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Guo L, Zhou G, Huang M, Tang K, Xu J, Chen J. The impact of EGFR T790M mutation status following the development of Osimertinib resistance on the efficacy of Osimertinib in non-small cell lung cancer: A meta-analysis. Clin Respir J 2024; 18:e13748. [PMID: 38584122 PMCID: PMC10999367 DOI: 10.1111/crj.13748] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/19/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Previous studies have suggested that loss of the EGFR T790M gene mutation may contribute to the development of resistance to Osimertinib in non-small cell lung cancer (NSCLC). AIMS This study aims to assess the relationship between the clinical effectiveness of Osimertinib in NSCLC patients and the T790M mutation status following resistance to Osimertinib and examine differences between plasma and tissue tests and between Asian and non-Asian groups. METHODS The PubMed, Web of Science, Cochrane, and EMBASE databases were comprehensively searched for studies on the association between T790M mutation status and the efficacy of Osimertinib between January 2014 and November 2023. Meta-analysis was carried out using Review Manager 5.4 software. RESULTS After evaluating 2727 articles, a total of 14 studies were included in the final analysis. Positive correlations between EGFR T790M mutation status after Osimertinib resistance and longer PFS (HR: 0.44, 95% CI: 0.30-0.66), longer OS (HR: 0.3, 95% CI: 0.10-0.86), longer TTD (HR: 0.69, 95% CI: 0.45-1.07), and improved clinical outcomes including PFS and TTD subgroups (HR: 0.58, 95% CI: 0.47-0.73) were observed. Subgroup analysis revealed that, compared with the blood tests, the results of the T790M mutation tests by the tissue are more significant (HR: 0.24, 95% CI: 0.11-0.52 for tissue tests; HR: 0.47, 95% CI: 0.22-1.00 for plasma tests), and the PFS of Osimertinib were similar for Asian and non-Asian patients (HR: 0.46, 95% CI: 0.31-0.68 for Asians; HR: 0.12, 95% CI: 0.01-1.27 for non-Asians). CONCLUSIONS Persistence of the T790M gene mutation after the development of Osimertinib resistance is associated with higher therapeutic benefits of Osimertinib in NSCLC patients. The results of tissue detection are more significant than those of plasma detection.
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Affiliation(s)
- Liuxian Guo
- Department of Pharmacy, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- School of Pharmaceutical Sciences, Sun Yat‐Sen University E‐132# Waihuandong RoadGuangzhou University CityGuangzhouChina
| | - Guojin Zhou
- Department of Pharmacy, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- School of Pharmaceutical Sciences, Sun Yat‐Sen University E‐132# Waihuandong RoadGuangzhou University CityGuangzhouChina
| | - Min Huang
- School of Pharmaceutical Sciences, Sun Yat‐Sen University E‐132# Waihuandong RoadGuangzhou University CityGuangzhouChina
| | - Kejing Tang
- Department of Pharmacy, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jing Xu
- Department of Pharmacy, Dermatology HospitalSouthern Medical UniversityGuangzhouChina
| | - Jie Chen
- Department of Pharmacy, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Lv H, Tian A, Zhao S, Zhao J, Song C. Next-generation sequencing-based detection in a breast MMPMN patient with EGFR T790M mutation: a rare case report and literature review. Front Oncol 2023; 13:1204041. [PMID: 37554157 PMCID: PMC10405930 DOI: 10.3389/fonc.2023.1204041] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] Open
Abstract
Multiple primary malignant neoplasms (MPMNs) are difficult to identify from the metastasis or recurrence of malignant tumors. Additionally, the genetic mutations in each primary tumor vary from each other; therefore, it is critical to explore potential abnormal genes. Next-generation sequencing (NGS) technology has emerged as a reliable approach for detecting mutated genes in primary tumors and can provide several targeted therapeutic options for patients with MPMNs. Here, we report a case of metachronous multiple primary malignant neoplasm (MMPMN) patient with primary ovarian and breast cancer. Targeted NGS genetic profiling revealed a rare EGFR T790M mutation in this patient's primary breast tumor tissue, which has only been reported previously in breast cancer (BC). Based on the NGS results, osimertinib was recommended for this patient. Although this patient did not receive osimertinib because of gastrointestinal hemorrhage, this case highlights the significance of NGS technology in the diagnosis and treatment of MPMNs.
