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Chen Z, Vallega KA, Wang D, Quan Z, Fan S, Wang Q, Leal T, Ramalingam SS, Sun SY. DNA topoisomerase II inhibition potentiates osimertinib's therapeutic efficacy in EGFR-mutant non-small cell lung cancer models. J Clin Invest 2024:e172716. [PMID: 38451729 DOI: 10.1172/jci172716] [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: 03/09/2024] Open
Abstract
Development of effective strategies to manage the inevitable acquired resistance to osimertinib, an approved 3rd generation EGFR inhibitor for the treatment of EGFR mutant (EGFRm) non-small cell lung cancer (NSCLC), is urgently needed. This study reported that the DNA topoisomerase II (Topo II) inhibitors, doxorubicin and etoposide (VP-16) synergistically decreased cell survival with enhanced induction of DNA damage and apoptosis in osimertinib-resistant cells, suppressed the growth of osimertinib-resistant tumors, and delayed the emergence of osimertinib acquired resistance. Mechanistically, osimertinib decreased Topo IIα levels in EGFRm NSCLC cells by facilitating FBXW7-mediated proteasomal degradation, resulting in induction of DNA damage; these effects were lost in osimertinib-resistant cell lines possessing elevated levels of Topo IIα. Topo IIα elevation was also detected in the majority of EGFRm NSCLC tissues relapsed from EGFR-TKI treatment. Enforced expression of an ectopic TOP2A gene in sensitive EGFRm NSCLC cells conferred resistance to osimertinib, whereas knockdown of TOP2A in osimertinib-resistant cell lines restored their response to undergo osimertinib-induced DNA damage and apoptosis. Together, these results reveal an essential role of Topo IIα inhibition in mediating the therapeutic efficacy of osimertinib against EGFRm NSCLC, providing scientific rationale for targeting Topo II to manage acquired resistance to osimertinib.
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Affiliation(s)
- Zhen Chen
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, United States of America
| | - Karin A Vallega
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, United States of America
| | - Dongsheng Wang
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, United States of America
| | - Zihan Quan
- Department of Pathology, The Second Xiangya Hospital, South Central University, Changsha, China
| | - Songqing Fan
- Department of Pathology, The Second Xiangya Hospital, South Central University, Changsha, China
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Ticiana Leal
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, United States of America
| | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, United States of America
| | - Shi-Yong Sun
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, United States of America
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Nassar AH, Kim SY, Aredo JV, Feng J, Shepherd F, Xu C, Kaldas D, Gray JE, Dilling TJ, Neal JW, Wakelee HA, Liu Y, Lin SH, Abuali T, Amini A, Nie Y, Patil T, Lobachov A, Bar J, Fitzgerald B, Fujiwara Y, Marron TU, Thummalapalli R, Yu H, Owen DH, Sharp J, Farid S, Rocha P, Arriola E, D'Aiello A, Cheng H, Whitaker R, Parikh K, Ashara Y, Chen L, Sankar K, Harris JP, Nagasaka M, Ayanambakkam A, Velazquez AI, Ragavan M, Lin JJ, Piotrowska Z, Wilgucki M, Reuss J, Luders H, Grohe C, Baena Espinar J, Feiner E, Punekar SR, Gupta S, Leal T, Kwiatkowski DJ, Mak RH, Adib E, Naqash AR, Goldberg SB. Consolidation Osimertinib Versus Durvalumab Versus Observation After Concurrent Chemoradiation in Unresectable EGFR-Mutant NSCLC: A Multicenter Retrospective Cohort Study. J Thorac Oncol 2024:S1556-0864(24)00032-7. [PMID: 38278303 DOI: 10.1016/j.jtho.2024.01.012] [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: 11/05/2023] [Revised: 12/31/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Durvalumab improves survival when used as consolidation therapy after chemoradiation (CRT) in patients with stage III NSCLC. The optimal consolidation therapy for patients with EGFR-mutant (EGFRmut) stage III NSCLC remains unknown. METHODS In this multi-institutional, international retrospective analysis across 24 institutions, we evaluated outcomes in patients with stage III EGFRmut NSCLC treated with concurrent CRT followed by consolidation therapy with osimertinib, durvalumab, or observation between 2015 and 2022. Kaplan-Meier method was used to estimate real-world progression-free survival (rwPFS, primary end point) and overall survival (secondary end point). Treatment-related adverse events (trAEs) during consolidation treatment were defined using Common Terminology Criteria for Adverse Events version 5.0. Multivariable Cox regression analysis was used. RESULTS Of 136 patients with stage III EGFRmut NSCLC treated with definitive concurrent CRT, 56 received consolidation durvalumab, 33 received consolidation osimertinib, and 47 was on observation alone. Baseline characteristics were similar across the three cohorts. With a median follow-up of 46 months for the entire cohort, the median duration of treatment was not reached (NR) for osimertinib (interquartile range: NR-NR) and was 5.5 (interquartile range: 2.4-10.8) months with durvalumab. After adjusting for nodal status, stage III A/B/C, and age, patients treated with consolidation osimertinib had significantly longer 24-month rwPFS compared to those treated with durvalumab or in the observation cohorts (osimertinib: 86%, durvalumab: 30%, observation: 27%, p < 0.001 for both comparisons). There was no difference in rwPFS between the durvalumab and the observation cohorts. No significant difference in overall survival across the three cohorts was detected, likely due to the limited follow-up. Any-grade trAE occurred in 52% (2 [6.1%] grade ≥3) and 48% (10 [18%] grade ≥3) of patients treated with osimertinib and durvalumab, respectively. Of 45 patients who progressed on consolidation durvalumab, 37 (82%) subsequently received EGFR tyrosine kinase inhibitors. Of these, 14 (38%) patients developed trAEs including five patients with pneumonitis (14%; 2 [5.4%] grade ≥3) and five patients with diarrhea (14%; 1 [2.7%] grade ≥3). CONCLUSIONS This study suggests that among patients with stage III unresectable NSCLC with a sensitizing EGFR mutation, consolidation osimertinib was associated with a significantly longer rwPFS compared to durvalumab or observation. No unanticipated safety signals were observed with consolidation osimertinib.
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Affiliation(s)
- Amin H Nassar
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - So Yeon Kim
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Jacqueline V Aredo
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jamie Feng
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Frances Shepherd
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Chao Xu
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - David Kaldas
- Department of Internal Medicine, University of South Florida, Tampa, Florida; Department of Clinical Oncology, Cairo University, Cairo, Egypt
| | - Jhanelle E Gray
- Thoracic Oncology Program, Moffitt Cancer Center, Tampa, Florida
| | - Thomas J Dilling
- Thoracic Oncology Program, Moffitt Cancer Center, Tampa, Florida
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yufei Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tariq Abuali
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Yunan Nie
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Tejas Patil
- Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
| | - Anastasiya Lobachov
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bailey Fitzgerald
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yu Fujiwara
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas U Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rohit Thummalapalli
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Dwight H Owen
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - John Sharp
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Saira Farid
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Pedro Rocha
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Edurne Arriola
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Angelica D'Aiello
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ryan Whitaker
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Luxi Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kamya Sankar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine Medical Center, Orange, California
| | - Misako Nagasaka
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, California
| | | | - Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Meera Ragavan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Jessica J Lin
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Zofia Piotrowska
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Molly Wilgucki
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Joshua Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Heike Luders
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Christian Grohe
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | | | - Ella Feiner
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Salman R Punekar
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Shruti Gupta
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ticiana Leal
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | | | - Raymond H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elio Adib
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sarah B Goldberg
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut.
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Leal T, Langer C. Tumor Treating Fields therapy in metastatic non-small-cell lung cancer - Authors' reply. Lancet Oncol 2023; 24:e454. [PMID: 38039996 DOI: 10.1016/s1470-2045(23)00584-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Ticiana Leal
- Winship Cancer Institute at Emory University, Atlanta, GA 30322, USA.
| | - Corey Langer
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Small cell lung cancer (SCLC) is a rapidly progressive neuroendocrine carcinoma that, until recently, had a very small armamentarium of effective treatments. Advances in DNA sequencing and whole transcriptomics have delineated key subtypes; therefore, SCLC is no longer viewed as a homogeneous cancer. Chemoimmunotherapy with PD1 blockade is now the standard of care for advanced disease, and ongoing research efforts are moving this strategy into the limited stage setting. Combination strategies of immunotherapy with radiation are also under active clinical trial in both limited and extensive stage disease. PLAIN LANGUAGE SUMMARY: Small cell lung cancer (SCLC) is a rapidly progressive neuroendocrine carcinoma that, until recently, had a very small armamentarium of effective treatments. Chemoimmunotherapy with immune check point inhibitors is now the standard of care for advanced disease. This comprehensive review provides an overview of current treatment strategies for SCLC, unmet needs in this patient population, and emerging treatment strategies incorporating immunotherapy that will hopefully further improve outcomes for patients.
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Affiliation(s)
- Jennifer W Carlisle
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ticiana Leal
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
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Leal T, Kotecha R, Ramlau R, Zhang L, Milanowski J, Cobo M, Roubec J, Petruzelka L, Havel L, Kalmadi S, Ward J, Andric Z, Berghmans T, Gerber DE, Kloecker G, Panikkar R, Aerts J, Delmonte A, Pless M, Greil R, Rolfo C, Akerley W, Eaton M, Iqbal M, Langer C. Tumor Treating Fields therapy with standard systemic therapy versus standard systemic therapy alone in metastatic non-small-cell lung cancer following progression on or after platinum-based therapy (LUNAR): a randomised, open-label, pivotal phase 3 study. Lancet Oncol 2023; 24:1002-1017. [PMID: 37657460 DOI: 10.1016/s1470-2045(23)00344-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Tumor Treating Fields (TTFields) are electric fields that disrupt processes critical for cancer cell survival, leading to immunogenic cell death and enhanced antitumour immune response. In preclinical models of non-small-cell lung cancer, TTFields amplified the effects of chemotherapy and immune checkpoint inhibitors. We report primary results from a pivotal study of TTFields therapy in metastatic non-small-cell lung cancer. METHODS This randomised, open-label, pivotal phase 3 study recruited patients at 130 sites in 19 countries. Participants were aged 22 years or older with metastatic non-small-cell lung cancer progressing on or after platinum-based therapy, with squamous or non-squamous histology and ECOG performance status of 2 or less. Previous platinum-based therapy was required, but no restriction was placed on the number or type of previous lines of systemic therapy. Participants were randomly assigned (1:1) to TTFields therapy and standard systemic therapy (investigator's choice of immune checkpoint inhibitor [nivolumab, pembrolizumab, or atezolizumab] or docetaxel) or standard therapy alone. Randomisation was performed centrally using variable blocked randomisation and an interactive voice-web response system, and was stratified by tumour histology, treatment, and region. Systemic therapies were dosed according to local practice guidelines. TTFields therapy (150 kHz) was delivered continuously to the thoracic region with the recommendation to achieve an average of at least 18 h/day device usage. The primary endpoint was overall survival in the intention-to-treat population. The safety population included all patients who received any study therapy and were analysed according to the actual treatment received. The study is registered with ClinicalTrials.gov, NCT02973789. FINDINGS Between Feb 13, 2017, and Nov 19, 2021, 276 patients were enrolled and randomly assigned to receive TTFields therapy with standard therapy (n=137) or standard therapy alone (n=139). The median age was 64 years (IQR 59-70), 178 (64%) were male and 98 (36%) were female, 156 (57%) had non-squamous non-small-cell lung cancer, and 87 (32%) had received a previous immune checkpoint inhibitor. Median follow-up was 10·6 months (IQR 6·1-33·7) for patients receiving TTFields therapy with standard therapy, and 9·5 months (0·1-32·1) for patients receiving standard therapy. Overall survival was significantly longer with TTFields therapy and standard therapy than with standard therapy alone (median 13·2 months [95% CI 10·3-15·5] vs 9·9 months [8·1-11·5]; hazard ratio [HR] 0·74 [95% CI 0·56-0·98]; p=0·035). In the safety population (n=267), serious adverse events of any cause were reported in 70 (53%) of 133 patients receiving TTFields therapy plus standard therapy and 51 (38%) of 134 patients receiving standard therapy alone. The most frequent grade 3-4 adverse events were leukopenia (37 [14%] of 267), pneumonia (28 [10%]), and anaemia (21 [8%]). TTFields therapy-related adverse events were reported in 95 (71%) of 133 patients; these were mostly (81 [85%]) grade 1-2 skin and subcutaneous tissue disorders. There were three deaths related to standard therapy (two due to infections and one due to pulmonary haemorrhage) and no deaths related to TTFields therapy. INTERPRETATION TTFields therapy added to standard therapy significantly improved overall survival compared with standard therapy alone in metastatic non-small-cell lung cancer after progression on platinum-based therapy without exacerbating systemic toxicities. These data suggest that TTFields therapy is efficacious in metastatic non-small-cell lung cancer and should be considered as a treatment option to manage the disease in this setting. FUNDING Novocure.
