Improved Survival Outcomes in Patients With MET-Dysregulated Advanced NSCLC Treated With MET Inhibitors: Results of a Multinational Retrospective Chart Review

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.

Structural and functional vascular dysfunction within brain metastases is linked to pembrolizumab inefficacy

Structurally and functionally aberrant vasculature is a hallmark of tumor angiogenesis and treatment resistance. Given the synergistic link between aberrant tumor vasculature and immunosuppression, we analyzed perfusion MRI for 44 patients with brain metastases (BM) undergoing treatment with pembrolizumab. To date, vascular-immune communication, or the relationship between immune checkpoint inhibitor (ICI) efficacy and vascular architecture, has not been well-characterized in human imaging studies. We found that ICI-responsive BM possessed a structurally balanced vascular makeup, which was linked to improved vascular efficiency and an immune-stimulatory microenvironment. In contrast, ICI-resistant BM were characterized by a lack of immune cell infiltration and a highly aberrant vasculature dominated by large-caliber vessels. Peri-tumor region analysis revealed early functional changes predictive of ICI resistance before radiographic evidence on conventional MRI. This study was one of the largest functional imaging studies for BM and establishes a foundation for functional studies that illuminate the mechanisms linking patterns of vascular architecture with immunosuppression, as targeting these aspects of cancer biology may serve as the basis for future combination treatments.

Safety and clinical activity of atezolizumab plus erlotinib in patients with non-small-cell lung cancer

BACKGROUND

Acquired resistance limits long-term epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) efficacy in patients with EGFR mutation-positive non-small-cell lung cancer (NSCLC) in whom anti-programmed death-ligand 1 (PD-L1) efficacy is also limited. We hypothesized that combining atezolizumab with erlotinib could enhance antitumor immunity and extend efficacy in these patients.

PATIENTS AND METHODS

This open-label phase Ib trial was conducted in adults aged ≥18 years who had advanced, unresectable NSCLC. Stage 1 (safety evaluation) enrolled EGFR TKI-naive patients regardless of EGFR status. Stage 2 (expansion) enrolled patients with EGFR-mutant NSCLC treated with ≤1 prior non-EGFR TKI therapy. Patients received 150 mg erlotinib orally once daily. After a 7-day erlotinib run-in, atezolizumab 1200 mg was administered intravenously every 3 weeks. The primary endpoint was the safety and tolerability of the combination in all patients; secondary endpoints included antitumor activity per RECIST 1.1 in stage 2 patients.

RESULTS

At the data cut-off on 7 May 2020, 28 patients (8 in stage 1, 20 in stage 2) were assessable for safety. No dose-limiting toxicities or grade 4 or 5 treatment-related adverse events occurred. Grade 3 treatment-related adverse events occurred in 46% of patients; the most common were increased alanine aminotransferase, diarrhea, pyrexia, and rash (each in 7% of patients). Serious adverse events occurred in 50% of patients. Pneumonitis (grade 1) was reported in a single patient (4%). The objective response rate was 75% [95% confidence interval (CI) 50.9% to 91.3%]), median response duration was 18.9 months (95% CI 9.5-40.5 months), median progression-free survival was 15.4 months (95% CI 8.4-39.0 months), and median overall survival was not estimable (NE) (95% CI 34.6-NE).

CONCLUSIONS

Atezolizumab combined with erlotinib demonstrated a tolerable safety profile and encouraging, durable clinical activity in patients with advanced EGFR mutation-positive NSCLC.

Phase Ib Study of Telisotuzumab Vedotin in Combination With Erlotinib in Patients With c-Met Protein-Expressing Non-Small-Cell Lung Cancer

PURPOSE

Overexpression of c-Met protein and epidermal growth factor receptor (EGFR) mutations can co-occur in non-small-cell lung cancer (NSCLC), providing strong rationale for dual targeting. Telisotuzumab vedotin (Teliso-V), a first-in-class antibody-drug conjugate targeting c-Met, has shown a tolerable safety profile and antitumor activity as monotherapy. Herein, we report the results of a phase Ib study (ClinicalTrials.gov identifier: NCT02099058) evaluating Teliso-V plus erlotinib, an EGFR tyrosine kinase inhibitor (TKI), in patients with c-Met-positive (+) NSCLC.