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Affiliation(s)
- Huiyun Lv
- Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Aijuan Tian
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Shanshan Zhao
- Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jinbo Zhao
- Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Chen Song
- Department of Oncology, The Second Hospital of Dalian Medical University, Dalian, China
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3
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Yang S, Wu S, Zhao Y, Chen G, Zhu B, Li X, Wang K, Shi J, Cang S, Yao W, Fan Y, Fang J, Zhang L, Zhou J, Wu L, Zheng R, Huang M, Pan Y, Yang Z, Sun M, Yu H, Wang D, Huang J, Wang L, Shu Y, Chen Z, Liu C, Li J, Liu J, Sun S, Guo Y, Meng Z, Liu Z, Han Z, Wu G, Lu H, Ma R, Hu S, Zhao G, Zhang L, Liu Z, Xie C, Zhong D, Zhao H, Bi M, Yi S, Guo S, Yi T, Li W, Lin Y, Chen Z, Zhuang Z, Guo Z, Greco M, Wang T, Zhou A, Shi Y. Central nervous system efficacy of rezivertinib (BPI-7711) in advanced NSCLC patients with EGFR T790M mutation: A pooled analysis of two clinical studies. Lung Cancer 2023; 180:107194. [PMID: 37163774 DOI: 10.1016/j.lungcan.2023.107194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Rezivertinib (BPI-7711) is a novel third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) which revealed the systematic and central nervous system (CNS) antitumor activities for EGFR T790M-mutated advanced NSCLC in previous clinical studies and is further analyzed here. METHODS Eligible patients from the previous phase I and phase IIb studies of rezivertinib were included for pooled analysis. Post-progressive patients who received a prescribed dosage (≥180 mg) of rezivertinib orally once daily were included in full analysis set (FAS), while those with stable, asymptomatic CNS lesions, including measurable and non-measurable ones at baseline were included in CNS full analysis set (cFAS). Patients with measurable CNS lesions were included in CNS evaluable for response set (cEFR). BICR-assessed CNS objective response rate (CNS-ORR), CNS disease control rate (CNS-DCR), CNS duration of response (CNS-DoR), CNS progression-free survival (CNS-PFS), and CNS depth of response (CNS-DepOR) were evaluated. RESULTS 355 patients were included in FAS, among whom 150 and 45 patients were included in cFAS and cEFR. This pooled analysis showed the CNS-ORR was 32.0% (48/150; 95% CI: 24.6-40.1%) and the CNS-DCR was 42.0% (63/150; 95% CI: 34.0-50.3%) in cFAS, while that in cEFR were 68.9% (31/45; 95% CI: 53.4-81.8%) and 100% (45/45; 95% CI: 92.1-100.0%). In cEFR, the median CNS-DepOR and the mean of CNS-DepOR were -52.0% (range: -100.0 to 16.1%) and -46.8% (95% CI: -55.5 to -38.1%). In cFAS, the median CNS-DoR and CNS-PFS were 13.8 (95% CI: 9.6-not calculable [NC]) and 16.5 (95% CI: 13.7-NC) months. CONCLUSIONS Rezivertinib demonstrated encouraging clinical CNS efficacy among advanced NSCLC patients with EGFR T790M mutation and CNS metastases.