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Affiliation(s)
- Ticiana Leal
- Winship Cancer Institute at Emory University, Atlanta, GA, USA.
| | - Rupesh Kotecha
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznan, Poland
| | - Li Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center (SYSUCC), Guangzhou, China
| | | | - Manuel Cobo
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, IBIMA, Málaga, Spain
| | - Jaromir Roubec
- Nemocnice AGEL Ostrava-Vítkovice, Ostrava, Czech Republic
| | | | | | | | - Jeffrey Ward
- Washington University School of Medicine, St Louis, MO, USA
| | - Zoran Andric
- University Clinical Hospital Centre Bezanijska Kosa, Belgrade, Serbia
| | - Thierry Berghmans
- Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - David E Gerber
- Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Joachim Aerts
- Department of Pulmonary Medicine, The Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Angelo Delmonte
- IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori (IRST), Meldola, Italy
| | - Miklos Pless
- Kantonsspital Winterthur, Winterthur, Switzerland
| | - Richard Greil
- Salzburg Cancer Research Institute-Center for Clinical Cancer and Immunology Trials (SCRI-CCCIT), Salzburg, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria; Cancer Cluster, Salzburg, Austria
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute at Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Wallace Akerley
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Mussawar Iqbal
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Corey Langer
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Leal T, Socinski MA. Emerging agents for the treatment of advanced or metastatic NSCLC without actionable genomic alterations with progression on first-line therapy. Expert Rev Anticancer Ther 2023; 23:817-833. [PMID: 37486248 DOI: 10.1080/14737140.2023.2235895] [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: 04/27/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Lung cancer is the second most common cancer in the world and the leading cause of cancer-related mortality. Immune checkpoint inhibitors (ICIs), as monotherapy or in combination with platinum-based chemotherapy, have emerged as the standard of care first-line treatment option for patients with advanced non-small cell lung cancer (NSCLC) without actionable genomic alterations (AGAs). Despite significant improvements in patient outcomes with these regimens, primary or acquired resistance is common and most patients develop disease progression, resulting in poor survival. AREAS COVERED We review the current treatments commonly used for NSCLC without AGAs in the first-line and subsequent settings and describe the unmet needs for these patients in the second-line setting, including a lack of standard definitions for primary and required resistance, and few effective treatment options for patients who develop progression of their disease on first-line therapy. We describe key mechanisms of resistance to ICIs and emerging therapies that are being investigated for patients who develop progression on ICIs and platinum-based chemotherapy. EXPERT OPINION Emerging agents in development have a variety of different mechanisms of action and will likely change standard of care for second-line therapy and beyond for patients with NSCLC without AGAs in the future.
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Fernandez-Cuesta L, Sexton-Oates A, Bayat L, Foll M, Lau SCM, Leal T. Spotlight on Small-Cell Lung Cancer and Other Lung Neuroendocrine Neoplasms. Am Soc Clin Oncol Educ Book 2023; 43:e390794. [PMID: 37229617 DOI: 10.1200/edbk_390794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Lung neuroendocrine neoplasms (NENs) encompass a spectrum of neoplasms that are subdivided into the well-differentiated neuroendocrine tumors comprising the low- and intermediate-grade typical and atypical carcinoids, respectively, and the poorly differentiated, high-grade neuroendocrine carcinomas including large-cell neuroendocrine carcinomas and small-cell lung carcinoma (SCLC). Here, we review the current morphological and molecular classifications of the NENs on the basis of the updated WHO Classification of Thoracic Tumors and discuss the emerging subclassifications on the basis of molecular profiling and the potential therapeutic implications. We focus on the efforts in subtyping SCLC, a particularly aggressive tumor with few treatment options, and the recent advances in therapy with the adoption of immune checkpoint inhibitors in the frontline setting for patients with extensive-stage SCLC. We further highlight the promising immunotherapy strategies in SCLC that are currently under investigation.
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Affiliation(s)
- Lynnette Fernandez-Cuesta
- Rare Cancers Genomics Team, Genomic Epidemiology Branch, International Agency for Research on Cancer IARC-WHO, Lyons, France
| | - Alexandra Sexton-Oates
- Rare Cancers Genomics Team, Genomic Epidemiology Branch, International Agency for Research on Cancer IARC-WHO, Lyons, France
| | - Leyla Bayat
- Department of Medical Oncology, NYU Langone Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Matthieu Foll
- Rare Cancers Genomics Team, Genomic Epidemiology Branch, International Agency for Research on Cancer IARC-WHO, Lyons, France
| | - Sally C M Lau
- Department of Medical Oncology, NYU Langone Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, NY
| | - Ticiana Leal
- Department of Hematology/Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA
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8
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Iams WT, Balbach ML, Phillips S, Sacher A, Bestvina C, Velcheti V, Wang X, Marmarelis ME, Sethakorn N, Leal T, Sackstein PE, Kim C, Robinson MA, Mehta K, Hsu R, Nieva J, Patil T, Camidge DR. A Multicenter Retrospective Chart Review of Clinical Outcomes Among Patients With KRAS G12C Mutant Non-Small Cell Lung Cancer. Clin Lung Cancer 2023; 24:228-234. [PMID: 36841727 DOI: 10.1016/j.cllc.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND On May 28, 2021, the United States Food and Drug Administration (FDA) granted accelerated approval to sotorasib for second-line or later treatment of patients with locally advanced or metastatic KRAS G12C mutant non-small cell lung cancer (NSCLC). This was the first FDA-approved targeted therapy for this patient population. Due to a paucity of real world data describing clinical outcomes in patients with locally advanced or metastatic KRAS G12C mutated NSCLC in the second-line or later, we sought to compile a large, academic medical center-based historical dataset to clarify clinical outcomes in this patient population. MATERIALS AND METHODS The clinical outcomes of 396 patients with stage IV (n = 268, 68%) or recurrent, metastatic (n = 128, 32%) KRAS G12C mutant NSCLC were evaluated in this multicenter retrospective chart review conducted through the Academic Thoracic Oncology Medical Investigator's Consortium (ATOMIC). Patients treated at 13 sites in the United States and Canada and diagnosed between 2006 and 2020 (30% 2006-2015, 70% 2016-2020) were included. Primary outcomes included real-world PFS (rwPFS) and overall survival (OS) from time of stage IV or metastatic diagnosis, with particular interest in patients treated with second-line docetaxel-containing regimens, as well as clinical outcomes in the known presence or absence of STK11 or KEAP1 comutations. RESULTS Among all patients with stage IV or recurrent, metastatic KRAS G12C mutant NSCLC (n = 201 with KRAS G12C confirmed prior to first line systemic therapy), the median first-line rwPFS was 9.3 months (95% CI, 7.3-11.8 months) and median OS was 16.8 months (95% CI, 12.7-22.3 months). In this historical dataset, first line systemic therapy among these 201 patients included platinum doublet alone (44%), PD-(L)1 inhibitor monotherapy (30%), platinum doublet chemotherapy plus PD-(L)1 inhibitor (18%), and other regimens (8%). Among patients with documented second-line systemic therapy (n = 123), the second-line median rwPFS was 8.3 months (95% CI, 6.1-11.9 months), with median rwPFS 4.6 months (95% CI, 1.4-NA) among 10 docetaxel-treated patients (9 received docetaxel and 1 received docetaxel plus ramucirumab). Within the total study population, 49 patients (12%) had a co-occurring STK11 mutation and 3 (1%) had a co-occurring KEAP1 mutation. Among the 49 patients with a co-occurring KRAS G12C and STK11 mutation, median rwPFS on first-line systemic therapy (n = 23) was 6.0 months (95% CI, 4.7-NA), and median OS was 14.0 months (95% CI, 10.8-35.3 months). CONCLUSION In this large, multicenter retrospective chart review of patients with KRAS G12C mutant NSCLC we observed a relatively short median rwPFS of 4.6 months among 10 patients with KRAS G12C mutant NSCLC treated with docetaxel with or without ramucirumab in the second-line setting, which aligns with the recently reported CodeBreak 200 dataset.
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Affiliation(s)
- Wade T Iams
- Vanderbilt University Medical Center, Nashville, TN.
| | | | | | - Adrian Sacher
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Xiao Wang
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | - Chul Kim
- Georgetown University, Washington DC, USA
| | | | | | - Robert Hsu
- University of Southern California, Los Angeles, CA
| | - Jorge Nieva
- University of Southern California, Los Angeles, CA
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9
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Vanderstraeten J, Marchal P, Moray J, Leal T, Muyldermans S, Dumoulin M, Vanbever R. Development of highly efficient approach to PEGylate nanobodies without loss of function in lung diseases: Case of a nanobody inhibiting B. cereus b-lactamase. Rev Mal Respir 2023. [DOI: 10.1016/j.rmr.2022.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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10
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Salous T, Shukla NA, Althouse SK, Perkins SM, Furqan M, Leal T, Traynor AM, Feldman LE, Hanna NH, Durm GA. A phase 2 trial of chemotherapy plus pembrolizumab in patients with advanced non-small cell lung cancer previously treated with a PD-1 or PD-L1 inhibitor: Big Ten Cancer Research Consortium BTCRC-LUN15-029. Cancer 2023; 129:264-271. [PMID: 36420773 DOI: 10.1002/cncr.34565] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/26/2022] [Revised: 07/06/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Immunotherapy using a checkpoint inhibitor (CPI) alone or in combination with chemotherapy is the standard of care for treatment-naive patients with advanced non-small cell lung cancer (NSCLC) without driver mutations for which targeted therapies have been approved. It is unknown whether continuing CPI treatment beyond disease progression results in improved outcomes. METHODS Patients who experienced progressive disease (PD) after a clinical benefit from chemotherapy plus a CPI were enrolled. Patients received pembrolizumab (200 mg every 3 weeks) plus next-line chemotherapy. The primary end point was progression-free survival (PFS) according to the Response Evaluation Criteria in Solid Tumors (version 1.1). Key secondary end points included the overall survival (OS), clinical benefit rate, and toxicity. The authors' hypothesis was that continuing pembrolizumab beyond progression would improve the median PFS to 6 months in comparison with a historical control of 3 months with single-agent chemotherapy alone. RESULTS Between May 2017 and February 2020, 35 patients were enrolled. The patient and disease characteristics were as follows: 51.4% were male; 82.9% were current or former smokers; and 74.3%, 20%, and 5.7% had adenocarcinoma, squamous cell carcinoma, and NSCLC not otherwise specified, respectively. The null hypothesis that the median PFS would be 3 months was rejected (p < .05). The median PFS was 5.1 months (95% confidence interval [CI], 3.6-8.0 months). The median OS was 24.5 months (95% CI, 15.6-30.9 months). The most common treatment-related adverse events were fatigue (60%), anemia (54.3%), and nausea (42.9%). There were no treatment-related deaths. CONCLUSIONS Pembrolizumab plus next-line chemotherapy in patients with advanced NSCLC who experienced PD after a clinical benefit from a CPI was associated with statistically significant higher PFS in comparison with historical controls of single-agent chemotherapy alone.
