1
|
Rodríguez-Abreu D, Cobo M, García-Román S, Viteri-Ramírez S, Jordana-Ariza N, García-Peláez B, Reguart N, Aguilar A, Codony-Servat J, Drozdowskyj A, Molina-Vila MA, d'Hondt E, Rosell R. The EPICAL trial, a phase Ib study combining first line afatinib with anti-EGF vaccination in EGFR-mutant metastatic NSCLC. Lung Cancer 2021; 164:8-13. [PMID: 34971901 DOI: 10.1016/j.lungcan.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Combination of anti-EGFR monoclonal antibodies or immune checkpoint inhibitors with TKIs has shown minimal benefit in EGFR mutant (EGFR-mut) NSCLC patients. Consequently, new combination approaches are needed. PATIENTS AND METHODS The EPICAL was a single arm, phase 1b study to evaluate safety, tolerability and anti-tumor activity of first line afatinib combined with anti-EGF vaccination in advanced EGFR-mut patients. EGFR status and mutations in liquid biopsies were determined by reverse transcriptase-polymerase chain reaction; serum biomarkers by ELISA and Western blotting analysis. RESULTS The assay enrolled 23 patients, 21 completed the anti-EGF immunization phase. Treatment was well tolerated and no serious adverse events (SAEs) related to the anti-EGF vaccine were reported. Objective response and disease control rates were 78.3% (95%CI = 53.6-92.5) and 95.7% (95%CI = 78.1-99.9), respectively. After a median follow-up of 24.2 months, median progression-free survival (PFS) was 14.8 months (95% CI = 9.5-20.1) and median overall survival (OS) 26.9 months (95% CI = 23.0-30.8). Among the 21 patients completing the immunization phase, PFS was 17.5 months (95% CI = 12.0-23.0) and OS 26.9 months (95% CI = 24.6-NR). At the end of the immunization phase, all 21 patients showed high serum titers of anti-EGF antibodies, while EGF levels had decreased significantly. Finally, treatment with fully immunized patient's sera inhibited the EGFR pathway in tumor cells growing in vitro. CONCLUSIONS Combination treatment with an anti-EGF vaccine is well tolerated; induces a sustained immunogenic effect and might enhance the clinical efficacy of EGFR TKIs.
Collapse
Affiliation(s)
- D Rodríguez-Abreu
- Medical Oncology, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - M Cobo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - S García-Román
- Laboratorio de Oncología, Pangaea Oncology, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain
| | | | - N Jordana-Ariza
- Laboratorio de Oncología, Pangaea Oncology, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain
| | - B García-Peláez
- Laboratorio de Oncología, Pangaea Oncology, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain
| | - N Reguart
- Department of Medical Oncology, Thoracic Oncology Unit, Hospital Clínic, Barcelona, Spain
| | - A Aguilar
- Instituto Oncológico Dr Rosell, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain
| | - J Codony-Servat
- Laboratorio de Oncología, Pangaea Oncology, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain
| | - A Drozdowskyj
- Instituto Oncológico Dr Rosell, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain
| | - M A Molina-Vila
- Laboratorio de Oncología, Pangaea Oncology, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain.
| | | | - R Rosell
- Instituto Oncológico Dr Rosell, Hospital Universitari Dexeus, Grupo Quirón Salud, Barcelona, Spain.