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Affiliation(s)
- Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, People's Republic of China
| | - Shiman Wu
- Department of Respiratory Medicine, The First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China
| | - Yanqiu Zhao
- Department of Respiratory Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Gongyan Chen
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Bo Zhu
- Department of Oncology, Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Xingya Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Jianhua Shi
- Department of Medical Oncology, Linyi Cancer Hospital, Linyi, People's Republic of China
| | - Shundong Cang
- Department of Medical Oncology, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China
| | - Wenxiu Yao
- Department of Medical Oncology, Sichuan Cancer Hospital, Chengdu, People's Republic of China
| | - Yun Fan
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Jian Fang
- Department of Thoracic Oncology, Beijing Cancer Hospital, Beijing, People's Republic of China
| | - Liangming Zhang
- Department of Medical Oncology, Yantai Yuhuangding Hospital, Yantai, People's Republic of China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, People's Republic of China
| | - Lin Wu
- Department of Thoracic Medical Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Rongsheng Zheng
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Meijuan Huang
- Thoracic Oncology Ward, Division of Medical Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yueyin Pan
- Department of Thoracic Cancer Chemotherapy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Zhixiong Yang
- Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Meili Sun
- Department of Oncology, Jinan Central Hospital Shandong University, Jinan, People's Republic of China
| | - Huiqing Yu
- Department of Palliative Care, Department of Geriatric Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Donglin Wang
- Department of Palliative Care, Department of Geriatric Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Jianan Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Lijun Wang
- Cancer Center, The Second Affiliated Hospital of Xingtai Medical College, Xingtai, People's Republic of China
| | - Yongqian Shu
- Department of Oncology, Jiangsu Province Hospital, Nanjing, People's Republic of China
| | - Zhaohong Chen
- Department of Oncology, People's Hospital of Deyang City, Deyang, People's Republic of China
| | - Chunling Liu
- Pulmonary Cancer Medicine, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Jingzhang Li
- Department of Oncology, Liuzhou People's Hospital, Liuzhou, People's Republic of China
| | - Jiwei Liu
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shenghua Sun
- Department of Respiratory Medicine, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Yanzhen Guo
- Department of Medical Oncology, The First Affiliated Hospital of Henan University of Science & Technology, Luoyang, People's Republic of China
| | - Zili Meng
- Department of Respiratory Medicine, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, People's Republic of China
| | - Zhefeng Liu
- Department of Oncology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhigang Han
- Pulmonary Cancer Medicine, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Hong Lu
- Department of Oncology, Huaihe Hospital of Henan University, Kaifeng, People's Republic of China
| | - Rui Ma
- Department of Thoracic Oncology, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China
| | - Sheng Hu
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan, People's Republic of China
| | - Guofang Zhao
- Department of Thoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
| | - Longzhen Zhang
- Department of Radiotherapy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Zheng Liu
- Department of Oncology, HanDan Central Hospital, Handan, People's Republic of China
| | - Congying Xie
- Department of Radiotherapy, The 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Hui Zhao
- Department of Respiratory Medicine, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Minghong Bi
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Shanyong Yi
- Department of Medical Oncology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shuliang Guo
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Tienan Yi
- Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Sciences, Xiangyang, People's Republic of China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine. Hangzhou, People's Republic of China
| | - Yingcheng Lin
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Zhendong Chen
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zhixiang Zhuang
- Department of Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Zhongliang Guo
- Department of Respiratory Medicine, Shanghai East Hospital, Shanghai, People's Republic of China
| | - Michael Greco
- Department of Drug Discovery, Beta Pharma Inc., Princeton, NJ, USA
| | - Tingting Wang
- Department of Clinical Development, Beta Pharma (Shanghai) Co., Ltd., Shanghai, People's Republic of China
| | - Anqi Zhou
- Department of Clinical Development, Beta Pharma (Shanghai) Co., Ltd., Shanghai, People's Republic of China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, People's Republic of China.
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4
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Kraskowski O, Stratmann JA, Wiesweg M, Eberhardt W, Metzenmacher M, Schmid KW, Herold T, Schildhaus HU, Darwiche K, Aigner C, Stuschke M, Laue K, Zaun G, Kasper S, Hense J, Sebastian M, Schuler M, Pogorzelski M. Favorable survival outcomes in epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer sequentially treated with a tyrosine kinase inhibitor and osimertinib in a real-world setting. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04839-3. [PMID: 37198447 PMCID: PMC10374675 DOI: 10.1007/s00432-023-04839-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE EGFR tyrosine kinase inhibitor (TKI) therapy in EGFR-mutated lung cancer is limited by acquired resistance. In half of the patients treated with first/second-generation (1st/2nd gen) TKI, resistance is associated with EGFR p.T790M mutation. Sequential treatment with osimertinib is highly active in such patients. Currently, there is no approved targeted second-line option for patients receiving first-line osimertinib, which thus may not be the best choice for all patients. The present study aimed to evaluate the feasibility and efficacy of a sequential TKI treatment with 1st/2nd gen TKI, followed by osimertinib in a real-world setting. METHODS Patients with EGFR-mutated lung cancer treated at two major comprehensive cancer centers were retrospectively analyzed by the Kaplan-Meier method and log rank test. RESULTS A cohort of 150 patients, of which 133 received first-line treatment with a first/second gen EGFR TKI, and 17 received first-line osimertinib, was included. Median age was 63.9 years, 55% had ECOG performance score of ≥ 1. First-line osimertinib was associated with prolonged progression-free survival (P = 0.038). Since the approval of osimertinib (February 2016), 91 patients were under treatment with a 1st/2nd gen TKI. Median overall survival (OS) of this cohort was 39.3 months. At data cutoff, 87% had progressed. Of those, 92% underwent new biomarker analyses, revealing EGFR p.T790M in 51%. Overall, 91% of progressing patients received second-line therapy, which was osimertinib in 46%. Median OS with sequenced osimertinib was 50 months. Median OS of patients with p.T790M-negative progression was 23.4 months. CONCLUSION Real-world survival outcomes of patients with EGFR-mutated lung cancer may be superior with a sequenced TKI strategy. Predictors of p.T790M-associated resistance are needed to personalize first-line treatment decisions.