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Affiliation(s)
- Tareq Salous
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Nikhil A Shukla
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA.,Community Hospital Oncology Physicians, Indianapolis, Indiana, USA
| | - Sandra K Althouse
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Susan M Perkins
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Muhammad Furqan
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA.,Winship Cancer Institute at Emory University, Atlanta, Georgia, USA
| | - Anne M Traynor
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | | | - Nasser H Hanna
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Greg A Durm
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
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11
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Ardeshir-Larijani F, Althouse SK, Leal T, Feldman LE, Hejleh TA, Patel M, Gentzler RD, Miller AR, Hanna NH. A Phase II Trial of Atezolizumab Plus Carboplatin Plus Pemetrexed Plus Bevacizumab in the Treatment of Patients with Stage IV Non-Squamous Non-Small Cell Lung Cancer: Big Ten Cancer Research Consortium (BTCRC)- LUN 17-139. Clin Lung Cancer 2022; 23:578-584. [PMID: 36041949 DOI: 10.1016/j.cllc.2022.07.001] [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: 06/02/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION LUN17-139 evaluated the safety and efficacy of Atezolizumab (A) plus Carboplatin (C) plus Pemetrexed (Pem) plus Bevacizumab (B) (ACBPem) in treatment naïve patients with stage IV non-squamous non-small cell lung cancer (Ns-NSCLC). PATIENTS AND METHODS In this multicenter, single-arm phase II trial, all patients received A (1200-mg, D1) + C (AUC 5, D1) + Pem (500-mg/m2, D1) + B (15-mg/kg D1) q3 week x4. If no PD (progressive disease), patients received maintenance ABPem until PD or intolerable side effects. The primary endpoint was progression-free survival (PFS). The positive PFS result was considered as PFS>6m (historical control). Secondary endpoints included objective response rate (ORR), disease control rate (DCR) defined by complete response (CR) + partial response (PR) + stable disease (SD) ≥ 2 months, overall survival (OS), and safety. RESULTS Thirty patients were enrolled from November 2018 to October 2020. The study was closed early due to 3 patient deaths, possibly related to treatment. Median age 64 (range 38-83); Men/Women 20/10; PD-L1 TPS < 1%/1-49%/ ≥ 50% (8/15/7). The median follow-up was 20.3 months ( 1-28.1). ORR 42.9% (95% CI, 24.5-62.8%), DCR 96.4% (95% CI, 81.7-99.9%). The median PFS and OS were 11.3m (5.5-14.9,P > .05) and 22.4m (22.4-NR), respectively. Four patients had G4 toxicity (anemia, febrile-neutropenia, severe neutropenia, sepsis), and 3 patients had G5 toxicity (thromboembolism, sepsis, colonic perforation). CONCLUSION ABCPem was associated with increased PFS compared to historical controls but this difference did not meet the statistical significance. Three on-treatment deaths and 5 thromboembolic events prompted early closure.
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Affiliation(s)
| | - Sandra K Althouse
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | | | | | | | - Malini Patel
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | - Nasser H Hanna
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN.
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12
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Osta BE, Carlisle J, Steuer C, Pakkala S, Leal T, Dhodapkar M, Liu Y, Chen Z, Owonikoko T, Ramalingam S. A Phase 2 Study of Docetaxel, Ramucirumab, and Pembrolizumab for Patients With Metastatic or Recurrent Non-Small-Cell Lung Cancer (NSCLC) who Progressed on Platinum-Doublet and PD-1/PD-L1 Blockade. Clin Lung Cancer 2022; 23:e400-e404. [PMID: 35863963 DOI: 10.1016/j.cllc.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND There is an urgent and unmet need for more effective treatment options for patients with metastatic and recurrent non-small-cell lung cancer (NSCLC) who progressed on platinum-based therapy, immune checkpoint inhibitors (ICI), and targeted therapies. Currently, the combination of docetaxel (D) and ramucirumab (R) is the next best salvage therapy with a modest historical progression free survival (PFS) of 4.5 months and 6-month PFS rate of 37% predating the era of ICI use. Anecdotal reports in patients who progressed on ICI suggest a higher response rate to docetaxel compared to historical experience. Furthermore, tumor related angiogenesis promotes tumor growth and may contribute to immune escape in patients treated with ICI. Therapeutic combination with anti-angiogenic, ICI, and chemotherapy have independently demonstrated clinical efficacy without additive toxicities in NSCLC patients. PATIENTS AND METHODS This multicenter, single arm, open label, phase 2 study will evaluate the safety and preliminary efficacy of the combination of docetaxel 75 mg/m2, ramucirumab 10 mg/kg, and pembrolizumab 200 mg in up to 41 patients with metastatic or recurrent NSCLC after progression on concomitant or sequential platinum-based chemotherapy and ICI. This treatment will be given intravenously on the same day every 3 weeks until disease progression, occurrence of severe side effects, or no clinical benefit. The primary endpoint is 6-month PFS rate. CONCLUSIONS This is the first study to evaluate the safety and efficacy of ICI combined with docetaxel and ramucirumab. The findings could provide valuable information for developing new treatment strategies for NSCLC patients.
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Affiliation(s)
- Badi El Osta
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA.
| | - Jennifer Carlisle
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Suchita Pakkala
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Ticiana Leal
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Madhav Dhodapkar
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
| | - Yuan Liu
- Winship Cancer Institute of Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics at Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zhengjia Chen
- Division of Epidemiology and Biostatistics, University of Illinois Cancer Center, Chicago, IL
| | - Taofeek Owonikoko
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA; University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA
| | - Suresh Ramalingam
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute of Emory University, Atlanta, GA
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13
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Durm G, Mamdani H, Althouse S, Jabbour S, Ganti A, Jalal S, Chesney J, Naidoo J, Hrinczenko B, Fidler M, Leal T, Feldman L, Fujioka N, Hanna N. MA06.05 Consolidation Nivolumab and Ipilimumab or Nivolumab Alone Following Concurrent Chemoradiation for Patients with Unresectable Stage III NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Gorgens U, Higgins K, Bradley J, Stokes B, Leal T, Kesarwala A, Tian S, McCall N. P2.04-05 Is Opioid Use in the Management of Stage III Non-Small Cell Lung Cancer Patients Necessary? J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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Mccall N, McGinnis H, Janopaul-Naylor J, Kesarwala A, Tian S, Stokes W, Shelton J, Steuer C, Carlisle J, Leal T, Ramalingam S, Bradley J, Higgins K. P1.10-04 Impact of Radiation Dose to the Immune Cells in Unresectable or Stage III Non-Small Cell Lung Cancer in the Durvalumab Era. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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16
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McCall NS, McGinnis HS, Janopaul-Naylor JR, Kesarwala AH, Tian S, Stokes WA, Shelton JW, Steuer CE, Carlisle JW, Leal T, Ramalingam SS, Bradley JD, Higgins KA. Impact of Radiation Dose to the Immune Cells in Unresectable or Stage III Non-Small Cell Lung Cancer in the Durvalumab Era. Radiother Oncol 2022; 174:133-140. [PMID: 35870727 DOI: 10.1016/j.radonc.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND /PURPOSE Higher estimated radiation doses to immune cells (EDIC) have correlated with worse overall survival (OS) in patients with locally-advanced non-small cell lung cancer (NSCLC) prior to the PACIFIC trial, which established consolidative durvalumab as standard-of-care. Here, we examine the prognostic impact of EDIC in the durvalumab era. MATERIALS/METHODS This single-institution, multi-center study included patients with unresectable stage II/III NSCLC treated with chemoradiation followed by durvalumab. Associations between EDIC [analyzed continuously and categorically (≤6 Gy vs. >6 Gy)] and OS, progression-free survival (PFS), and locoregional control (LRC) were evaluated by Kaplan-Meier and Cox proportional methods. RESULTS 100 patients were included with median follow-up of 23.7 months. The EDIC >6 Gy group had a significantly greater percentage of stage IIIB/IIIC disease (76.0% vs. 32.6%; p<0.001) and larger tumor volumes (170cc vs. 42cc; p<0.001). There were no differences in early durvalumab discontinuation from toxicity (24.1% vs. 15.2%; p=0.27). Median OS was shorter among the EDIC >6 Gy group (29.6 months vs. not reached; p<0.001). On multivariate analysis, EDIC >6 Gy correlated with worse OS (HR: 4.15, 95%CI: 1.52-11.33; p=0.006), PFS (HR: 3.79; 95%CI: 1.80-8.0; p<0.001), and LRC (HR: 2.66, 95%CI: 1.15-6.18; p=0.023). Analyzed as a continuous variable, higher EDIC was associated with worse OS (HR: 1.34; 95%CI: 1.16-1.57; p<0.001), PFS (HR: 1.52; 95%CI: 1.29-1.79; p<0.001), and LRC (HR: 1.34, 95%CI: 1.13-1.60; p=0.007). CONCLUSIONS In the immunotherapy era, EDIC is an independent predictor of OS and disease control in locally advanced NSCLC, warranting investigation into techniques to reduce dose to the immune compartment.
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Affiliation(s)
- Neal S McCall
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States.
| | - Hamilton S McGinnis
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
| | - James R Janopaul-Naylor
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
| | - Aparna H Kesarwala
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
| | - Sibo Tian
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
| | - William A Stokes
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
| | - Joseph W Shelton
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
| | - Conor E Steuer
- Winship Cancer Institute of Emory University, Department of Hematology & Medical Oncology, United States
| | - Jennifer W Carlisle
- Winship Cancer Institute of Emory University, Department of Hematology & Medical Oncology, United States
| | - Ticiana Leal
- Winship Cancer Institute of Emory University, Department of Hematology & Medical Oncology, United States
| | - Suresh S Ramalingam
- Winship Cancer Institute of Emory University, Department of Hematology & Medical Oncology, United States
| | - Jeffrey D Bradley
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
| | - Kristin A Higgins
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, United States
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17
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Lortie J, Rush B, Osterbauer K, Colgan TJ, Tamada D, Garlapati S, Campbell TC, Traynor A, Leal T, Patel V, Helgager JJ, Lee K, Reeder SB, Kuchnia AJ. Corrigendum: Myosteatosis as a Shared Biomarker for Sarcopenia and Cachexia Using MRI and Ultrasound. Front Rehabilit Sci 2022; 3:982949. [PMID: 36191164 PMCID: PMC9397885 DOI: 10.3389/fresc.2022.982949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jevin Lortie
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Jevin Lortie
| | - Benjamin Rush
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Katie Osterbauer
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - T. J. Colgan
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Daiki Tamada
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Sujay Garlapati
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Toby C. Campbell
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Anne Traynor
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Ticiana Leal
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Viharkumar Patel
- Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Jeffrey J. Helgager
- Department of Pathology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Kenneth Lee
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Scott B. Reeder
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Adam J. Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
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18
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Vaidya R, Unger JM, Qian L, Minichiello K, Herbst RS, Gandara DR, Neal JW, Leal T, Patel JD, Dragnev KH, Waqar SN, Edelman MJ, Sigal EV, Adam S, Malik SM, Blanke CD, LeBlanc ML, Kelly K, Redman MW. Representativeness of patients enrolled in the Lung Cancer Master Protocol (Lung-MAP). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6543 Background: A major goal of Lung-MAP, a biomarker-driven master protocol conducted within the National Clinical Trials Network of the NCI using a public-private partnership, was to improve access to novel therapeutics. Representative enrollment of patient sub-groups in clinical trials is essential for improving confidence that trial findings are valid and applicable to all patients. We examined the representativeness of patients enrolled in Lung-MAP by demographic and area-level measures compared to patients in other advanced non-small cell lung cancer (NSCLC) trials and with the US NSCLC population. Methods: We analyzed data on patients enrolled to Lung-MAP between 2014-2020 according to sex, age ( < 65 years v. ≥ 65 years), race (White v. Black v. Asian), ethnicity (Hispanic v. not Hispanic), residence (rural v. urban), insurance type (Medicaid or no insurance v. private), and neighborhood socioeconomic deprivation (quintiles of Area Deprivation Index score). Rates were compared to SWOG-led NSCLC trials conducted between 2001-2020 (date range to provide sufficient power) and, where possible, to US NSCLC population rates using Surveillance, Epidemiology, and End Results (SEER) registry data (2014-2018). Two-sided tests of proportions at the 5% level were used for all comparisons. Results: 3,556 patients enrolled to Lung-MAP were compared to 2,267 patients enrolled to SWOG-led NSCLC studies. Lung-MAP patients were more likely to be ≥ 65 years old (57.2% v. 46.7%; p <.001) and from rural areas (17.3% v. 14.3%; p =.002) but less likely to be female (38.6% v. 47.2%; p <.001), Asian (2.7% v. 5.1%; p < 0.0001), or Hispanic (2.4% v. 3.7%; p =.003). Compared to the US NSCLC population, Lung-MAP patients were less likely to be ≥ 65 years (57.2% v. 73.5%; p <.001), female (38.6% v. 47.8%; p <.001), or a racial or ethnic minority (15.5% v. 19.3%; p <.001). Lung-MAP patients were more likely to be from socioeconomically deprived neighborhoods (42.2% vs. 36.5%, p <.001). Among patients aged < 65 years, Lung-MAP enrolled more patients reporting Medicaid/no insurance as their primary insurance (27.6% v. 17.9%; p <.001). Conclusions: Lung-MAP improved access to novel therapeutics for older patients, rural patients, those with Medicaid/no insurance, and patients from socioeconomically deprived areas compared to other NSCLC trials. Lung-MAP enrolled exclusively squamous cell lung cancers from 2014-2018, which explains decreased representation of females. Consistent with prior research, Lung-MAP patients were younger and less diverse compared to the US NSCLC population. Further examination of the underrepresentation of Asian and Hispanic patients in Lung-MAP is required to identify barriers to access and potential solutions. The conduct of a master protocol across multiple locations may improve trial participation for patients with limited access due to area-level (rural, socioeconomic deprivation) or insurance barriers.