PATIENTS AND METHODS

This study evaluated Teliso-V (2.7 mg/kg once every 21 days) plus erlotinib (150 mg once daily) in adult patients (age ≥ 18 years) with c-Met+ NSCLC. Later enrollment required presence of an EGFR-activating mutation (EGFR-M+) and progression on a prior EGFR TKI. End points included safety, pharmacokinetics, objective response rate (ORR), and progression-free survival (PFS). The efficacy-evaluable population consisted of c-Met+ patients (confirmed histology [H]-score ≥ 150) who had at least one postbaseline scan; c-Met+ patients with H-scores ≥ 225 were classified as c-Met high.

RESULTS

As of January 2020, 42 patients were enrolled (N = 36 efficacy-evaluable). Neuropathies were the most common any-grade adverse events reported, with 24 of 42 patients (57%) experiencing at least one event. The pharmacokinetic profile of Teliso-V plus erlotinib was similar to Teliso-V monotherapy. Median PFS for all efficacy-evaluable patients was 5.9 months (95% CI, 2.8 to not reached). ORR for EGFR-M+ patients (n = 28) was 32.1%. Of EGFR-M+ patients, those who were c-Met high (n = 15) had an ORR of 52.6%. Median PFS was 6.8 months for non-T790M+ and for those whose T790M status was unknown, versus 3.7 months for T790M+.

CONCLUSION

Teliso-V plus erlotinib showed encouraging antitumor activity and acceptable toxicity in EGFR TKI-pretreated patients with EGFR-M+, c-Met+ NSCLC.

A Phase 1b Study of Telisotuzumab Vedotin in Combination With Nivolumab in Patients With NSCLC

Introduction

Telisotuzumab vedotin (Teliso-V) is an anti-c-Met-directed antibody-drug conjugate that has exhibited antitumor activity as monotherapy in NSCLC. Its potential activity combined with programmed cell death protein-1 inhibitors has not been previously evaluated.

Methods

In a phase 1b study (NCT02099058), adult patients (≥18 y) with advanced NSCLC received combination therapy with Teliso-V (1.6, 1.9, or 2.2 mg/kg, every 2 wk) plus nivolumab (3 mg/kg, 240 mg, or per locally approved label). The primary objective was to assess safety and tolerability; secondary objectives included the evaluation of antitumor activity.

Results

As of January 2020, a total of 37 patients received treatment with Teliso-V (safety population) in combination with nivolumab; 27 patients (efficacy population) were c-Met immunohistochemistry-positive. Programmed death-ligand 1 (PD-L1) status was evaluated in the efficacy population (PD-L1-positive [PD-L1+]: n = 15; PD-L1-negative [PD-L1-]: n = 9; PD-L1-unknown: n = 3). The median age was 67 years and 74% (20 of 27) of patients were naive to immune checkpoint inhibitors. The most common any-grade treatment-related adverse events were fatigue (27%) and peripheral sensory neuropathy (19%). The pharmacokinetic profile of Teliso-V plus nivolumab was similar to Teliso-V monotherapy. The objective response rate was 7.4%, with two patients (PD-L1+, c-Met immunohistochemistry H-score 190, n = 1; PD-L1-, c-Met H-score 290, n = 1) having a confirmed partial response. Overall median progression-free survival was 7.2 months (PD-L1+: 7.2 mo; PD-L1-: 4.5 mo; PD-L1-unknown: not reached).

Conclusions

Combination therapy with Teliso-V plus nivolumab was well tolerated in patients with c-Met+ NSCLC with limited antitumor activity.