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Affiliation(s)
- Oliver Kraskowski
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
| | - Jan A Stratmann
- Department of Internal Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
| | - Wilfried Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
| | - Kurt W Schmid
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Thomas Herold
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, West German Cancer Center, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Kaid Darwiche
- Section of Interventional Pneumology, Department of Pneumology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Clemens Aigner
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Department of Thoracic Surgery and Surgical Endoscopy, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Martin Stuschke
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
- Department of Radiation Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Katharina Laue
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
| | - Gregor Zaun
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
| | - Stefan Kasper
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Jörg Hense
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
| | - Martin Sebastian
- Department of Internal Medicine, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Frankfurt, Frankfurt, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany
| | - Michael Pogorzelski
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 46147, Essen, Germany.
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5
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Shi Y, Wu S, Wang K, Cang S, Yao W, Fan Y, Wu L, Huang M, Li X, Pan Y, Yang Z, Zhu B, Chen G, Shi J, Sun M, Fang J, Wang L, Chen Z, Liu C, Li J, Liu J, Sun S, Zhao Y, Guo Y, Meng Z, Liu Z, Han Z, Lu H, Ma R, Hu S, Zhao G, Liu Z, Xie C, Zhong D, Zhao H, Yu H, Zhang L, Bi M, Yi S, Guo S, Yi T, Li W, Lin Y, Shu Y, Chen Z, Guo Z, Greco M, Wang T, Shen H. Efficacy and Safety of Rezivertinib (BPI-7711) in Patients With Locally Advanced or Metastatic/Recurrent EGFR T790M-Mutated NSCLC: A Phase 2b Study. J Thorac Oncol 2022; 17:1306-1317. [PMID: 36049654 DOI: 10.1016/j.jtho.2022.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Rezivertinib (BPI-7711) is a novel third-generation EGFR tyrosine kinase inhibitor (TKI) targeting both EGFR-sensitizing mutations and EGFR T790M mutation. This study aimed to evaluate the efficacy and safety of rezivertinib in patients with locally advanced or metastatic/recurrent EGFR T790M-mutated NSCLC. METHODS Patients with locally advanced or metastatic/recurrent NSCLC with confirmed EGFR T790M mutation who progressed after first-/second-generation EGFR TKI therapy or primary EGFR T790M mutation were enrolled. Patients received rezivertinib at 180 mg orally once daily until disease progression, unacceptable toxicity, or withdrawal of consent. The primary end point was objective response rate (ORR) assessed by blinded independent central review per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary end points included disease control rate (DCR), duration of response, progression-free survival (PFS), overall survival, and safety. This study is registered with Clinical Trials.gov (NCT03812809). RESULTS A total of 226 patients were enrolled from July 5, 2019, to January 22, 2020. By the data cutoff date on January 24, 2022, the median duration of follow-up was 23.3 months (95% confidence interval [CI]: 22.8-24.0). The ORR by blinded independent central review was 64.6% (95% CI: 58.0%-70.8%), and DCR was 89.8% (95% CI: 85.1%-93.4%). The median duration of response was 12.5 months (95% CI: 10.0-13.9), and median PFS was 12.2 months (95% CI: 9.6-13.9). The median overall survival was 23.9 months (95% CI: 20.0-not calculated [NC]). Among 91 (40.3%) patients with central nervous system (CNS) metastases, the median CNS PFS was 16.6 months (95% CI: 11.1-NC). In 29 patients with more than or equal to one brain target lesion at baseline, the CNS ORR and CNS DCR were 69.0% (95% CI: 49.2%-84.7%) and 100% (95% CI: 88.1%-100%), respectively. Time to progression of CNS was 16.5 months (95% CI: 9.7-NC). Of 226 patients, 188 (83.2%) had at least one treatment-related adverse event, whereas grade more than or equal to 3 occurred in 45 (19.9%) patients. No interstitial lung disease was reported. CONCLUSIONS Rezivertinib was found to have promising efficacy and favorable safety profile for patients with locally advanced or metastatic/recurrent NSCLC with EGFR T790M mutation.