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Affiliation(s)
- Riha Vaidya
- SWOG Statistics and Data Management Center, Seattle, WA
| | | | - Lu Qian
- SWOG Statistics and Data Management Center, Seattle, WA
| | | | | | - David R. Gandara
- Division of Hematology/Oncology, Department of Medicine, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Joel W. Neal
- Stanford University, Stanford Cancer Institute, Palo Alto, CA
| | | | - Jyoti D. Patel
- Northwestern University-Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Stacey Adam
- Foundation for the National Institutes of Health, North Bethesda, MD
| | | | - Charles David Blanke
- Division of Hematology and Medical Oncology, Oregon Health and Science University, andSWOG Group Chair’s Office, Portland, OR
| | | | - Karen Kelly
- University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Mary Weber Redman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA
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19
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Durm GA, Mamdani H, Althouse SK, Jabbour SK, Ganti AK, Jalal SI, Chesney JA, Naidoo J, Hrinczenko B, Fidler MJJ, Leal T, Feldman LE, Fujioka N, Hanna NH. Consolidation nivolumab plus ipilimumab or nivolumab alone following concurrent chemoradiation for patients with unresectable stage III non-small cell lung cancer: BTCRC LUN 16-081. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8509 Background: The PACIFIC trial demonstrated that a year of consolidation PD-(L)1 inhibition following concurrent chemoradiation (CRT) for unresectable stage III NSCLC improves overall survival (OS). The optimal duration of consolidation IO therapy in this setting is undefined. Studies in metastatic NSCLC demonstrate that combination PD-(L)1/CTLA-4 inhibition improves OS over chemotherapy alone. This trial evaluated the use of combination Nivolumab (N) plus Ipilimumab (IPI) or N alone for up to 6 months in unresectable stage III NSCLC after concurrent CRT. Methods: This is a randomized phase II, multicenter trial of 105 pts with unresectable stage IIIA/IIIB NSCLC. All pts received concurrent CRT and were then enrolled and randomized 1:1 to receive N 480mg IV q4wks (Arm A) for up to 24 weeks or N 3mg/kg IV q2 wks + IPI 1mg/kg IV q6 wks (Arm B) for up to 24 weeks. The primary endpoint is 18-month PFS compared to historical controls of CRT alone for arm A (30%) and CRT followed by Durva for arm B (44%). Secondary endpoints include OS and toxicity. Results: From 9/2017 to 4/2021, 105 pts were enrolled and randomized, 54 to N alone (A) and 51 to N + IPI (B). The baseline characteristics for arm A/B: median age (65/63), male (44.4%/56.9%), stage IIIA (55.6%/56.9%), stage IIIB (44.4%/43.1%), non-squamous (57.4%/54.9%), and squamous (42.6%/45.1%). The percentage of pts completing the full treatment was 70.4% on A and 56.9% on B (p = 0.15). Median f/u was 24.5 and 24.1 months on A and B, respectively. The 18-month PFS was 62.3% on A (p < 0.1) and 67% on B (p < 0.1), and median PFS was 25.8 months and 25.4 months, respectively. Median OS was not reached on either arm, but the 18- and 24-month OS estimates were 82.1% and 76.6% for A and 85.5% and 82.8% for B, respectively. Treatment-related adverse events (trAE) on arm A/B were 72.2%/80.4%, and grade ≥3 trAEs on arm A/B were 38.9%/52.9%. There was 1 grade 5 event on each arm (COVID19-A, Cardiac Arrest-B). The number of pts with grade ≥2 pneumonitis were 12 (22.2%) on A and 15 (29.4%) on B, with 5 (9.3%) and 8 (15.7%) grade ≥3 events, respectively. The most common ( > 10%) non-pneumonitis trAEs on A were fatigue (31.5%), rash (16.7%), dyspnea (14.8%), and hypothyroidism (13%), and on B were fatigue (31.4%), diarrhea (19.6%), dyspnea (19.6%), pruritus (17.7%), hypothyroidism (15.7%), rash (15.7%), arthralgia (11.8%), and nausea (11.8%). Conclusions: Following concurrent CRT for unresectable stage III NSCLC, both N and N + IPI demonstrated improved 18-month PFS compared with historical controls despite a shortened interval (6 months) of treatment. OS data are still maturing but 18- and 24-month OS estimates compare favorably to prior consolidation trials. Toxicity for N alone was similar to prior single-agent trials, and the combination of N + IPI resulted in a higher incidence of trAE’s, although consistent with prior reports. Clinical trial information: NCT03285321.
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Affiliation(s)
- Greg Andrew Durm
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Hirva Mamdani
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI
| | | | - Salma K. Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ
| | - Apar Kishor Ganti
- VA Nebraska Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE
| | - Shadia Ibrahim Jalal
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Richard L Roudebush VA Medical Center, Indianapolis, IN
| | - Jason Alan Chesney
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Jarushka Naidoo
- Sidney Kimmel Comprehensive Cancer Center, RCSI Cancer Centre (Dublin, Ireland), Baltimore, MD
| | | | | | - Ticiana Leal
- Emory University Winship Cancer Institute, Atlanta, GA
| | - Lawrence Eric Feldman
- University of Illinois Hospital & Health Sciences System, Jesse Brown VA Medical Center, Chicago, IL
| | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
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Spira AI, Spigel DR, Camidge DR, De Langen A, Kim TM, Goto K, Elamin YY, Shum E, Reckamp KL, Rotow JK, Goldberg SB, Gadgeel SM, Leal T, Albayya F, Fitzpatrick S, Louie-Gao M, Parepally J, Zalutskaya A, Yu HA. A phase 1/2 study of the highly selective EGFR inhibitor, BLU-701, in patients with EGFR-mutant non–small cell lung cancer (NSCLC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9142 Background: Although 3rd-generation tyrosine kinase inhibitors (TKIs), such as osimertinib, are highly effective in front-line metastatic EGFR-mutated ( EGFRm) NSCLC, treatment resistance ultimately occurs, including the emergence of the on-target C797X mutation for which there are no approved TKIs. BLU-701 is an investigational, reversible, brain-penetrant, wildtype-sparing oral TKI with nanomolar potency on common activating (exon 19 deletion and L858R) and C797X resistance mutations (Tavera L et al. AACR 2022). BLU-701 has shown promising preclinical data, including antitumor central nervous system (CNS) activity that may improve patient outcomes. Additionally, combining BLU-701 with standard of care therapies may provide enhanced disease control across multiple lines of treatment, including against heterogenous tumors, in patients with EGFRm NSCLC. Methods: HARMONY (NCT05153408) is an ongoing, global phase 1/2, open-label, first-in-human study designed to evaluate the safety, tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and antitumor activity of BLU-701 as a monotherapy or in combination with osimertinib or platinum-based chemotherapy in patients with EGFRm NSCLC. Key inclusion criteria include patients ≥18 years of age with metastatic EGFRm NSCLC; Eastern Cooperative Oncology Group performance status 0–1; and previous treatment with ≥1 EGFR-targeted TKI. Patients in the phase 2 monotherapy part must harbor an EGFR C797X resistance mutation (locally assessed). Key exclusion criteria are tumors harboring EGFR T790M mutations, EGFR exon 20 insertions, or other known driver alterations, including KRAS, BRAF V600E, NTRK1/2/3, HER2, ALK, ROS1, MET, or RET. Phase 1 primary endpoints are maximum tolerated dose, recommended phase 2 dose (RP2D), and safety. The phase 2 primary endpoint is overall response rate (ORR) by RECIST 1.1. Secondary endpoints include ORR (phase 1), duration of response, and PK/PD (phase 1 and phase 2); disease control rate, progression-free survival, overall survival, antitumor CNS activity, and safety (phase 2). The phase 1 dose escalation will adopt a Bayesian optimal interval design. Patients will be enrolled into 3 treatment cohorts: part 1A (n≈40–80; BLU-701), part 1B (n≈35; BLU-701 + osimertinib), and part 1C (n≈18; BLU-701 + carboplatin and pemetrexed). Patients in the phase 2 dose expansion (n≈24) will be treated at the RP2D of BLU-701 as monotherapy. Patients may receive treatment until disease progression, unacceptable toxicity, or other discontinuation criteria are met. Enrollment in this study has started, and sites will be open across North America, Europe, and Asia. Clinical trial information: NCT05153408.
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Affiliation(s)
- Alexander I. Spira
- NEXT Oncology Virginia and Virginia Cancer Specialists Research Institute, Fairfax, VA
| | - David R. Spigel
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | | | | | - Tae Min Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Koichi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yasir Y Elamin
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elaine Shum
- Perlmutter Cancer Center, New York University Langone Health, New York, NY
| | | | | | | | | | - Ticiana Leal
- Department of Hematology & Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
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Lortie J, Rush B, Osterbauer K, Colgan TJ, Tamada D, Garlapati S, Campbell TC, Traynor A, Leal T, Patel V, Helgager JJ, Lee K, Reeder SB, Kuchnia AJ. Myosteatosis as a Shared Biomarker for Sarcopenia and Cachexia Using MRI and Ultrasound. Front Rehabilit Sci 2022; 3:896114. [PMID: 36189019 PMCID: PMC9397668 DOI: 10.3389/fresc.2022.896114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022]
Abstract
Purpose Establish bedside biomarkers of myosteatosis for sarcopenia and cachexia. We compared ultrasound biomarkers against MRI-based percent fat, histology, and CT-based muscle density among healthy adults and adults undergoing treatment for lung cancer. Methods We compared ultrasound and MRI myosteatosis measures among young healthy, older healthy, and older adults with non-small cell lung cancer undergoing systemic treatment, all without significant medical concerns, in a cross-sectional pilot study. We assessed each participant's rectus femoris ultrasound-based echo intensity (EI), shear wave elastography-based shear wave speed, and MRI-based proton density fat-fraction (PDFF). We also assessed BMI, rectus femoris thickness and cross-sectional area. Rectus femoris biopsies were taken for all older adults (n = 20) and we analyzed chest CT scans for older adults undergoing treatment (n = 10). We determined associations between muscle assessments and BMI, and compared these assessments between groups. Results A total of 10 young healthy adults, 10 older healthy adults, and 10 older adults undergoing treatment were recruited. PDFF was lower in young adults than in older healthy adults and older adults undergoing treatment (0.3 vs. 2.8 vs. 2.9%, respectively, p = 0.01). Young adults had significantly lower EI than older healthy adults, but not older adults undergoing treatment (48.6 vs. 81.8 vs. 75.4, p = 0.02). When comparing associations between measures, PDFF was strongly associated with EI (ρ = 0.75, p < 0.01) and moderately negatively associated with shear wave speed (ρ = −0.49, p < 0.01) but not BMI, whole leg cross-sectional area, or rectus femoris cross-sectional area. Among participants with CT scans, paraspinal muscle density was significantly associated with PDFF (ρ = −0.70, p = 0.023). Histological markers of inflammation or degradation did not differ between older adult groups. Conclusion PDFF was sensitive to myosteatosis between young adults and both older adult groups. EI was less sensitive to myosteatosis between groups, yet EI was strongly associated with PDFF unlike BMI, which is typically used in cachexia diagnosis. Our results suggest that ultrasound measures may serve to determine myosteatosis at the bedside and are more useful diagnostically than traditional weight assessments like BMI. These results show promise of using EI, shear wave speed, and PDFF proxies of myosteatosis as diagnostic and therapeutic biomarkers of sarcopenia and cachexia.