Abstract P225: Preliminary interim data of elzovantinib (TPX-0022), a novel inhibitor of MET/SRC/CSF1R, in patients with advanced solid tumors harboring genetic alterations in MET: Update from the Phase 1 SHIELD-1 trial

Background: Elzovantinib is a novel, type I tyrosine kinase inhibitor (TKI) that targets MET, SRC, and CSF1R. Genetic alterations in MET, including exon 14 skipping (Δex14), amplifications, fusions, and mutations occur in many tumor types. SRC is a key downstream MET effector while CSF1R modulates tumor associated macrophages. Inhibition of SRC and CSF1R can potentially improve the durability of response compared to inhibition of MET alone. Currently there are no approved targeted therapies after progression on a MET TKI. The Phase 1 SHIELD-1 trial (NCT03993873) is evaluating the safety, pharmacokinetics (PK), and preliminary activity of elzovantinib in patients with advanced solid tumors harboring genetic MET alterations. A previous interim analysis included 15 efficacy evaluable patients. Among 10 MET TKI-naïve patients, 5 had achieved PRs (3 confirmed), including 3 gastric/GE junction, 1 CRC, and 1 NSCLC. Of the 5 MET TKI-pretreated NSCLC patients, 3 had stable disease (Hong et al. EORTC-NCI-AACR 2020, Abstract nr LBA-01). Here we report updated data from the SHIELD-1 trial. Patients and methods: Adults with advanced solid tumors harboring genetic MET alterations were enrolled using a 3+3 dose-escalation design. Expansion was allowed at doses where clinical activity was observed. Elzovantinib was given orally in continuous 28-day cycles. Results: As of 13 May 2021, 52 patients have been enrolled across 7 dose levels, including 30 NSCLC patients (20 Δex14, 8 amplifications, 2 mutations), 9 gastric cancer patients (8 amplifications, 1 fusion), and 13 patients who had other cancers with MET alterations. Median age was 63 (33-84) years. Median number of prior therapies was 2 (range 0-6). 34 of 52 patients (65%: 13 NSCLC; 9 gastric; 12 others) had not received a prior MET TKI and 18 (35%: 17 NSCLC; 1 liver) had a prior MET TKI. The most common adverse events (AEs) were dizziness (65%), lipase increase (33%), anemia (29%), constipation (29%), and fatigue (29%). Most AEs were Grade 1 or 2 with 94% of dizziness AEs being Grade 1 or 2. No events of interstitial lung disease/pneumonitis, Grade 3/4 edema, or treatment-related Grade 3/4 ALT/AST elevation were reported. Two dose-limiting toxicities (Grade 2 dizziness; Grade 3 vertigo) occurred at the highest tested dose of 120 mg QD. Systemic exposure increased in a dose-dependent manner. The steady state trough concentrations were consistently above the IC95 for inhibition of MET phosphorylation across all cohorts with a terminal half-life of 13-17 hours. Evaluation of the recommended Phase 2 dose (RP2D) is ongoing and further efficacy analysis will be available for presentation. Conclusions: Elzovantinib is a novel MET/SRC/CSF1R inhibitor with a favorable PK profile. Elzovantinib was generally well tolerated with primarily low-grade dizziness, and no high-grade edema reported. The RP2D is currently under evaluation and updated safety and efficacy data will be available for presentation. A global multi-cohort Phase 2 trial of patients with MET-altered tumors is planned.

Citation Format: David S. Hong, Daniel Catenacci, Lyudmila Bazhenova, Byoung Chul Cho, Mariano Ponz-Sarvise, Rebecca Heist, Victor Moreno, Gerald Falchook, Viola W. Zhu, Aurélie Swalduz, Benjamin Besse, Dong-Wan Kim, Shinkyo Yoon, Xiuning Le, Tingting Zhao, Alysha Kadva, Zachary Zimmerman, Jeeyun Lee. Preliminary interim data of elzovantinib (TPX-0022), a novel inhibitor of MET/SRC/CSF1R, in patients with advanced solid tumors harboring genetic alterations in MET: Update from the Phase 1 SHIELD-1 trial [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2021 Oct 7-10. Philadelphia (PA): AACR; Mol Cancer Ther 2021;20(12 Suppl):Abstract nr P225.