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Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, People's Republic of China.
| | - Shiman Wu
- Department of Respiratory Medicine, The First Hospital of Shanxi Medical Univers, Taiyuan, People's Republic of China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Shundong Cang
- Department of Medical Oncology, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China
| | - Wenxiu Yao
- Department of Medical Oncology, Sichuan Cancer Hospital, Chengdu, People's Republic of China
| | - Yun Fan
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Lin Wu
- Department of Thoracic Medical Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Meijuan Huang
- Department of Oncology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Xingya Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yueyin Pan
- Department of Thoracic Cancer Chemotherapy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Zhixiong Yang
- Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Bo Zhu
- Department of Oncology, Institute of Cancer, Xinqiao Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Gongyan Chen
- Department of Respiratory Medicine, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Jianhua Shi
- Department of Medical Oncology, Linyi Cancer Hospital, Linyi, People's Republic of China
| | - Meili Sun
- Department of Oncology, Ji'nan Central Hospital Shandong University, Jinan, People's Republic of China
| | - Jian Fang
- Department of Thoracic Oncology, Beijing Cancer Hospital, Beijing, People's Republic of China
| | - Lijun Wang
- Cancer Center, The Second Affiliated Hospital of Xingtai Medical College, Xingtai, People's Republic of China
| | - Zhaohong Chen
- Department of Oncology, People's Hospital of Deyang City, Deyang, People's Republic of China
| | - Chunling Liu
- Pulmonary Cancer Medicine, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Jingzhang Li
- Department of Oncology, Liuzhou People's Hospital, Liuzhou, People's Republic of China
| | - Jiwei Liu
- Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shenghua Sun
- Department of Respiratory Medicine, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Yanqiu Zhao
- Department of Respiratory Medicine, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yanzhen Guo
- Department of Medical Oncology, The First Affiliated Hospital of Henan University of Science & Technology, Luoyang, People's Republic of China
| | - Zili Meng
- Department of Respiratory Medicine, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Huai'an, People's Republic of China
| | - Zhefeng Liu
- Department of Oncology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhigang Han
- Pulmonary Cancer Medicine, Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Hong Lu
- Department of Oncology, Huaihe Hospital of Henan University, Kaifeng, People's Republic of China
| | - Rui Ma
- Department of Thoracic Oncology, Liaoning Cancer Hospital & Institute, Shenyang, People's Republic of China
| | - Sheng Hu
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan, People's Republic of China
| | - Guofang Zhao
- Department of Thoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, People's Republic of China
| | - Zheng Liu
- Department of Oncology, Handan Central Hospital, Handan, People's Republic of China
| | - Congying Xie
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Hui Zhao
- Department of Respiratory Medicine, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Huiqing Yu
- Department of Palliative Care, Department of Geriatric Oncology, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Longzhen Zhang
- Department of Radiotherapy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Minghong Bi
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Shanyong Yi
- Department of Medical Oncology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shuliang Guo
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Tienan Yi
- Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Sciences, Xiangyang, People's Republic of China
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yingcheng Lin
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Yongqian Shu
- Department of Oncology, Jiangsu Province Hospital, Nanjing, People's Republic of China
| | - Zhendong Chen