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Affiliation(s)
- Jevin Lortie
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Jevin Lortie
| | - Benjamin Rush
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Katie Osterbauer
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - T. J. Colgan
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Daiki Tamada
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Sujay Garlapati
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Toby C. Campbell
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Anne Traynor
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Ticiana Leal
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Viharkumar Patel
- Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Jeffrey J. Helgager
- Department of Pathology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Kenneth Lee
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Scott B. Reeder
- Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Adam J. Kuchnia
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, United States
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22
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Rush B, Lortie J, Osterbauer K, Garlapati S, Campbell T, Traynor A, Leal T, Lee K, Reeder SB, Kuchnia A. Determining Biomarkers of Myosteatosis for Sarcopenia and Cachexia Using MRI and Ultrasound. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin Rush
- Nutritional SciencesUniversity of Wisconsin‐MadisonMadisonWI
| | - Jevin Lortie
- Nutritional SciencesUniversity of Wisconsin‐MadisonMadisonWI
| | | | - Sujay Garlapati
- Nutritional SciencesUniversity of Wisconsin‐MadisonMadisonWI
| | - Toby Campbell
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Anne Traynor
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Ticiana Leal
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
- Department of Hematology and Medical OncologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Kenneth Lee
- RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Scott B. Reeder
- RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWI
| | - Adam Kuchnia
- Nutritional SciencesUniversity of Wisconsin‐MadisonMadisonWI
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Smeltzer M, Bunn B, Choi Y, Coate L, Corona-Cruz J, Drilon A, Duma N, Edelman M, Fidler M, Gadgeel S, Goto Y, Herbst R, Hesdorffer M, Higgins K, Labdi B, Leal T, Liu S, Mazotti J, Novello S, Patel S, Popat S, Ramirez R, Reckamp K, Reguart N, Soo R, Tan A, Wolf J, Yano S, Stiles B, Baird A. OA17.04 The Global Impact of COVID-19 on Telehealth and Care for Persons With Thoracic Cancers. J Thorac Oncol 2021. [PMCID: PMC8523155 DOI: 10.1016/j.jtho.2021.08.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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24
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Malhotra J, Nikolinakos P, Leal T, Lehman J, Morgensztern D, Patel JD, Wrangle JM, Curigliano G, Greillier L, Johnson ML, Ready N, Robinet G, Lally S, Maag D, Valenzuela R, Blot V, Besse B. A Phase 1–2 Study of Rovalpituzumab Tesirine in Combination With Nivolumab Plus or Minus Ipilimumab in Patients With Previously Treated Extensive-Stage SCLC. J Thorac Oncol 2021; 16:1559-1569. [DOI: 10.1016/j.jtho.2021.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
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Shukla N, Althouse SK, Perkins S, Furqan M, Leal T, Hanna NH, Durm GA. A phase II trial of chemotherapy plus pembrolizumab in patients with advanced NSCLC previously treated with a PD-1 or PD-L1 inhibitor: Big Ten Cancer Research Consortium BTCRC-LUN15-029. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9073 Background: Chemoimmunotherapy with a platinum doublet plus a checkpoint inhibitor (CPI) is a standard of care for pts with advanced NSCLC. While some pts experience prolonged responses to initial CPI therapy, the majority of pts will eventually experience PD. It is unknown if continuing CPI treatment beyond progression has any advantages in this setting. We report the results of a phase 2 trial of chemotherapy plus pembrolizumab in pts with advanced NSCLC previously treated with a PD-1 or PD-L1 inhibitor. Methods: Pts experiencing PD after clinical benefit to CPI (PFS > 3 months) were enrolled. Pts received pembrolizumab 200 mg q3wks plus next-line chemotherapy (gemcitabine 1000 mg/m2 IV D1 and D8 q3wks, or docetaxel 60-75 mg/m2 IV D1 q3wks, or pemetrexed 500 mg/m2 IV D1 q3wks [non-squamous histology only]). The primary endpoint was PFS by RECIST 1.1. Key secondary endpoints included ORR, OS, and toxicity. The null hypothesis was median 3-month PFS with pembrolizumab plus next-line chemotherapy and the alternative hypothesis was median 6-month PFS with pembrolizumab plus chemotherapy. Results: 35 pts were enrolled. Median follow-up was 18.1 months and median age 63 (44-80). 51.4% male and 48.6% female. 82.9% were current or former smokers. Histology included 74.3% with adenocarcinoma, 20% with squamous cell carcinoma, 5.7% with NSCLC NOS. Treatment regimens included pembrolizumab/docetaxel (40%), pembrolizumab/gemcitabine (45.7%), or pembrolizumab/pemetrexed (14.3%). Median number of cycles of pembrolizumab was 6 (1-31). Median PFS using RECIST 1.1 and irRECIST was 5.2 months (95% CI 3.6-11.2, p < 0.05) and 6.9 months (95% CI 3.8-12), respectively. Median OS was 26.8 months (95% CI 13.4-30.9). Best response using RECIST 1.1 was PR (23.5%) and SD (53%). 45.7% of pts experienced G3 or higher treatment-related AEs (TRAEs). Most common TRAEs were fatigue (60%), anemia (51.4%), and nausea (42.9%). There were no treatment related deaths. Conclusions: Pembrolizumab plus next-line chemotherapy in pts with advanced NSCLC who experienced PD after clinical benefit to CPI was associated with prolonged PFS compared with historical controls of single agent chemotherapy. Further investigations into which pts would benefit from continued CPI treatment after progression is warranted. Clinical trial information: NCT03083808.
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Affiliation(s)
- Nikhil Shukla
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Sandra K. Althouse
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Greg Andrew Durm
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Bassetti MF, Sethakorn N, Lang JM, Schehr JL, Schultz Z, Morris ZS, Matkowskyj KA, Eickhoff JC, Morris B, Traynor AM, Duma N, Campbell TC, Baschnagel A, Leal T. Outcomes and safety analysis of a phase IB trial of stereotactic body radiotherapy (SBRT) to all sites of oligometastatic non-small cell lung cancer combined with durvalumab and tremelimumab. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21212] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21212 Background: Combining local ablative and systemic therapies in patients with oligometastatic NSCLC leads to improved overall survival (OS) and progression-free survival (PFS). The potential immunostimulatory effects of ablating all visible disease with SBRT in combination with dual immune checkpoint inhibition has prompted interest, but the toxicity and benefit are unknown. Methods: We conducted a phase Ib study to investigate the safety of SBRT, with doses between 30 and 50 Gy in five fractions to all sites of disease, followed by durvalumab 1500 mg IV in combination with tremelimumab 75 mg IV every 4 weeks x 4 cycles, followed by durvalumab maintenance until progression. Eligible patients had 1-6 extracranial metastatic sites, allowing multiple metastases per location, with all lesions suitable for SBRT, ECOG performance status 0-1, no actionable driver mutation, and no prior immunotherapy. The primary endpoint was safety of this combination. Secondary endpoints include PFS and OS. Dose-limiting toxicities (DLTs) (any Grade ≥ 3 toxicity) were evaluated from the first administration of SBRT until 28 days post start of durvalumab and tremelimumab. Baseline tumor mutational burden, PD-L1 expression on post-SBRT biopsy and circulating tumor cells will be correlated with outcomes. In this first cohort analysis, we assess the safety and outcomes of the first 17 patients. Results: From 2/2018-2/2021, the first 17 pts were enrolled. Characteristics of those enrolled included: median age 68 years, female/male 4/13, squamous/non-squamous 2/15, median number of non-central nervous system (CNS) metastatic sites 2 (1-5), median number of non-CNS metastatic lesions 2 (1-9), CNS involvement 6/17 (35.3%), previous treatment 4/17 (23.5%). DLTs were seen in 2/17 (11.8%) patients; DLTs were autoimmune hepatitis and autoimmune pancreatitis. Most treatment-related adverse events (TRAEs) were grade (G) 1/2. TRAEs included: all TRAEs n = 188, 88.2% (of patients); G 3 n = 17, 29.4%; G 4 n = 1, 5.8%. There were no treatment-related deaths. Five patients discontinued treatment due to grade 3/4 immune related adverse events (IRAE). At a median follow up of 20 months 11/17 (64.7%) patients are alive with 10/17 (58.8%) with no evidence of disease (NED). Six of 17 (35.2%) patients experienced disease progression and 4/17 (23.5%) patients died of disease progression. Median PFS and OS are not yet reached. Conclusions: There were no unexpected safety signals in the cohort of patients enrolled. The incidence of grade ≥ 3 IRAEs is similar to the treatment of advanced NSCLC and no additional toxicity was observed with the addition of SBRT. Clinical outcomes look promising with median OS and PFS not yet reached at 20 months median follow up. The study continues to enroll a second cohort and results will be updated. Clinical trial information: NCT03275597.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
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Ardeshir-Larijani F, Althouse SK, Leal T, Feldman LE, Abu Hejleh T, Patel M, Gentzler RD, Miller AR, Hanna NH. Phase II trial of atezolizumab (A) + carboplatin (C) + pemetrexed (P) + bevacizumab (B) in pts with stage IV non-squamous non-small cell lung cancer (NSq-NSCLC): Big Ten Cancer Research Consortium Study LUN 17-139. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9034 Background: The addition of A to C+ Paclitaxel (Pac) + plus B improved progression free survival (PFS) and overall survival (OS) compared with C + Pac + B alone in pts with metastatic NS-NSCLC. However, C + Pem is more commonly used for this patient population with a shorter infusion time and favorable toxicity profile compared with Pac. Methods: Multicenter single arm phase II clinical trial of chemo and immunotherapy-naïve pts with stage IV NSq-NSCLC. All pts received A (1200 mg, D1) + C (AUC 5, D1) + P (500 mg/m2, D1) + B (15mg/kg D1) q3 week x4. If non-PD, pts could receive maintenance APB until PD or intolerable side effects. The primary endpoint was 1 yr. PFS. Sample size of 42 planned with 87% power and two-sided type I error of 0.05 for 1 yr PFS. Secondary endpoints included ORR, disease control rate (DCR) [defined by CR + PR + SD], and toxicity. Results: 30 pts were enrolled from 11/15/2018 to 10/5/2020. The study was closed early due to 3 patient deaths, possibly related to treatment (VTE, Febrile neutropenia, colonic perforation). Median age 64 (range 38-83); M/F 20/10; mutations in EGFR/ALK/KRAS/BRAF (5/1/4/2); PD-L1 TPS < 1%/1-49%/ > 50% (9/14/6) and one pt did not have PDL-1 status. Median f/u was11.6 mos (range 1-20). ORR 35.71% (95% CI: 18.64%-55.95%), DCR 92.85% (95% CI: 83%-100%). 1yr PFS and OS were 55.27% and 82.90% respectively. The most common G III and G II toxicity were HTN (20%) and fatigue (33.3%).3 pts had G IV toxicity (Anemia, Febrile neutropenia and colonic perforation) and 2 pts had Grade (G) V toxicity (VTE, Hypoxia/Sepsis). Conclusions: Atezolizumab + Carboplatin + Pemetrexed + Bevacizumab was associated with longer DCR, PFS, and OS than historical controls. 3 on-treatment deaths, possibly related to therapy (more likely bevacizumab), prompted early closure. A phase 3 study evaluating this regimen is ongoing by another group NCT03786692. Clinical trial information: NCT03713944.