Abstract CT061: Binimetinib in patients with tumors with NRAS mutations: NCI-MATCH ECOG-ACRIN Cancer Research Group subprotocol EAY131-Z1A

Background: NRAS-mutations are established oncologic drivers in many malignancies with no effective targeted therapy options. Preclinical and clinical data have suggested that downstream inhibition with a MEK inhibitor, such as binimetinib, might be efficacious for NRAS-mutated cancers. Methods: Patients who enrolled in the multicenter NCI-MATCH trial master protocol underwent tumor biopsy and molecular profiling by targeted next generation sequencing with a custom Oncomine AmpliSeq™ panel. Patients with refractory solid tumors harboring codon 12, 13, or 61 NRAS-mutations were enrolled in subprotocol Z1A, a single arm study of binimetinib 45 mg twice daily. Patients with melanoma were excluded. The primary endpoint was objective response rate (ORR). Secondary endpoints included progression-free survival (PFS) and overall survival (OS). A post-hoc analysis examined association of NRAS-mutation allele with outcome and histology. Results: 47 eligible patients with refractory solid tumors harboring codon 12, 13, or 61 NRAS-mutations were treated on this trial. The most common cancer types enrolled on this subprotocol were colorectal adenocarcinoma (24/47, 51%), cholangiocarcinoma (7/47, 15%), low-grade papillary serous carcinoma of the ovary (3/47, 6%), and endometrioid endometrial adenocarcinoma patients (3/47, 6%). Observed toxicity was moderate, similar to previous reports, and 27.7% (13 of 47) of eligible patients discontinued binimetinib because of adverse events. The ORR was 2.1% (1 of 47 patients), and the median PFS was 3.5 months. The sole confirmed partial response (PR) was observed in a codon 61 NRAS-mutated indolent malignant ameloblastoma. One patient with a colorectal cancer harboring a NRAS codon 61 mutation had an unconfirmed PR, and two others with NRAS codon 61 mutated colorectal cancer had stable disease for at least 12 months. In a post-hoc analysis, patients with cancers bearing a codon 61 NRAS-mutation (n=22) had a significantly longer OS (p=0.04) and PFS (p=0.006) than those with tumors harboring codon 12 or 13 NRAS-mutations (n=25). Similarly, colorectal cancer patients with NRAS codon 61 mutations treated with binimetinib (n=8) had a significantly longer OS (p=0.03) and PFS (p=0.007) than those with NRAS codon 12 or 13 mutated (n=16) tumors. Conclusions: Single-agent binimetinib did not demonstrate promising efficacy in NRAS-mutated solid tumors. Further studies are needed to clarify whether the increased OS and PFS observed in codon 61 NRAS-mutated cancers reflects a more favorable prognosis for this subtype.

Citation Format: James M. Cleary, Victoria Wang, Rebecca Heist, Scott Kopetz, Edith P. Mitchell, James Zwiebel, Helen X. Chen, Shuli Li, Robert Gray, Lisa McShane, Larry Rubinstein, David Patton, Funda Meric-Bernstam, Melissa Dillmon, Mickey Williams, Stanley Hamilton, Barbara Conley, Peter O'Dwyer, Lyndsay Harris, Carlos Arteaga, Alice Chen, Keith Flaherty. Binimetinib in patients with tumors with NRAS mutations: NCI-MATCH ECOG-ACRIN Cancer Research Group subprotocol EAY131-Z1A [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 CT061.

A phase 2 clinical trial of the heat shock protein 90 (HSP 90) inhibitor ganetespib in patients with refractory advanced esophagogastric cancer

Subsets of esophagogastric (EG) cancers harbor genetic abnormalities, including amplification of HER2, MET, or FGFR2 or mutations in PIK3CA, EGFR, or BRAF. Ganetespib which is a novel triazolone heterocyclic inhibitor of HSP90, is a potentially biologically rational treatment strategy for advanced EG cancers with these gene amplification. This multicenter, single-arm phase 2 trial enrolled patients with histologically confirmed advanced EG cancer with progression on at least one line of systemic therapy. Patients received Ganetespib 200 mg/m2 IV on Days 1, 8, and 15 of a 28-day cycle. The primary endpoint was overall response rate (ORR). Secondary endpoints included: Progression Free Survival (PFS); to correlate the presence of HSP clients with ORR and PFS; evaluating the safety, tolerability and adverse events profile. In this study 26 eligible patients mainly: male 77%, median age 64 years were enrolled. The most common drug-related adverse events were diarrhea (77%), fatigue (65%), elevated ALKP (42%), and elevated AST (38%). The most common grade 3/4 AEs included: leucopenia (12%), fatigue (12%), diarrhea (8%), and elevated ALKP (8%). The ORR of 4% reflects the single patient of 26 who had a complete response and stayed on treatment for more than seventy (70) months. Median PFS and OS was 61 days (2.0 months), 94 days (3.1 months) respectively. Ganetespib showed manageable toxicity. While the study was terminated early due to insufficient evidence of single-agent activity, the durable CR and 2 minor responses suggest that there may be a subset of EG patients who could benefit from this drug.

