-mutant melanoma. We aimed to assess the antitumour activity and safety of dabrafenib plus trametinib in patients with BRAF(V600E)-mutant NSCLC. METHODS In this phase 2, multicentre, non-randomised, open-label study, we enrolled adult patients (aged ≥18 years) with pretreated metastatic stage IV BRAF(V600E)-mutant NSCLC who had documented tumour progression after at least one previous platinum-based chemotherapy and had had no more than three previous systemic anticancer therapies. Patients with previous BRAF or MEK inhibitor treatment were ineligible. Patients with brain metastases were allowed to enrol only if the lesions were asymptomatic, untreated (or stable more than 3 weeks after local therapy if treated), and measured less than 1 cm. Enrolled patients received oral dabrafenib (150 mg twice daily) plus oral trametinib (2 mg once daily) in continuous 21-day cycles until disease progression, unacceptable adverse events, withdrawal of consent, or death. The primary endpoint was investigator-assessed overall response, which was assessed by intention to treat in the protocol-defined population (patients who received second-line or later treatment); safety was also assessed in this population and was assessed at least once every 3 weeks, with adverse events, laboratory values, and vital signs graded according to the Common Terminology Criteria for Adverse Events version 4.0. The study is ongoing but no longer recruiting patients. This trial is registered with ClinicalTrials.gov, number NCT01336634. FINDINGS Between Dec 20, 2013, and Jan 14, 2015, 59 patients from 30 centres in nine countries across North America, Europe, and Asia met eligibility criteria. Two patients who had previously been untreated due to protocol deviation were excluded; thus, 57 eligible patients were enrolled. 36 patients (63·2% [95% CI 49·3-75·6]) achieved an investigator-assessed overall response. Serious adverse events were reported in 32 (56%) of 57 patients and included pyrexia in nine (16%), anaemia in three (5%), confusional state in two (4%), decreased appetite in two (4%), haemoptysis in two (4%), hypercalcaemia in two (4%), nausea in two (4%), and cutaneous squamous cell carcinoma in two (4%). The most common grade 3-4 adverse events were neutropenia in five patients (9%), hyponatraemia in four (7%), and anaemia in three (5%). Four patients died during the study from fatal adverse events judged to be unrelated to treatment (one retroperitoneal haemorrhage, one subarachnoid haemorrhage, one respiratory distress, and one from disease progression that was more severe than typical progression, as assessed by the investigator). INTERPRETATION Dabrafenib plus trametinib could represent a new targeted therapy with robust antitumour activity and a manageable safety profile in patients with BRAF(V600E)-mutant NSCLC. FUNDING GlaxoSmithKline.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/genetics
- Adenocarcinoma/secondary
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/genetics
- Carcinoma, Large Cell/drug therapy
- Carcinoma, Large Cell/genetics
- Carcinoma, Large Cell/secondary
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/secondary
- Female
- Follow-Up Studies
- Humans
- Imidazoles/administration & dosage
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/pathology
- Lymphatic Metastasis
- Male
- Middle Aged
- Mutation/genetics
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/genetics
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Oximes/administration & dosage
- Prognosis
- Proto-Oncogene Proteins B-raf/genetics
- Pyridones/administration & dosage
- Pyrimidinones/administration & dosage
- Survival Rate
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Affiliation(s)
| | - Benjamin Besse
- Gustave Roussy, Villejuif, France; Paris-Sud University, Orsay, France
| | - Harry J M Groen
- University of Groningen, Groningen, Netherlands; University Medical Center Groningen, Groningen, the Netherlands
| | | | - Elisabeth Quoix
- University Hospital, Nouvel Hôpital Civil, Strasbourg, France
| | | | - Fabrice Barlesi
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology & Therapeutic Innovations Department, Hôpital Nord, Marseille, France
| | - Tae Min Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Julien Mazieres
- Rangueil-Larrey Hospital, Toulouse, France; Paul Sabatier University, Toulouse, France
| | - Silvia Novello
- Department of Oncology, University of Turin, Orbassano, Italy
| | - James R Rigas