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Affiliation(s)
| | - Sandra K. Althouse
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | - Malini Patel
- Rutgers Cancer Institute of New Jersey, New Bruswick, NJ
| | | | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Boyer M, Sendur M, Rodríguez-Abreu D, Park K, Lee D, Cicin I, Yumuk P, Orlandi F, Leal T, Molinier O, Soparattanapaisam N, Langleben A, Califano R, Medgyasszay B, Hsia T, Otterson G, Xu L, Piperdi B, Samkari A, Reck M. PS01.09 Pembrolizumab Plus Ipilimumab vs Pembrolizumab Plus Placebo as 1L Therapy for Metastatic NSCLC of PD-L1 TPS ≥50%: KEYNOTE-598. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Liu SV, Reck M, Mansfield AS, Mok T, Scherpereel A, Reinmuth N, Garassino MC, De Castro Carpeno J, Califano R, Nishio M, Orlandi F, Alatorre-Alexander J, Leal T, Cheng Y, Lee JS, Lam S, McCleland M, Deng Y, Phan S, Horn L. Updated Overall Survival and PD-L1 Subgroup Analysis of Patients With Extensive-Stage Small-Cell Lung Cancer Treated With Atezolizumab, Carboplatin, and Etoposide (IMpower133). J Clin Oncol 2021; 39:619-630. [PMID: 33439693 PMCID: PMC8078320 DOI: 10.1200/jco.20.01055] [Citation(s) in RCA: 278] [Impact Index Per Article: 92.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMpower133 (ClinicalTrials.gov identifier: NCT02763579), a randomized, double-blind, phase I/III study, demonstrated that adding atezolizumab (anti-programmed death-ligand 1 [PD-L1]) to carboplatin plus etoposide (CP/ET) for first-line (1L) treatment of extensive-stage small-cell lung cancer (ES-SCLC) resulted in significant improvement in overall survival (OS) and progression-free survival (PFS) versus placebo plus CP/ET. Updated OS, disease progression patterns, safety, and exploratory biomarkers (PD-L1, blood-based tumor mutational burden [bTMB]) are reported.
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Affiliation(s)
- Stephen V Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| | | | - Tony Mok
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong, PR China
| | | | - Niels Reinmuth
- Thoracic Oncology, Asklepios Clinics Munich-Gauting, Gauting, Germany
| | | | | | - Raffaele Califano
- Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Makoto Nishio
- The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Jong-Seok Lee
- Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | | | - Yu Deng
- Genentech, Inc., South San Francisco, CA
| | - See Phan
- Genentech, Inc., South San Francisco, CA
| | - Leora Horn
- Vanderbilt University Medical Center, Nashville, TN
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Mottais A, Detry C, Beka M, Achouri Y, Leal T. WS07.4 Development of a humanised cystic fibrosis mouse model. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00954-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Enright TL, Witt JS, Burr AR, Yadav P, Leal T, Baschnagel AM. Combined Immunotherapy and Stereotactic Radiotherapy Improves Neurologic Outcomes in Patients with Non-small-cell Lung Cancer Brain Metastases. Clin Lung Cancer 2020; 22:110-119. [PMID: 33281062 DOI: 10.1016/j.cllc.2020.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to compare the outcomes of patients with non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiotherapy (SRT) alone versus SRT and immune checkpoint inhibitors (ICIs). PATIENTS AND METHODS Patients treated for their first diagnosis of intracranial metastases with SRT or SRT plus ICI were retrospectively identified. Overall survival (OS), local control (LC), distant brain failure (DBF), neurologic death, and rates of radiation necrosis were calculated. Univariate (UVA) and multivariable (MVA) analyses with competing risk analysis were performed. RESULTS Seventy-seven patients with 132 lesions were analyzed, including 44 patients with 68 lesions in the SRT group and 33 patients with 64 lesions in the SRT plus ICI group. There were no differences in baseline factors between groups. Use of ICI predicted for decreased DBF (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.24-0.84; P = .01), decreased rates of neurologic death (HR, 0.29; 95% CI, 0.10-0.85; P = .02), and better OS (HR, 0.46; 95% CI, 0.23-0.91; P = .03). Two-year LC was 97% for the SRT + ICI group, and 86% for the SRT-alone group (P = .046). Actuarial 2-year DBF was 39% for the SRT + ICI group and 66% for the SRT alone group (P = .016). On MVA, ICI use persisted in predicting lower incidence of neurologic death (HR, 0.25; 95% CI, 0.09-0.72; P = .01) and DBF (HR, 0.47; 95% CI, 0.25-0.85; P = .01) when adjusted for competing risk of death. CONCLUSION In this cohort of patients with NSCLC brain metastases, ICI use combined with SRT predicted for improved LC and OS and decreased DBF and risk of neurologic death.
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Affiliation(s)
- Tom L Enright
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jacob S Witt
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adam R Burr
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Poonam Yadav
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ticiana Leal
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Andrew M Baschnagel
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Leal T, Bueno R, Havel L, Ward J. 365 Tumor treating fields (TTFields, 150 kHz) concurrent with standard of care treatment for stage 4 non-small cell lung cancer (NSCLC) in phase 3 LUNAR Study. J Immunother Cancer 2020. [DOI: 10.1136/jitc-2020-sitc2020.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundTumor Treating Fields (TTFields) are a non-invasive, anti-mitotic treatment that disrupts the formation of the mitotic spindle and dislocation of intracellular constituents. TTFields plus temozolomide significantly extended survival in newly diagnosed glioblastoma. Efficacy of TTFields in NSCLC has been shown in preclinical models as well as safety in combination with pemetrexed in a pilot study. In the Phase 3 LUNAR study [NCT02973789], we investigated if the addition of TTFields to immune checkpoint inhibitors or docetaxel increases overall survival (OS).MethodsPatients (N=534), with squamous or non-squamous NSCLC, are stratified by their selected standard therapy (immune checkpoint inhibitors or docetaxel), histology and geographical region. Key inclusion criteria are disease progression, ECOG 0-2, no electronic medical devices in the upper torso, and absence of brain metastasis. TTFields (150 kHz) are applied to the upper torso for at >18 hours/day until progression in the thorax and/or liver. The primary endpoint is superiority in OS between patients treated with TTFields in combination with the standard of care treatments versus standard of care treatments alone. Key secondary endpoints compare the OS in patients treated with TTFields and docetaxel versus docetaxel alone, and patients treated with TTFields and immune checkpoint inhibitors vs those treated with immune checkpoint inhibitors alone. An exploratory analysis will test non-inferiority of TTFields with docetaxel compared to checkpoint inhibitors alone. Secondary endpoints include progression-free survival, radiological response rate, quality of life based on the EORTC QLQ C30 questionnaire. The sample size is powered to detect a HR of 0.75 in TTFields-treated patients versus control group. In March 2020, an independent Data Monitoring Committee (DMC) performed a review of the LUNAR trial data collected to that point. The DMC concluded that no unexpected safety issues could be found in patients treated with the combination of immune checkpoint inhibitors and TTFields, and recommended to continue the LUNAR study as planned.ResultsN/AConclusionsN/AAcknowledgementsN/ATrial RegistrationNCT02973789Ethics ApprovalThe study was approved by participating centers‘ Institution’s Ethics Boards,.NCT02973789ConsentNot applicableReferencesN/A
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Horn L, Liu SV, Mansfield AS, Mok T, Scherpereel A, Reinmuth N, Garassino MC, Carpeno JDC, Califano R, Nishio M, Orlandi F, Alexander JAA, Leal T, Cheng Y, Lee JS, Lam S, McCleland M, Deng Y, Phan S, Reck M. Abstract CT220: IMpower133: Updated OS and exploratory analyses of first-line (1L) atezolizumab (atezo) + carboplatin (C) + etoposide (E) in extensive-stage SCLC (ES-SCLC). Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: IMpower133 (NCT02763579), a global Phase I/III, randomized, double-blind, placebo (PBO)-controlled trial, showed that the addition of atezo (anti-PD-L1) to CE for 1L ES-SCLC led to statistically and clinically significant OS and PFS improvement vs CE alone. Here we report updated OS and exploratory analyses. Methods: Pts with untreated ES-SCLC were randomized 1:1 to receive four 21-day cycles of E (100 mg/m2 IV, days 1-3) + C (AUC 5 mg/mL/min IV, day 1) with atezo (1200 mg IV, day 1) or PBO, followed by maintenance therapy with atezo or PBO until intolerable toxicity, progression or loss of clinical benefit. PD-L1 testing was not required for enrollment. Coprimary endpoints were investigator-assessed PFS (RECIST 1.1) and OS. Interim and final OS analyses were planned for ≈240 and ≈306 events, respectively. OS was significant at the interim analysis. Updated OS, exploratory biomarkers and patterns of disease progression were analyzed. Results: 201 and 202 pts were randomized to receive atezo+CE and PBO+CE, respectively. The median follow-up was 22.9 mo and 302 deaths had occurred. Median OS for the atezo and PBO arms was 12.3 and 10.3 mo, respectively (HR, 0.76 [95% CI: 0.60, 0.95]; descriptive P = 0.0154). At the 18-mo landmark, the OS rate was 13% higher with atezo+CE than with PBO+CE (Table). Exploratory analyses showed treatment benefit with atezo+CE regardless of biomarker status. 181 (90.0%) And 194 (96.0%) pts in the atezo+CE and PBO+CE arms, respectively, had RECIST-defined disease progression. Progression at existing, new or existing and new lesions was numerically lower with atezo+CE than with PBO+CE. Common sites of new lesions included the CNS, lung, lymph node and liver, with similar incidences between arms. Conclusion: Adding atezo to CE continued to provide OS improvement for 1L ES-SCLC in an all-comer population. The updated results of IMpower133 further support this regimen for untreated ES-SCLC.
Landmark OSAtezo + CE, n = 201PBO + CE, n = 20212 Mo, n (%)93 (51.9)74 (39.0)18 Mo, n (%)61 (34.0)39(21.0)Median OS in biomarker subgroupsAtezo + CEPBO + CEITT (N = 403), mo12.310.3HR (95% CI)0.76 (0.61, 0.96)aITT-BEP (n = 137), mo9.98.9HR (95% CI)0.70 (0.48, 1.02)Non-BEP (n = 266), mo14.611.2HR (95% CI)0.81 (0.61, 1.08)PD-L1 expression, 1% TC or IC< 1% (n = 65), mo10.28.3HR (95% CI)0.51 (0.30, 0.89)≥ 1% (n = 72), mo9.710.6HR (95% CI)0.87 (0.51, 1.49)PD-L1 expression, 5% TC or IC< 5% (n = 108), mo9.28.9HR (95% CI)0.77 (0.51, 1.17)≥ 5% (n = 29), mo21.69.2HR (95% CI)0.60 (0.25, 1.46)Disease progression at sites, n (%)Atezo + CEPBO + CEExisting116 (57.7)131 (64.9)New86 (42.8)99 (49.0)Existing and new42 (20.9)57 (28.2)BEP, biomarker-evaluable population; ITT, intention-to-treat population.a Stratified HR. BEP included pts evaluable by PD-L1 IHC using the VENTANA SP263 assay.
Citation Format: Leora Horn, Stephen V. Liu, Aaron S. Mansfield, Tony Mok, Arnaud Scherpereel, Niels Reinmuth, Marina Chiara Garassino, Javier De Castro Carpeno, Raffaele Califano, Makoto Nishio, Francisco Orlandi, Jorge Arturo Alatorre Alexander, Ticiana Leal, Ying Cheng, Jong-Seok Lee, Sivuonthanh Lam, Mark McCleland, Yu Deng, See Phan, Martin Reck. IMpower133: Updated OS and exploratory analyses of first-line (1L) atezolizumab (atezo) + carboplatin (C) + etoposide (E) in extensive-stage SCLC (ES-SCLC) [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 CT220.