Five-Year Follow-Up of Nivolumab in Previously Treated Advanced Non–Small-Cell Lung Cancer: Results From the CA209-003 Study

Purpose

In two phase III studies, nivolumab, a programmed death-1 (PD-1) inhibitor antibody, improved overall survival (OS) versus docetaxel in pretreated advanced non–small-cell lung cancer (NSCLC). We report 5-year follow-up results from an early phase I study of nivolumab in this patient population and describe characteristics of 5-year survivors.

Patients and Methods

Patients with pretreated, advanced NSCLC received nivolumab 1, 3, or 10 mg/kg every 2 weeks in 8-week cycles for up to 96 weeks. OS from the time of first dose was estimated by the Kaplan-Meier method.

Results

The estimated 5-year OS rate was 16% for all treated patients (N = 129); 5-year OS rates were similar for squamous (16%) and nonsquamous (15%) NSCLC. Of 16 5-year survivors, most (88%) were known current or former smokers. Of 10 5-year survivors with quantifiable PD-1 ligand 1 expression, 70% had ≥ 1% PD-1 ligand 1 expression at baseline. Twelve 5-year survivors (75%) achieved a partial response to nivolumab per Response Evaluation Criteria in Solid Tumors, version 1.0, and two each (12%) had stable disease and progressive disease as best response. Nine 5-year survivors (56%) completed the maximum 96 weeks of nivolumab; four (25%) discontinued owing to adverse events and three (19%) owing to disease progression. As of a November 2016 database lock, 12 5-year survivors (75%) received no subsequent therapy and were without evidence of progressive disease at last follow-up.

Conclusions

Nivolumab treatment resulted in long-term OS and durable responses in a proportion of patients with pretreated advanced NSCLC. Long-term survivors had diverse baseline and on-treatment characteristics.

Molecularly targeted therapies in non-small-cell lung cancer annual update 2014

There have been significant advances in the understanding of the biology and treatment of non-small-cell lung cancer (NSCLC) during the past few years. A number of molecularly targeted agents are in the clinic or in development for patients with advanced NSCLC. We are beginning to understand the mechanisms of acquired resistance after exposure to tyrosine kinase inhibitors in patients with oncogene addicted NSCLC. The advent of next-generation sequencing has enabled to study comprehensively genomic alterations in lung cancer. Finally, early results from immune checkpoint inhibitors are very encouraging. This review summarizes recent advances in the area of cancer genomics, targeted therapies, and immunotherapy.

Adjuvant therapy for a 3.9-cm adenocarcinoma of the lung

After routine staging tests, including a FDG-PET scan and MRI of the brain, a 59-year-old mother of four, never smoker, undergoes uncomplicated right lower lobectomy of the lung to remove a 3.9 cm adenocarcinoma with visceral pleural invasion (pIB,T2N0M0). Should she receive adjuvant chemotherapy? If so, what drug, dose, and schedule?

Genome-wide association study of prognosis in advanced non-small cell lung cancer patients receiving platinum-based chemotherapy

PURPOSE

Genetic variation may influence chemotherapy response and overall survival in cancer patients.

EXPERIMENTAL DESIGN

We conducted a genome-wide scan in 535 advanced-stage non-small cell lung cancer (NSCLC) patients from two independent cohorts (307 from Nanjing and 228 from Beijing). A replication was carried out on an independent cohort of 340 patients from Southeastern China followed by a second validation on 409 patients from the Massachusetts General Hospital (Boston, MA).