| |
Collapse
|
2
|
Mayo-de-Las-Casas C, Jordana-Ariza N, Garzón-Ibañez M, Balada-Bel A, Bertrán-Alamillo J, Viteri-Ramírez S, Reguart N, Muñoz-Quintana MA, Lianes-Barragan P, Camps C, Jantús E, Remon-Massip J, Calabuig S, Aguiar D, Gil ML, Viñolas N, Santos-Rodríguez AK, Majem M, García-Peláez B, Villatoro S, Pérez-Rosado A, Monasterio JC, Ovalle E, Catalán MJ, Campos R, Morales-Espinosa D, Martínez-Bueno A, González-Cao M, González X, Moya-Horno I, Sosa AE, Karachaliou N, Rosell R, Molina-Vila MA. Large scale, prospective screening of EGFR mutations in the blood of advanced NSCLC patients to guide treatment decisions. Ann Oncol 2018; 28:2248-2255. [PMID: 28911086 DOI: 10.1093/annonc/mdx288] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background In a significant percentage of advanced non-small-cell lung cancer (NSCLC) patients, tumor tissue is unavailable or insufficient for genetic analyses. We prospectively analyzed if circulating-free DNA (cfDNA) purified from blood can be used as a surrogate in this setting to select patients for treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Patients and methods Blood samples were collected in 119 hospitals from 1138 advanced NSCLC patients at presentation (n = 1033) or at progression to EGFR-TKIs (n = 105) with no biopsy or insufficient tumor tissue. Serum and plasma were sent to a central laboratory, cfDNA purified and EGFR mutations analyzed and quantified using a real-time PCR assay. Response data from a subset of patients (n = 18) were retrospectively collected. Results Of 1033 NSCLC patients at presentation, 1026 were assessable; with a prevalence of males and former or current smokers. Sensitizing mutations were found in the cfDNA of 113 patients (11%); with a majority of females, never smokers and exon 19 deletions. Thirty-one patients were positive only in plasma and 11 in serum alone and mutation load was higher in plasma and in cases with exon 19 deletions. More than 50% of samples had <10 pg mutated genomes/µl with allelic fractions below 0.25%. Patients treated first line with TKIs based exclusively on EGFR positivity in blood had an ORR of 72% and a median PFS of 11 months. Of 105 patients screened after progression to EGFR-TKIs, sensitizing mutations were found in 56.2% and the p.T790M resistance mutation in 35.2%. Conclusions Large-scale EGFR testing in the blood of unselected advanced NSCLC patients is feasible and can be used to select patients for targeted therapy when testing cannot be done in tissue. The characteristics and clinical outcomes to TKI treatment of the EGFR-mutated patients identified are undistinguishable from those positive in tumor.
Collapse
Affiliation(s)
- C Mayo-de-Las-Casas
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - N Jordana-Ariza
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - M Garzón-Ibañez
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - A Balada-Bel
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - J Bertrán-Alamillo
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - S Viteri-Ramírez
- Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona
| | - N Reguart
- Department of Medical Oncology, Hospital Clínic, Barcelona
| | - M A Muñoz-Quintana
- Department of Medical Oncology, Valencia Institute of Oncology, Valencia
| | | | - C Camps
- Molecular Oncology Laboratory, Fundación Investigación, Valencia General University Hospital, Valencia.,CIBERONC, Valencia.,Medical Oncology Department, Valencia General University Hospital, Valencia.,Department of Medicine, Universitat de València
| | - E Jantús
- Molecular Oncology Laboratory, Fundación Investigación, Valencia General University Hospital, Valencia.,CIBERONC, Valencia.,Department of Biotechnology, Universitat Politècnica de València
| | | | - S Calabuig
- Molecular Oncology Laboratory, Fundación Investigación, Valencia General University Hospital, Valencia.,CIBERONC, Valencia.,Department of Biotechnology, Universitat Politècnica de València
| | - D Aguiar
- Department of Medical Oncology, Hospital Dr Negrín of Gran Canaria, Las Palmas
| | - M L Gil
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - N Viñolas
- Department of Medical Oncology, Hospital Clínic, Barcelona
| | | | - M Majem
- Medical Oncology Service, Hospital de Sant Pau, Barcelona
| | - B García-Peláez
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - S Villatoro
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - A Pérez-Rosado
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - J C Monasterio
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - E Ovalle
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - M J Catalán
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - R Campos
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| | - D Morales-Espinosa
- Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona
| | - A Martínez-Bueno
- Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona
| | - M González-Cao
- Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona
| | - X González
- Dr Rosell Oncology Institute, General Hospital of Catalonia, Sant Cugat del Vallés
| | - I Moya-Horno
- Dr Rosell Oncology Institute, General Hospital of Catalonia, Sant Cugat del Vallés
| | - A E Sosa
- Dr Rosell Oncology Institute, University Hospital Sagrat Cor, Barcelona
| | - N Karachaliou
- Dr Rosell Oncology Institute, University Hospital Sagrat Cor, Barcelona
| | - R Rosell
- Cancer Biology and Precision Medicine Program, Catalan Institute of Oncology, Germans Trias i Pujol Health Sciences Institute and Hospital, Badalona, Spain
| | - M A Molina-Vila
- Laboratory of Oncology, Pangaea Oncology, Quirón Dexeus University Hospital, Barcelona
| |
Collapse
|