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Affiliation(s)
| | - Stephen V. Liu
- 2Georgetown Lombardi Comprehensive Cancer Center, Washington DC, DC
| | | | - Tony Mok
- 4State Key Laboratory of South China, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Arnaud Scherpereel
- 5Department of Pulmonary and Thoracic Oncology, Lille University Hospital, Lille, France
| | - Niels Reinmuth
- 6Thoracic Oncology, Asklepios Clinics Munich-Gauting, Gauting, Germany
| | | | | | - Raffaele Califano
- 9Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Makoto Nishio
- 10The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Ticiana Leal
- 13University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Ying Cheng
- 14Jilin Province Cancer Hospital, Jilin, China
| | - Jong-Seok Lee
- 15Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Democratic People's Republic of Korea
| | | | | | - Yu Deng
- 16Genentech, Inc., South San Francisco, CA
| | - See Phan
- 16Genentech, Inc., South San Francisco, CA
| | - Martin Reck
- 17LungenClinic Grosshansdorf, Airway Clinical Research Center North, German Center for Lung Research, Grosshansdorf, Germany
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Lema DA, Jankowska-Gan E, Sethakorn N, Burlingham W, Leal T. Identification of PD1-mediated regulation of antitumor antigen response in patients with NSCLC using the trans vivo DTH assay. J Immunother Cancer 2020; 8:jitc-2019-000152. [PMID: 32527929 PMCID: PMC7292037 DOI: 10.1136/jitc-2019-000152] [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] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives Emerging evidence has shown a role for tumor antigen-specific regulation in cancer. Identifying individuals with pre-existing regulatory responses may be key to understand those who are more likely to respond to Programmed Death-1 (PD-1) or PD-1 Ligand 1 (PD-L1) checkpoint blockade. We hypothesized that a functional assay could identify the role of PD-1/PD-L1 interactions on tumor-specific immune cells in the peripheral blood in patients with advanced non-small-cell lung cancer (NSCLC). Methods We performed the trans vivo delayed-type hypersensitivity assay to identify the role of PD-1/PD-L1-mediated tumor-specific immune regulation in ten patients with advanced NSCLC. Results The majority of patients had PD-1-mediated anergic immune responses towards their tumor antigens. Eight out of nine of these patients did not respond to their own tumor antigens but responded in the presence of anti-PD-1 antibody (‘PD-1 anergy’ phenotype). A minority (3/9) also had ‘active’ PD-1-mediated immune suppressive regulatory responses. Our results suggest that PD-1-anergy is a common feature of NSCLC immune responses, whereas PD-1-mediated immune suppression is present only in a minority of patients. The latter was associated with poor clinical outcomes in our sample. Conclusions Overall, our results indicate that bystander suppression or the ‘anergy-only’ phenomenon may be novel biomarkers in NSCLC and suggest prediction value based on these phenotypes.
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Affiliation(s)
- Diego A Lema
- Surgery-Transplant, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Ewa Jankowska-Gan
- Surgery-Transplant, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Nan Sethakorn
- Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - William Burlingham
- Surgery-Transplant, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Ticiana Leal
- Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
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Reynaerts A, Vermeulen F, Melotti P, Gohy S, Frédérick R, Nietert M, Leal T. WS09.2 Automated image analyses of cystic fibrosis transmembrane conductance regulation-dependent, β-adrenergically-evoked sweat secretion driven by iontophoresis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30213-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Burat B, Reynaerts A, Baiwir D, Fléron M, Eppe G, Leal T, Mazzucchelli G. P202 Sweat proteomics for cystic fibrosis diagnosis and personalised therapy. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yan M, Durm GA, Mamdani H, Ernani V, Jabbour SK, Naidoo J, Hrinczenko B, Leal T, Feldman LE, Kloecker GH, Fujioka N, Fidler MJ, Hanna NH. Consolidation nivolumab/ipilimumab versus nivolumab following concurrent chemoradiation in patients with unresectable stage III NSCLC: A planned interim safety analysis from the BTCRC LUN 16-081 trial. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9010 Background: Consolidation PD-1/PD-L1 inhibition after chemoradiation (CRT) for unresectable stage III NSCLC improves overall survival. In stage IV NSCLC, the combination of nivolumab/ipilimumab improved overall survival compared to chemotherapy in patients with PD-L1 > 1% and performed favorably in patients with PD-L1 < 1%. The safety of consolidation nivolumab/ipilimumab after CRT has not been previously assessed. Methods: In this randomized, multi-center, phase II study, a total of 105 planned pts with unresectable stage IIIA/IIIB NSCLC will receive chemoradiation, then randomize 1:1 to either nivolumab 480mg IV q4 wks (Arm A) or nivolumab 3mg/kg IV q2 wks + ipilimumab 1mg/kg IV q6 wks (Arm B), for up to 24 wks. In this planned interim analysis, the safety of the first 50 patients, with 25 patients treated on each arm, is assessed. Results: From 9/2017 to 6/2019, the first 50 patients were accrued and analyzed for this planned safety analysis. Baseline characteristics for Arm A/B: median age 64/62, stage IIIA 17/16, stage IIIB 8/9, non-squamous 14/13, squamous 11/12. The median number of cycles completed in Arm A was 6 (range 1-6, cycle length q4 wks) and in Arm B was 4 (range 1-4, cycle length q6 wks). The rate of treatment-related adverse events leading to discontinuation of therapy was 16% in Arm A and 40% in Arm B. The percentage of patients with any > grade 3 adverse event (AE) was 32% in Arm A and 44% in Arm B. With respect to immune-related AE (irAEs), the percentage of patients with any ≥grade 2 was 44% in Arm A and 60% in Arm B; any ≥ grade 3 irAEs was 16% in Arm A and 32% in Arm B. The incidence of > grade 2 pneumonitis was 16% in Arm A and 36% in Arm B. The percentage of patients with > grade 3 pneumonitis was 4% in Arm A and 20% in Arm B. No treatment-related deaths were reported on either arm. Conclusions: In the post chemoradiation setting, the incidence of > grade 3 toxicity was greater in the consolidative nivolumab/ipilimumab arm, which resulted in a higher rate of treatment discontinuation than nivolumab alone. The Data and Safety Monitoring Board recommended continued enrollment without modification to the trial and the study currently remains open to accrual (66 of 105 patients have been enrolled as of 1/17/2020). Clinical trial information: NCT03285321.
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Affiliation(s)
- Melissa Yan
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Greg Andrew Durm
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | - Jarushka Naidoo
- Johns Hopkins Kimmel Comprehensive Cancer Center and Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, MD
| | | | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Goetz H. Kloecker
- University of Louisville School of Medicine, Division of Hematology and Medical Oncology, James Brown Graham Cancer Center, Louisville, KY
| | | | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Leal T, Wang Y, Dowlati A, Lewis DA, Chen Y, Mohindra AR, Razaq M, Ahuja HG, Liu J, King DM, Sumey CJ, Ramalingam SS. Randomized phase II clinical trial of cisplatin/carboplatin and etoposide (CE) alone or in combination with nivolumab as frontline therapy for extensive-stage small cell lung cancer (ES-SCLC): ECOG-ACRIN EA5161. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9000] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
9000 Background: Immune checkpoint inhibition is now given in combination with chemotherapy for first line (1L) therapy of extensive stage small cell lung cancer (ES-SCLC). We conducted a randomized phase II study of nivolumab (anti-PD1) in combination with platinum-etoposide (CE) as 1L treatment for patients with ES-SCLC (EA5161, NCT03382561). Methods: Patients with measurable (RECIST v1.1) ES-SCLC, ECOG performance status 0 or 1, who had not received prior systemic treatment for ES-SCLC were enrolled. Patients were randomized 1:1 to nivolumab 360 mg + CE every 21 days for 4 cycles followed by maintenance nivolumab 240 mg every 2 weeks until progression or up to 2 years (arm A) or CE every 21 days for 4 cycles followed by observation (arm B). Prophylactic cranial irradiation (PCI) was permitted at the investigator’s discretion. Investigator’s choice of cisplatin or carboplatin was allowed across both arms. The primary endpoint was PFS in eligible and treated patients. Secondary endpoints included OS, ORR, and safety. Adverse events (AEs) were graded per NCI-CTCAE v4.0. Results: This study was activated in May 2018 and completed accrual in December 2018. 160 patients were enrolled. Baseline characteristics were well balanced between arms. In the ITT population (n = 160), nivolumab + CE significantly improved the PFS compared to CE with HR 0.65 (95% CI, 0.46, 0.91; p = 0.012); mPFS 5.5 versus 4.6 months, respectively. Secondary endpoint of OS was also improved with nivolumab + CE versus CE with HR 0.67 (95% CI, 0.46, 0.98; p = 0.038); mOS 11.3 versus 8.5 months. Among patients who initiated study therapy, nivolumab + CE significantly improved the PFS compared to CE with HR 0.68 (95% CI, 0.48, 1.00; p = 0.047); mPFS 5.5 versus 4.7 months, respectively; in this population, OS was also improved with nivolumab + CE versus CE with HR 0.73 (95% CI, 0.49, 1.11; p = 0.14); mOS 11.3 versus 9.3 months. The ORR was 52.29% versus 47.71%. The incidence of treatment-related grade 3/4 AEs was 77% versus 62% and AEs leading to discontinuation 6.21% versus 2.07%. Ten patients remain on maintenance nivolumab. Lethal adverse events independent of treatment were similar between the two arms (9 in arm A; 7 in arm B). Conclusions: The addition of nivolumab to CE as 1L treatment for ES-SCLC significantly improved PFS and OS. No new safety signals were observed. Clinical trial information: NCT03382561.
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Affiliation(s)
- Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Afshin Dowlati
- Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH
| | | | - Yuanbin Chen
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI
| | | | - Mohammad Razaq
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Percent IJ, Reynolds CH, Konduri K, Whitehurst MT, Nidhiry EA, Yanagihara RH, Nagasaka M, Schreeder MT, Uyeki J, Azzi G, Pachipala KK, Comer JC, Lerner RE, Leal T, Alvarez D, Neuteboom ST, Reddinger N, yan X, Shazer RL, Waterhouse DM. Phase III trial of sitravatinib plus nivolumab vs. docetaxel for treatment of NSCLC after platinum-based chemotherapy and immunotherapy (SAPPHIRE). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps9635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9635 Background: Sitravatinib is an oral spectrum-selective tyrosine kinase inhibitor that targets the TAM (TYRO3/AXL/MERTK) and split (VEGFR2/KIT) family receptor tyrosine kinases (RTKs), as well as MET. Inhibition of TAM RTKs may promote the depletion of myeloid-derived suppressor cells (MDSCs) in the tumor microenvironment (TME) and repolarize tumor associated macrophages towards the pro-inflammatory M1 phenotype. Inhibition of the split RTKs may reduce immunosuppressive regulatory T cells in addition to MDSCs within the TME. Given these pleiotropic immune-stimulating effects, sitravatinib may reverse resistance to checkpoint inhibitor therapy (CIT) and augment the antitumor immune response of nivolumab in patients (pts) with non-small cell lung cancer (NSCLC). An ongoing Phase 2 study (MRTX-500) demonstrates clinical activity of this combination in pts with metastatic non-squamous NSCLC after progression on or after CIT. Methods: Global, randomized, open-label, Phase 3 study of sitravatinib in combination with nivolumab vs docetaxel in pts with advanced non-squamous NSCLC who have progressed on or after CIT. Pts must have also received platinum-based chemotherapy either in combination with CIT or prior to CIT. Pts are randomized (1:1) to receive oral sitravatinib 120 mg once daily in continuous 28-day cycles combined with nivolumab IV 240 mg every 2 weeks or 480 mg every 4 weeks vs treatment with docetaxel 75 mg/m2 IV every 3 weeks. Patients are stratified based on number of prior treatment regimens in the advanced setting, ECOG performance status, and presence of brain metastases. Key eligibility criteria include duration of treatment of CIT of at least 4 months, discontinuation of prior treatment with CIT < 90 days prior to the date of randomization, and absence of symptomatic or uncontrolled brain metastases. The primary endpoint is overall survival (OS). Key secondary endpoints include safety and tolerability, ORR, PFS, PROs, and PK. OS will be analyzed using Kaplan-Meier methods and the stratified log-rank test to estimate and compare the median OS between the two treatment arms with 95% CI. An IDMC will review safety at regular intervals and efficacy at a planned interim analysis based on OS. Enrollment is ongoing. Clinical trial information: NCT03906071 .