RESULTS

Consistent associations with NSCLC survival were identified for five single-nucleotide polymorphisms (SNP) in Chinese populations with P values ranging from 3.63 × 10(-5) to 4.19 × 10(-7) in the additive genetic model. The minor allele of three SNPs (rs7629386 at 3p22.1, rs969088 at 5p14.1, and rs3850370 at 14q24.3) were associated with worse NSCLC survival while 2 (rs41997 at 7q31.31 and rs12000445 at 9p21.3) were associated with better NSCLC survival. In addition, rs7629386 at 3p22.1 (CTNNB1) and rs3850370 at 14q24.3 (SNW1-ALKBH1-NRXN3) were further replicated in the Caucasian population.

CONCLUSION

In this three-stage genome-wide association studies, we identified five SNPs as markers for survival of advanced-stage NSCLC patients treated with first-line platinum-based chemotherapy in Chinese Han populations. Two of these SNPs, rs7629386 and rs3850370, could also be markers for survival among Caucasian patients.

Cigarette smoking increases copy number alterations in nonsmall-cell lung cancer

Cigarette smoking has been a well-established risk factor of lung cancer for decades. How smoking contributes to tumorigenesis in the lung remains not fully understood. Here we report the results of a genome-wide study of DNA copy number and smoking pack-years in a large collection of nonsmall-cell lung cancer (NSCLC) tumors. Genome-wide analyses of DNA copy number and pack-years of cigarette smoking were performed on 264 NSCLC tumors, which were divided into discovery and validation sets. The copy number-smoking associations were investigated in three scales: whole-genome, chromosome/arm, and focal regions. We found that heavy cigarette smokers (>60 pack-years) have significantly more copy number gains than non- or light smokers (≤60 pack-years) (P = 2.46 × 10(-4)), especially in 8q and 12q. Copy number losses tend to occur away from genes in non/light smokers (P = 5.15 × 10(-5)) but not in heavy smokers (P = 0.52). Focal copy number analyses showed that there are strong associations of copy number and cigarette smoking pack-years in 12q23 (P = 9.69 × 10(-10)) where IGF1 (insulin-like growth factor 1) is located. All of the above analyses were tested in the discovery set and confirmed in the validation set. DNA double-strand break assays using human bronchial epithelial cell lines treated with cigarette smoke condensate were also performed, and indicated that cigarette smoke condensate leads to genome instability in human bronchial epithelial cells. We conclude that cigarette smoking leads to more copy number alterations, which may be mediated by the genome instability.

Tumor epidermal growth factor receptor genotype and depression in stage IV non-small cell lung cancer

INTRODUCTION

Depression appears to be associated with worse survival from cancer, but underlying mechanisms for this association are unknown. In the present study, we explored the degree to which tumor genotype may be associated with depression in patients with non-small cell lung cancer (NSCLC). We examined differences in depression severity and rates of positive screens for major depressive disorder among newly diagnosed patients with stage IV NSCLC and known epidermal growth factor receptor (EGFR) genotype.

METHODS

Newly diagnosed patients (n = 53) with metastatic NSCLC attending an initial thoracic oncology consultation completed self-report questionnaires regarding demographics, smoking behavior, and depression before meeting with their oncologist. Biopsy samples were subsequently genotyped, including screening for EGFR mutations. We conducted a retrospective chart review to obtain clinical data, including tumor stage, performance status, and EGFR genotype.

RESULTS

Twelve patients (22.6%) tested positive for EGFR mutation. No EGFR mutation-positive cases met the screening criteria for major depressive disorder, in comparison with 29.3% of patients with wild-type EGFR (p = .03). Mutations of EGFR were also associated with lower depression severity than with wild-type EGFR, independent of gender, performance status, and smoking history (p < .05). This finding persisted for both the cognitive-affective and somatic domains of depression symptoms.

CONCLUSIONS

EGFR mutations were associated with lower depression severity and lower rates of probable major depressive disorder in patients with metastatic NSCLC, based on mood screening performed before results of genotyping were known. Findings support further work to explore the directionality of the associations and potential biological pathways to depression.