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | | | - Pingkuan Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Planchard D, Kim TM, Mazieres J, Quoix E, Riely G, Barlesi F, Souquet PJ, Smit EF, Groen HJM, Kelly RJ, Cho BC, Socinski MA, Pandite L, Nase C, Ma B, D'Amelio A, Mookerjee B, Curtis CM, Johnson BE. Dabrafenib in patients with BRAF(V600E)-positive advanced non-small-cell lung cancer: a single-arm, multicentre, open-label, phase 2 trial. Lancet Oncol 2016; 17:642-50. [PMID: 27080216 DOI: 10.1016/s1470-2045(16)00077-2] [Citation(s) in RCA: 300] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/20/2016] [Accepted: 01/27/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Activating BRAF(V600E) (Val600Glu) mutations are found in about 1-2% of lung adenocarcinomas, which might provide an opportunity for targeted treatment in these patients. Dabrafenib is an oral selective inhibitor of BRAF kinase. We did a trial to assess the clinical activity of dabrafenib in patients with advanced non-small-cell lung cancer (NSCLC) positive for the BRAF(V600E) mutation. METHODS In this phase 2, multicentre, non-randomised, open-label study, we enrolled previously treated and untreated patients with stage IV metastatic BRAF(V600E)-positive NSCLC. Patients received oral dabrafenib 150 mg twice daily. The primary endpoint was investigator-assessed overall response, which was assessed in patients who had received at least one dose of dabrafenib; safety was also assessed in this population. The study is ongoing but not enrolling patients in this cohort. This trial is registered with ClinicalTrials.gov, number NCT01336634. FINDINGS Between Aug 3, 2011, and Feb 25, 2014, 84 patients were enrolled, six of whom had not previously received systemic treatment for NSCLC. 26 of the 78 previously treated patients achieved an investigator-assessed overall response (33% [95% CI 23-45]). Four of the six previously untreated patients had an objective response. One patient died from an intracranial haemorrhage that was judged by the investigator to be due to the study drug. Serious adverse events were reported in 35 (42%) of 84 patients. The most frequent grade 3 or worse adverse events were cutaneous squamous-cell carcinoma in ten (12%), asthenia in four (5%), and basal-cell carcinoma in four (5%). INTERPRETATION Dabrafenib showed clinical activity in BRAF(V600E)-positive NSCLC. Our findings suggest that dabrafenib could represent a treatment option for a population of patients with limited therapeutic options. FUNDING GlaxoSmithKline.
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Affiliation(s)
- David Planchard
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Julien Mazieres
- Thoracic Oncology Unit, Rangueil-Larrey Hospital, Toulouse, France; Paul Sabatier University, Toulouse, France
| | - Elisabeth Quoix
- Pneumology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Gregory Riely
- Department of Medicine, Thoracic Oncology Service, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Joan and Sanfor I Weill Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Fabrice Barlesi
- Multidisciplinary Oncology and Therapeutic Innovations Department, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Livon, Marseille, France
| | - Pierre-Jean Souquet
- Acute Respiratory Medicine and Thoracic Oncology Department, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Egbert F Smit
- Department of Pulmonary Diseases, Vrije Universiteit VU Medical Centre, Amsterdam, Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University of Groningen, Groningen, Netherlands; University Medical Center Groningen, Groningen, Netherlands
| | - Ronan J Kelly
- Upper Aerodigestive Malignancies Division, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - B C Cho
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Mark A Socinski
- Lung Cancer Section, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | | | | | | | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Carbonnaux M, Souquet PJ, Meert AP, Scherpereel A, Peters M, Couraud S. Inequalities in lung cancer: a world of EGFR. Eur Respir J 2016; 47:1502-9. [PMID: 27030679 DOI: 10.1183/13993003.01157-2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/25/2016] [Indexed: 11/05/2022]
Abstract
Epidermal growth factor receptor gene (EGFR) mutation status has emerged as a crucial issue in lung cancer management. Availability and cost of tests and tyrosine kinase inhibitors (TKIs) may vary as a function of country development.We conducted a prospective specialist opinion survey to map EGFR test and EGFR-TKI availability and detect associations with the Human Development Index (HDI). A questionnaire was sent to specialists in thoracic oncology in all United Nations Member States.We obtained responses from 74 countries, comprising 78% of the worldwide population. Nonresponding countries had significantly lower HDI rank than responding countries. EGFR mutation analysis was routinely available in 57 countries (70% of the worldwide population). The cost of the test was <US$500 in 49 countries (42.5% of the worldwide population). Test availability and cost were both significantly linked to HDI. Erlotinib, gefitinib, afatinib and icotinib were routinely available in 75%, 66%, 31% and 23% of the worldwide population, respectively, also associated with HDI.EGFR mutation testing and EGFR-TKIs are widely accessible in routine practice worldwide. However, there are large discrepancies in access to this innovative treatment path and in its cost for patients as a function of country development.