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Affiliation(s)
- Ivor John Percent
- Florida Cancer Specialists South/Sarah Cannon Research Institute, Port Charlotte, FL
| | | | | | | | | | | | | | | | | | - Georges Azzi
- Holy Cross Medical Group, Michael and Dianne Bienes Comprehensive Cancer Center, Fort Lauderdale, FL
| | | | | | - Rachel E. Lerner
- Frauenshuh Cancer Center and Park Nicollet Institute, Minneapolis, MN
| | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
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Osterbauer K, Lortie J, Rush B, Colgan TJ, Lee K, Leal T, Reeder S, Kuchnia A. Identification of Muscle Wasting in Lung Cancer using MRI Proton Density Fat Fraction and Ultrasound. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.09640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leal T, Wakelee H, Reckamp K, Chiappori A, Oxnard G, Waqar S, Patel S, Blumenschein G, Neal J, Harrow K, Holzhausen A, Selvaggi G, Zhou J, Horn L. PD2.04 Long Term Efficacy and Safety of Ensartinib in Pre-Treated Anaplastic Lymphoma Kinase (ALK) Positive Non-Small Cell Lung Cancer (NSCLC) Patients (eXalt2). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.09.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wakelee H, Reckamp K, Leal T, Chiappori A, Waqar S, Zeman K, Neal J, Liang C, Harrow K, Holzhausen A, Zhou J, Selvaggi G, Horn L. P1.14-32 Rash and Efficacy in Anaplastic Lymphoma Kinase Positive (ALK+) Non-Small Cell Lung Cancer Patients Treated with Ensartinib. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mottais A, Achouri Y, Delion M, Beka M, Reynaerts A, Leal T. WS13-4 Development of a humanised cystic fibrosis mouse model. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30195-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] [Indexed: 10/26/2022]
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Malhotra J, Nikolinakos P, Leal T, Lehman J, Morgensztern D, Patel JD, Wrangle JM, Curigliano G, Dansin E, Greillier L, Johnson ML, Ready N, Robinet G, Lally S, Wong S, Avsar E, Valenzuela R, Scripture CD, Selvaggi G, Besse B. Ph1/2 study of Rova-T in combination with nivolumab (Nivo) ± ipilimumab (Ipi) for patients (pts) with 2L+ extensive-stage (ED) SCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8516 Background: Rovalpituzumab tesirine (Rova-T™) is an antibody-drug conjugate targeting DLL3, a Notch ligand expressed in SCLC but not normal tissue. Nivo ± Ipi has activity in 2L+ SCLC. Preliminary data suggest Rova-T may result in immunogenic cell death, complementing effects of Nivo ± Ipi. Methods: Eligibility: DLL3 expression (DLT phase only), progression after ≥1 line of therapy including a platinum-based regimen; ECOG 0-1; no prior immunotherapy. All pts received 0.3 mg/kg Rova-T IV on Day 1 of two 6-wk cycles. Cohort 1 (C1) also received two 3-wk cycles of 360 mg Nivo beginning on wk 4. Cohort 2 (C2) received four 3-wk cycles of 1 mg/kg Nivo and 1 mg/kg Ipi beginning on wk 4. Both cohorts then received 480 mg Nivo q4wks until PD. Primary objective: safety. Secondary: antitumor activity by RECISTv1.1, OS. Exploratory: PK. Results: As of Sep 7, 2018, 30 pts were dosed in C1 and 12 in C2. 55% were DLL3 high (≥75% DLL3 expression). 28 (67%) completed 2 planned cycles of Rova-T. 4 pts (1 in C1, 3 in C2) experienced DLTs including rash (3), pneumonitis (1) and colitis (1). C1 completed recruitment, and C2 enrollment was stopped after DLT evaluation phase. Preliminary PK showed Nivo±Ipi had no substantial effect on Rova-T exposure. Clinical trial information: NCT03026166. Conclusions: Despite activity in 2L+ ED-SCLC, Rova-T with Nivo/Ipi is not appropriate due to DLTs. Rova-T/Nivo demonstrated some durable responses; however, the safety data suggest that optimization of dose and schedule is warranted. NCT03026166.[Table: see text]
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Affiliation(s)
- Jyoti Malhotra
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | | | | | | | - Giuseppe Curigliano
- University of Milano, European Institute of Oncology, Division of Early Drug Development, Milan, Italy
| | | | - Laurent Greillier
- Assistance Publique–Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | | | - Neal Ready
- Duke University Medical Center, Durham, NC
| | | | | | | | | | | | | | | | - Benjamin Besse
- Paris-Sud University, Orsay and Gustave Roussy, Villejuif, France
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Turk AA, Leal T, Chan N, Wesolowski R, Spencer KR, Malhotra J, Lang JM, McNeel DG, O'Regan R, Mehnert JM, Eickhoff JC, Liu G, Wisinski KB. NCI9782: A phase 1 study of talazoparib in combination with carboplatin and paclitaxel in patients with advanced solid tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14640 Background: Poly(ADP-ribose) polymerase (PARP) enzymes are involved in DNA repair and activated by DNA strand breaks. DNA damage from carboplatin is associated with activation of PARP. Preclinical data indicate that PARP inhibition and trapping potentiates the anti-tumor effect of platinum chemotherapy. Talazoparib (T) is an oral, selective PARP inhibitor. This phase I study combines T with carboplatin (C) and paclitaxel (P). Methods: Two dosing schedules are being investigated. C is administered on day 1 and P on days 1, 8, and 15 of a 21-day cycle. T (100-1000mcg) is dosed once daily for days 1-7 (schedule A) or days 1-3 (schedule B). Dose escalation is by 3+3 design. Patients (pts) must have tumor type that is expected to respond to C + P or have BRCA germline or somatic mutation and adequate organ function. After 4-6 cycles of combination therapy, pts may continue the combination, change to C and intermittent T without P or change to T alone. Each schedule will have a 6 pt dose expansion at the MTD. The dose level (DL) 1 for schedule B is the previously reported MTD from schedule A (T 250mcg with C AUC 6 + P 80mg/m2). Results: Schedule B results are reported: 15 pts (median age 56 yrs [range 43-76]) have been enrolled. Primary malignancies include colorectal (4), pancreas (4), prostate (2), urothelial (2), and other (3). Dose was initiated at Schedule A MTD. DL2 (T 350mcg with C AUC 6 + P 80mg/m2) exceeded the MTD with 2 of 6 pts experiencing hematologic dose limiting toxicities (DLTs). DL1 is the confirmed schedule B MTD. Dose expansion to 6 pts is ongoing. Of the 11 pts with measurable disease, 3 (27%) had PR and 5 (45%) had SD. Pts were on study a median of 10 weeks (range 5-36+). Most common grade 3/4 AEs include leukopenia (53%), neutropenia (47%), and anemia (47%). One grade 5 AE of intracranial hemorrhage occurred, possibly related to therapy in the setting of grade 3 thrombocytopenia and concern for CNS disease. Conclusions: The schedule B MTD and RP2D is T 250 mcg with C AUC 6 and P 80mg/m2. Data from the full dose expansion will be presented. This combination was tolerated with prolonged responses seen at lower dose T in combination with C+P. Clinical trial information: NCT02317874.
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Affiliation(s)
| | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Nancy Chan
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH
| | | | - Jyoti Malhotra
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | | | - Ruth O'Regan
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Jens C. Eickhoff
- Department of Biostatistics, University of Wisconsin, Madison, WI
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, WI
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Yan M, Durm GA, Mamdani H, Ganti AK, Hrinczenko B, Jabbour SK, Feldman LE, Kloecker GH, Leal T, Almokadem S, Naidoo J, Fujioka N, Hanna NH. Interim safety analysis of consolidation nivolumab and ipilimumab versus nivolumab alone following concurrent chemoradiation for unresectable stage IIIA/IIIB NSCLC: Big Ten Cancer Research Consortium LUN 16-081. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
8535 Background: Consolidation PD-1 inhibition after chemoradiation (chemoRT) for unresectable stage IIIA/IIIB NSCLC improves overall survival. The efficacy and safety of combining a CTLA-4 inhibitor with a PD-1 inhibitor in this setting are unknown but may further improve efficacy in this patient population. Methods: In this randomized, multi-center, phase II study, 105 pts with unresectable stage IIIA/IIIB NSCLC will receive chemoRT, then randomize 1:1 to either nivolumab 480mg IV q4 wks (nivo) or nivolumab 3mg/kg IV q2 wks + ipilimumab 1mg/kg IV q6 wks (nivo/ipi), for up to 24 wks. In this interim analysis, we assess the safety of the first 20 patients treated. Results: From 9/2017 to 11/2018, 20 patients were accrued. Characteristics of those treated on the nivo arm (n = 10) were: median age 62 years, stage IIIA/B 7/3; non-squamous/squamous 7/3; and the nivo/ipi arm (n = 10): median age 61 years; stage IIIA/B 6/4; non-squamous/squamous 7/3. Most toxicities were grade 1 or 2 and the most frequently noted grade 2 AEs included fatigue (25%), pneumonia (25%), extremity pain (20%). Adverse events reported in the Nivo only arm included 81 total events with only four grade 3 events and a single grade 4 thromboembolic event. The Nivo/Ipi arm reported 101 total AEs, with only 3 grade 3 events and a single grade 4 toxicity (amylase elevation). With respect to immune-related adverse events (irAEs), in the nivo arm there were two cases of grade 2 pneumonitis and no grade 3/ 4 events. In the nivo/ipi arm, there was one grade 2 pneumonitis, three grade 3 irAEs (pneumonitis, colitis, pancreatitis), and one asympomatic grade 4 amylase elevation. No treatment-related deaths were observed in either arm. Conclusions: There were no unexpected safety signals in the first 20 patients treated on BIG10CRC LUN 16-081. The incidence of grade 3 or higher irAEs was higher in the nivo/ipi arm, as expected, but this was manageable with the use of established guidelines. The study currently remains open to accrual (32 of 105 have been randomized as of 2/8/19). Clinical trial information: NCT03285321.
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Affiliation(s)
- Melissa Yan
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | - Greg Andrew Durm
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | | | - Goetz H. Kloecker
- University of Louisville School of Medicine, Division of Hematology and Medical Oncology, James Brown Graham Cancer Center, Louisville, KY
| | - Ticiana Leal
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | | | - Jarushka Naidoo
- Johns Hopkins Kimmel Comprehensive Cancer Center and Bloomberg-Kimmel Institute for Cancer Immunotherapy, Baltimore, MD
| | | | - Nasser H. Hanna
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
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Affiliation(s)
- J M Costa
- Gastroenterology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.
| | - T Leal
- Gastroenterology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - S D Carvalho
- Pathology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - R Gonçalves
- Gastroenterology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
| | - B Arroja
- Gastroenterology Department, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal
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Leal T, Schehr J, Kaminski A, Campbell T, Traynor A, Lang J. PD.2.06 Identifying Resistance to Checkpoint Inhibitors by Screening for PD-L1 and MHC I Expression on CTCs in NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Noel S, Leal T, Obieglo K, Nijholt D, Lamontagne N, Montgomery S, Bujny M. EPS3.02 Exploratory immune assays distinguish healthy volunteer from CF patient cohorts and were validated in a dose escalation study of QR-010 in subjects with cystic fibrosis homozygous for the F508del CFTR mutation. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bassetti M, Lang J, Morris Z, Morris B, Eickhoff J, Traynor A, Campbell T, Matkowskyj K, Baschnagel A, Leal T. P3.04-009 Stereotactic Body Radiotherapy to All Sites of Oligometastatic Non-Small Cell Lung Cancer (NSCLC) Combined with Durvalumab and Tremelimumab. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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