Abstract 2760: Nicotinic acetylcholine receptor SNPs are associated with smoking cessation

Introduction: Several genes have been linked with smoking behavior, and recent findings from candidate gene and genome wide association studies (GWAS) point to an area on Chr15q24-25.1 as a plausible site. The association region contains several genes, including three that encode nicotinic acetylcholine receptor subunits (CHRNA5, CHRNA3 and CHRNB4). Consistent results have been reported for cigarettes smoked per day (CPD), but data for smoking initiation, duration and cessation remain mixed. In this study, we assessed the relationship between the two most significant and consistently reported single nucleotide polymorphisms (SNPs), rs1051730 and rs8034191 and various smoking phenotypes.

Methods: From a large ongoing case-control study of the molecular epidemiology of lung cancer, which began in 1992 at the Massachusetts General Hospital, we derived this study population of controls only (i.e., no diagnosis of lung cancer). The polymorphisms were genotyped by the 5’ nuclease assay (Taqman) using the ABI Prism 7900HT Sequence Detection System (Applied Biosystems, Foster City, CA). Interviewer-administered questionnaires collected information on demographics, and detailed smoking histories from each subject. We log transformed all the continuous smoking phenotype variables. Multiple linear regression models were used to assess the association between SNPs and continuous outcomes and estimates for the association with binary outcomes were obtained from logistic regression. We used the additive genetic model for individual SNPs, controlling for age, gender and college education.

Results: There were 1452 subjects. There were statistically significant differences in age, gender, and college education between never, former and current smokers. Never smokers were excluded in the comparison of smoking variables. Age of smoking initiation and smoking duration differed significantly between former and current smokers. There was no significant difference between genotypes of rs1051730 except by smoking status (never, former, current). The proportion of never smokers was much higher in the wildtype group compared to heterozygous and homozygous variant group.

The association of smoking cessation (current vs. former smokers) with rs1051730, adjusted for age, gender and college education was statistically significant (p=0.05). Results for the other smoking phenotype included smoking initiation (never vs. ever smokers) (P=0.62), age of smoking initiation (P=0.83), smoking duration (P=0.76), CPD (0.08), and number of year of smoking cessation (0.36). We obtained similar results for SNP rs8034191.

Conclusion In conclusion, we have shown an association between rs1051730 and smoking cessation. We also replicated previous findings for intensity (CPD). If confirmed in future studies, these findings may provide a role for genetic screening in smoking cessations programs.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2760. doi:10.1158/1538-7445.AM2011-2760

Abstract 937: Nicotinic acetylcholine receptor polymorphisms, secondhand smoke and lung cancer risk

Introduction: Passive or secondhand smoke (SHS) exposure is an independent risk factor for adult non-small cell lung cancer (NSCLC). In 2008, three genome wide association studies (GWAS) identified a locus on chromosome region 15q24-25.1 that was strongly associated with lung cancer. In this study, we assessed the interaction of the two most significant single nucleotide polymorphisms (SNPs) reported (rs8034191, rs1051730) with SHS on lung cancer risk. We hypothesize that after adjusting for active cigarette smoking, individuals with the risk alleles and the highest cumulative exposure to SHS are at the greatest risk of lung cancer.

Methods: This study population is derived from a large ongoing case control study evaluating the molecular epidemiology of lung cancer, which began in 1992 at the Massachusetts General Hospital. The polymorphisms were genotyped by the 5V nuclease assay (Taqman) using the ABI Prism 7900HT Sequence Detection System (Applied Biosystems, Foster City, CA). Interviewer-administered questionnaires collected information on demographics, and detailed smoking histories from each subject. Second hand smoke exposure duration and frequency was self-reported for three different activities (leisure, work and at home). The cumulative SHS exposure was the sum of all durations multiplied by their frequency weight. We used the co-dominant genetic model for individual SNPs, controlling for age, gender, pack years, years since smoking cessation and smoking status. We tested for interaction using the Likelihood Ratio Test by incorporating cross product interaction terms of indicator variables for each SNP and quartiles of cumulative exposure.