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Affiliation(s)
- Mélodie Carbonnaux
- Dept of Respiratory Medicine and Thoracic Oncology, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France
| | - Pierre-Jean Souquet
- Dept of Respiratory Medicine and Thoracic Oncology, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France EMR3738 Therapeutic Targeting in Oncology, Faculty of Medicine Lyon-Sud Charles Mérieux, Lyon 1 University, Lyon, France
| | - Anne-Pascale Meert
- Head of the European Respiratory Society Thoracic Oncology Assembly, Dept of Intensive Care and Oncological Emergencies and Thoracic Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Arnaud Scherpereel
- Secretary of the European Respiratory Society Thoracic Oncology Assembly, Pulmonology and Thoracic Oncology Dept, Lille University Hospital, Lille, France
| | - Matthew Peters
- Representative of the Thoracic Society of Australia and New Zealand, Dept of Thoracic Medicine, Concord Repatriation General Hospital, Sydney, Australia
| | - Sébastien Couraud
- Dept of Respiratory Medicine and Thoracic Oncology, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France EMR3738 Therapeutic Targeting in Oncology, Faculty of Medicine Lyon-Sud Charles Mérieux, Lyon 1 University, Lyon, France
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45
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Deplanque G, Gervais R, Vergnenegre A, Falchero L, Souquet PJ, Chavaillon JM, Taviot B, Fraboulet G, Saal H, Robert C, Chosidow O. Doxycycline for prevention of erlotinib-induced rash in patients with non-small-cell lung cancer (NSCLC) after failure of first-line chemotherapy: A randomized, open-label trial. J Am Acad Dermatol 2016; 74:1077-85. [PMID: 26946985 DOI: 10.1016/j.jaad.2016.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/11/2015] [Accepted: 01/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rash is a common epidermal growth factor receptor inhibitor-induced toxicity that can impair quality of life and treatment compliance. OBJECTIVE We sought to evaluate the efficacy of doxycycline in preventing erlotinib-induced rash (folliculitis) in patients with non-small-cell lung cancer. METHODS This open-label, randomized, prospective, phase II trial was conducted in 147 patients with locally advanced or metastatic non-small-cell lung cancer progressing after first-line chemotherapy, randomized for 4 months with erlotinib alone 150 mg/d per os (control arm) or combined with doxycycline 100 mg/d (doxycycline arm). Incidence and severity of rash, compliance, survival, and safety were assessed. RESULTS Baseline characteristics of the 147 patients were well balanced in the intent-to-treat population. Folliculitis occurred in 71% of patients in the doxycycline arm and 81% in the control arm (P = .175). The severity of folliculitis and other skin lesions was lower in the doxycycline arm compared with the control arm. Other adverse events were reported at a similar frequency across arms. There was no significant difference in survival between treatment arms. LIMITATIONS The open-label design of the study and the duration of the treatment with doxycycline are limitations. CONCLUSION Doxycycline did not reduce the incidence of erlotinib-induced folliculitis, but significantly reduced its severity.
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Affiliation(s)
| | - Radj Gervais
- Centre Régional de Lutte Contre le Cancer Baclesse, Caen, France
| | | | - Lionel Falchero
- Centre Hospitalier de Villefranche, Villefranche sur Saône, France
| | | | | | - Bruno Taviot
- Centre Médical N. De Pontoux, Chalon Sur Saône, France
| | | | - Hakim Saal
- Laboratoires Roche, Boulogne-Billancourt, France
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Bouledrak K, Walter T, Souquet PJ, Lombard-Bohas C. [Metastatic bronchial carcinoid tumors]. Rev Pneumol Clin 2016; 72:41-48. [PMID: 26831129 DOI: 10.1016/j.pneumo.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/27/2015] [Accepted: 12/29/2015] [Indexed: 06/05/2023]
Abstract
Bronchial carcinoids are uncommon pulmonary neoplasms and represent 1 to 2 % of all lung tumors. In early stage of disease, the mainstay and only curative treatment is surgery. Bronchial carcinoids are generally regarded as low-grade carcinomas and metastatic dissemination is unusual. The management of the metastatic stage is not currently standardized due to a lack of relevant studies. As bronchial carcinoids and in particular their metastatic forms are rare, we apply treatment strategies that have been evaluated in gastrointestinal and pancreatic neuroendocrine tumors. However, bronchial carcinoids have their own characteristic. A specific therapeutic feature of these metastatic tumors is that they require a dual approach: both anti-secretory for the carcinoid syndrome, and anti-tumoral.
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Affiliation(s)
- K Bouledrak
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Lyon 1, 69100 Villeurbanne, France.
| | - T Walter
- Université Lyon 1, 69100 Villeurbanne, France; Fédération des spécialités digestives, hôpital Édouard-Herriot, hospices civils de Lyon, 69003 Lyon, France; Inserm, UMR 1052 CNRS UMR 5286, 69008 Lyon cedex, France
| | - P J Souquet
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université Lyon 1, 69100 Villeurbanne, France
| | - C Lombard-Bohas
- Université Lyon 1, 69100 Villeurbanne, France; Fédération des spécialités digestives, hôpital Édouard-Herriot, hospices civils de Lyon, 69003 Lyon, France; Inserm, UMR 1052 CNRS UMR 5286, 69008 Lyon cedex, France
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47
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Avrillon V, Locatelli-Sanchez M, Folliet L, Carbonnaux M, Perino E, Fossard G, Desseigne M, Freymond N, Geriniere L, Perrot E, Souquet PJ, Couraud S. Lung cancer may increase serum procalcitonin level. Infect Disord Drug Targets 2016; 15:57-63. [PMID: 25809625 DOI: 10.2174/1871526515666150320162950] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/12/2014] [Accepted: 03/12/2015] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Serum procalcitonin (PCT) is a biomarker used routinely to diagnose infections. Some malignancies are usual false positives for PCT. However, its value and behavior in the setting of lung cancers are poorly known. The objective of this study was to assess PCT positivity in a lung cancer cases series. METHOD Between November 2011 and September 2012, all cases of newly diagnosed lung cancer with a pre-antineoplastic PCT assay and no patent signs of infection were included in the study. All PCT levels were assessed by immunofluorescent assay in a single laboratory. RESULTS Eighty-nine patients were included (70.8% male; mean age 62; small-cell cancer 20.2%; stage IV cancer 60.7%). Overall, PCT was positive in 42%. A neuroendocrine component, having 2 or more metastatic sites, having a pleura or a liver metastasis, and being positive for CRP were all significantly associated with positive PCT in univariate analysis. In multivariate analysis, only the presence of a neuroendocrine component remained strongly associated with a positive PCT (AOR=7.24 [CI=95% 1.91-27.51]; P=0.004). Finally, baseline PCT levels <0.5 µg/l were found in 43% of NSCLC with a neuroendocrine component, vs. 9% of cancers with other histology (P=0.0001). CONCLUSION Lung cancer may cause false positives for procalcitonin, particularly in cases of neuroendocrine cancers or in the presence of multiple metastases. These results should be taken into account for PCT-based decisional algorithms.
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Grard S, Catho G, Valour F, Bouaziz A, Perpoint T, Braun E, Biron F, Miailhes P, Ferry T, Chidiac C, Souquet PJ, Couraud S, Lina G, Goutelle S, Veziris N, Dumitrescu O, Ader F. Linezolid in the Starter Combination for Multidrug-Resistant Tuberculosis: Time to Move on to Group Four? Open Forum Infect Dis 2015; 2:ofv175. [PMID: 26719846 PMCID: PMC4690547 DOI: 10.1093/ofid/ofv175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/06/2015] [Indexed: 11/15/2022] Open
Abstract
Linezolid (LNZ), a group 5 antituberculous drug (unclear efficacy), was used in the starter regimens of 23 adults with multidrug-resistant tuberculosis. The LNZ-containing regimens were effective in achieving culture conversions and relapse-free outcomes. The most frequent LNZ-related side effect was neuropathy. We propose that LNZ should be reclassified among bactericidal second-line drugs.