Results: A total of 2071 cases and 1506 controls were analyzed. Among cases, exposure to SHS at home 1924(93%), work 1727 (83%), leisure 1791 (86%); among controls 1328 (88%), 1044 (69%) and 1233 (82%) respectively. In stratified analysis, for study participants in the highest quartile of cumulative SHS exposure and comparing the homozygous variant to the wildtype, the adjusted odds ratio (AOR) for lung cancer was 1.55 (0.99-2.44) (rs8034191) and 1.66 (1.05-2.62) (rs1051730). In the lowest quartile of SHS exposure the corresponding results were 0.94 (0.47-1.89) (rs8034191) and 0.91(0.45-1.84) (rs1051730). There was no evidence for gene-SHS interaction.

Conclusion: Our results indicate that secondhand smoke does not modify the association of rs1051730 and rs8034191 with non-small cell lung cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 937.

Epidermal growth factor (EGF) gene polymorphism, gastroesophageal reflux disease (GERD), and esophageal adenocarcinoma (EAC) risk

11029

Background: Single nucleotide polymorphisms (SNPs) of key cancer genes, such as EGF A61G, are associated with an elevated risk of EAC, but the lack of full penetrance indicates that the effects of these SNPs on esophageal carcinogenesis are modified by additional genetic or environmental variables. Since GERD is an established risk factor for EAC, we evaluated whether the association between EGF polymorphism and EAC development is altered by the presence of GERD. Methods: EGF genotyping of DNA samples was performed and GERD history was collected for 309 EAC patients and 275 matched healthy controls. Associations between genotypes and EAC risk were examined with adjusted logistic regression. Genotype-GERD relationships were explored using analyses stratified by GERD history and joint effects models that considered severity and duration of GERD symptoms. Results: Baseline characteristics were comparable between cases and controls except that EGF variants (A/G or G/G) were more common (p=0.02) and GERD was more prevalent (p<0.001) in cases than in controls. When compared to the EGF wild type A/A genotype, the G/G variant was associated with an increased risk of EAC (OR 1.9; 95% CI, 1.2–3.0; p=0.007). Stratified analyses revealed that the G/G variant contributed to a substantial increase in EAC risk among individuals with GERD, but a slight decrease in risk for GERD-free individuals (see table). In the joint effects models, the odds of EAC was also highest for G/G patients who either experienced frequent GERD of more than once per week (OR 21.8; 95% CI, 5.1–94.0; p<0.001) or suffered GERD for longer than 15 years (OR 22.4; 95% CI, 6.5–77.6; p<0.001). There was a highly significant interaction between the G/G genotype and the presence of GERD (p<0.001). Conclusions: EGF A61G polymorphism exerts its effect on EAC susceptibility through an interaction with GERD. Performing EGF genotyping for patients with severe or longstanding GERD can help to identify individuals at the greatest risk of EAC. [Table: see text]

No significant financial relationships to disclose.

Epidermal growth factor receptor polymorphisms and clinical outcomes in non-small-cell lung cancer patients treated with gefitinib

The-216G/T, -191C/A, intron 1 and Arg497Lys epidermal growth factor receptor (EGFR) polymorphisms were evaluated in 92 advanced non-small-cell lung cancer patients treated with gefitinib, an EGFR tyrosine-kinase inhibitor. Improved progression free survival (PFS) was found in patients homozygous for the shorter lengths of intron 1 polymorphism (S/S; S=16 or fewer CA repeats; log-rank test (LRT) P=0.03) and for patients carrying any T allele of the -216G/T polymorphism (LRT, P=0.005). When considered together, patients with intron 1 S/S genotype and at least one T allele of -216G/T had improved PFS (LRT P=0.0006; adjusted hazard ratio (AHR), 0.60 (95% confidence interval, 0.36-0.98)) and overall survival (LRT P=0.02; AHR, 0.60 (0.36-1.00)) when compared with all others. The T allele of -216G/T was also associated with significantly higher rates of stable disease/partial response (P=0.01) and a significantly higher risk of treatment-related rash/diarrhea (P=0.004, multivariate model). EGFR intron 1 and -216G/T polymorphisms influence clinical outcomes in gefitinib-treated non-small-cell lung cancer patients.