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Affiliation(s)
| | - Gaud Catho
- Service de Pneumologie et Allergologie Pédiatriques , Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon , Bron ; Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Florent Valour
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1111 Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon I
| | - Anissa Bouaziz
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Evelyne Braun
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - François Biron
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Patrick Miailhes
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1111 Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon I
| | - Christian Chidiac
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon
| | | | | | - Gérard Lina
- Laboratoire de Microbiologie , Centre Hospitalier Lyon Sud, Hospices Civils de Lyon , Pierre Bénite ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1111 Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon I
| | - Sylvain Goutelle
- Unité Mixte de Recherche Centre National de la Recherche Scientifique 5558, Laboratoire de Biométrie et Biologie Évolutive , Villeurbanne
| | - Nicolas Veziris
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Sorbonne Universités, Unité de Phytopharmacie et Médiateurs Chimiques University Paris 06, CR7, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, Team 13 (Bacteriology) , France
| | - Oana Dumitrescu
- Laboratoire de Microbiologie , Centre Hospitalier Lyon Sud, Hospices Civils de Lyon , Pierre Bénite ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1111 Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon I
| | - Florence Ader
- Service de Maladies Infectieuses et Tropicales , Hôpital de la Croix-Rousse, Hospices Civils de Lyon ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1111 Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon I
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Tissot C, Toffart AC, Villar S, Souquet PJ, Merle P, Moro-Sibilot D, Pérol M, Zavadil J, Brambilla C, Olivier M, Couraud S. Circulating free DNA concentration is an independent prognostic biomarker in lung cancer. Eur Respir J 2015; 46:1773-80. [PMID: 26493785 DOI: 10.1183/13993003.00676-2015] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/05/2015] [Indexed: 12/25/2022]
Abstract
Plasma circulating cell-free (cf)DNA is of interest in oncology because it has been shown to contain tumour DNA and may thus be used as liquid biopsy. In nonsmall cell lung cancer (NSCLC), cfDNA quantification has been proposed for the monitoring and follow-up of patients. However, available studies are limited and need to be confirmed by studies with larger sample sizes and including patients who receive more homogenous treatments. Our objective was to assess the predictive and prognostic value of plasma cfDNA concentration in a large series of patients with NSCLC and treated with a standard chemotherapy regimen.We included samples from lung cancer patients recruited into the Pharmacogenoscan study. The cfDNA of 218 patients was extracted and quantified by fluorometry before and after two or three cycles of platinum-based chemotherapy. The association between baseline and post-chemotherapy concentrations and treatment response, assessed by RECIST (response evaluation criteria in solid tumours) or patient survival was analysed.Patients with high cfDNA concentrations (highest tertile) at baseline had a significantly worse disease-free and overall survival than those with lower concentrations (lowest and middle tertiles) (median overall survival 10 months (95% CI 10.7-13.9) versus 14.2 months (95% CI 12.6-15.8), respectively; p=0.001). In multivariate analysis, increased baseline concentration of cfDNA was an independent prognostic factor. However, we did not find any association between cfDNA concentration and response to treatment.cfDNA may be a biomarker for the assessment of prognosis in NSCLC. However, total concentration of cfDNA does not appear to predict chemotherapy response.
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MESH Headings
- Adenocarcinoma/blood
- Adenocarcinoma/drug therapy
- Adenocarcinoma/pathology
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers/blood
- Biomarkers, Tumor/blood
- Carcinoma, Large Cell/blood
- Carcinoma, Large Cell/drug therapy
- Carcinoma, Large Cell/pathology
- Carcinoma, Non-Small-Cell Lung/blood
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Squamous Cell/blood
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/pathology
- DNA/blood
- DNA, Neoplasm/blood
- Female
- Fluorometry
- Humans
- Lung Neoplasms/blood
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
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Affiliation(s)
- Claire Tissot
- Department of Acute Respiratory Medicine and Thoracic Oncology Department, Lyon Sud Hospital and Lyon University Cancer Institute, Lyon University Hospital, Pierre Bénite, France International Agency for Research on Cancer, Molecular Mechanisms and Biomarkers Group, Lyon, France
| | - Anne-Claire Toffart
- Université Grenoble 1, INSERM, U 823, Institut A Bonniot, Université J Fourier, La Tronche, France Thoracic Oncology Unit, Teaching Hospital A Michallon, Grenoble, France
| | - Stéphanie Villar
- International Agency for Research on Cancer, Molecular Mechanisms and Biomarkers Group, Lyon, France
| | - Pierre-Jean Souquet
- Department of Acute Respiratory Medicine and Thoracic Oncology Department, Lyon Sud Hospital and Lyon University Cancer Institute, Lyon University Hospital, Pierre Bénite, France
| | - Patrick Merle
- Thoracic Oncology Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Denis Moro-Sibilot
- Université Grenoble 1, INSERM, U 823, Institut A Bonniot, Université J Fourier, La Tronche, France Thoracic Oncology Unit, Teaching Hospital A Michallon, Grenoble, France
| | - Maurice Pérol
- Thoracic Oncology Unit, Lyon Cancer Centre Léon Bérard, Lyon, France
| | - Jiri Zavadil
- International Agency for Research on Cancer, Molecular Mechanisms and Biomarkers Group, Lyon, France
| | - Christian Brambilla
- Université Grenoble 1, INSERM, U 823, Institut A Bonniot, Université J Fourier, La Tronche, France Thoracic Oncology Unit, Teaching Hospital A Michallon, Grenoble, France
| | - Magali Olivier
- International Agency for Research on Cancer, Molecular Mechanisms and Biomarkers Group, Lyon, France
| | - Sébastien Couraud
- Department of Acute Respiratory Medicine and Thoracic Oncology Department, Lyon Sud Hospital and Lyon University Cancer Institute, Lyon University Hospital, Pierre Bénite, France EMR 3738 "Therapeutic Targeting in Oncology", Lyon Sud - Charles Mérieux Faculty of Medicine, Lyon 1 University, Oullins, France
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Tissot C, Couraud S, Tanguy R, Bringuier PP, Girard N, Souquet PJ. Clinical characteristics and outcome of patients with lung cancer harboring BRAF mutations. Lung Cancer 2015; 91:23-8. [PMID: 26711930 DOI: 10.1016/j.lungcan.2015.11.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 09/11/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION BRAF (v-Raf murine sarcoma viral oncogene homolog B) mutations are identified in approximately 2% of non-small cell lung cancer (NSCLC). Because of the rarity of those mutations, associated clinical features and prognostic significance have not been thoroughly described so far. METHODS Here we took advantage of the French National Cancer Institute Program of systematic molecular profiling of metastatic lung cancer, to collect clinical characteristics and analyze the outcome of consecutive patients with NSCLC harboring BRAF mutations at the Lyon University Hospital laboratory between February 2012 and October 2014. Especially, we compared those variables with that of patients with EGFR-, BRAF-, KRAS-, HER2-, PIK3CA- wild-type NSCLCs. RESULTS Among 2690 patients with genotyped NSCLC during the study period, BRAF mutations were identified in 80 (3%) cases, consisting of V600E substitution in 42 (53%) cases; non-V600E mutation were observed in 38 (48%) cases. Concurrent mutations were not observed in case of BRAF V600 mutation, and were identified in 5 patients with BRAF non-V600E mutations, in all cases consisting of KRAS mutations. Non-V600E mutations were more likely to be observed in smokers, as compared V600E mutations. There was no significant difference in age, histologic type, performance status, and stage at diagnosis between cases of V600E and non-V600E mutations. Overall survival did not significantly differ in BRAF wild-type, V600E, and non-V600E patients. CONCLUSION This one of the largest series of patients with BRAF mutant NSCLC. Our clinical data suggest that BRAF mutations define specific subsets of patients with NSCLC; while their oncogenic nature is yet to be established in lung cancer, especially for non-V600E mutations, the value of BRAF mutations to predict the efficacy of targeted agents remains unclear.
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Affiliation(s)
- Claire Tissot
- Acute Respiratory Medicine and Thoracic Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre Bénite, France
| | - Sébastien Couraud
- Acute Respiratory Medicine and Thoracic Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre Bénite, France; EMR 3738 Therapeutic Targeting in Oncology, Lyon sud-Charles Mérieux Faculty of Medicine, Lyon 1 University, 69600 Oullins, France
| | - Ronan Tanguy
- Radiotherapy Unit, Lyon Cancer Center Léon Bérard, 69008, Lyon, France
| | - Pierre-Paul Bringuier
- Molecular Diagnostics Laboratory, Hôpital Édouard-Herriot, 69437 Lyon cedex 03, France
| | - Nicolas Girard
- Respiratory Medicine and Thoracic Oncology Service, Hôpital Louis Pradel, Hospices Civils de Lyon, 69677 Lyon cedex, France
| | - Pierre-Jean Souquet
- Acute Respiratory Medicine and Thoracic Oncology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre Bénite, France.
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