- Department of Oncology, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zhongliang Guo
- Department of Respiratory Medicine, Shanghai East Hospital, Shanghai, People's Republic of China
| | - Michael Greco
- Department of Drug Discovery, Beta Pharma Inc., Princeton, New Jersey
| | - Tingting Wang
- Department of Clinical Development, Beta Pharma (Shanghai) Co., Ltd., Shanghai, People's Republic of China
| | - Haijiao Shen
- Department of Clinical Development, Beta Pharma (Shanghai) Co., Ltd., Shanghai, People's Republic of China
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Zhang SS, Ou SHI. Spotlight on Furmonertinib (Alflutinib, AST2818). The Swiss Army Knife (del19, L858R, T790M, Exon 20 Insertions, "uncommon-G719X, S768I, L861Q") Among the Third-Generation EGFR TKIs? Lung Cancer (Auckl) 2022; 13:67-73. [PMID: 36317157 PMCID: PMC9617553 DOI: 10.2147/lctt.s385437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
Osimertinib, a third-generation (3G) epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is now considered the standard of care for the first-line (1L) treatment of advanced EGFR+ NSCLC due to statistically significant improved progression-free survival (PFS) and overall survival (OS) compared with first-generation (1G) treatment from the FLAURA trial. Recently two other 3G EGFR TKIs (aumolertinib and furmonertinib) have been approved in China for treatment of EGFR T790M+ NSCLC. Randomized Phase 3 trials of these two 3G EGFR TKIs have also demonstrated PFS over gefitinib respectively. Among these two Chinese home-grown, 3G EGFR TKIs, furmonertinib seems to most closely resemble osimertinib in terms of dosing regimen, efficacy and adverse events profile. In this article, we reviewed the clinical activity and adverse events of furmonertinib at 80 mg daily (approved dose), potential usage of 160 mg daily for CNS metastasis in EGFR+ NSCLC, and usage of 160 mg or 240 mg daily in EGFR exon20 insertion positive (EGFRex20ins+) NSCLC patients.
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Affiliation(s)
- Shannon S Zhang
- University of California Irvine School of Medicine, Department of Medicine, Department of Medicine, Orange, CA, USA
| | - Sai-hong Ignatius Ou
- University of California Irvine School of Medicine, Department of Medicine, Department of Medicine, Orange, CA, USA,Chao Family Comprehensive Cancer Center, Orange, CA, USA,Correspondence: Sai-hong Ignatius Ou, Chao Family Comprehensive Cancer Center, Division of Hematology and Oncology, Department of Medicine, University of California Irvine School of Medicine, 200 South Manchester Ave, Suite 400, Orange, CA, 92868, USA, Email
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Dal Maso A, Del Bianco P, Cortiula F, Nardo G, Zulato E, Bonanno L, Follador A, De Maglio G, Pasello G, Indraccolo S. EGFR T790M testing through repeated liquid biopsy over time: a real-world multicentric retrospective experience. J Thorac Dis 2022; 14:3364-3375. [PMID: 36245580 PMCID: PMC9562526 DOI: 10.21037/jtd-22-745] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
Background About 15% of non-small cell lung cancers (NSCLCs) harbor epidermal growth factor receptor (EGFR) mutations. Upfront treatment with first and second generation EGFR tyrosine kinase inhibitors (1-2gen TKIs) is superior to chemotherapy. The most frequent resistance mechanism to 1-2gen TKIs is EGFR T790M mutation, which is targeted by osimertinib. T790M mutation can be revealed by liquid biopsy (LB) or by tissue rebiopsy (TB). LB is easily feasible but less sensitive than TB. We focused on repeated LBs and analyzed clinical features associated with EGFR T790M detection. Methods This is a retrospective multicenter observational study including EGFR-mutant NSCLC consecutive patients with disease progression (PD) after 1-2gen TKIs and with a first EGFR LB negative for T790M mutation, referred between 2016 and 2019. Aims of the study were to determine the prevalence of T790M mutation using LB in a real-life setting and the prevalence of T790M mutation by repeated LBs. We explored the association of T790M with clinical-pathological features and, through a survey, we evaluated the decision-making process behind LB request. Data on TBs were also collected. Results One hundred and ten patients were included in the study, for a total of 326 LBs. Median number of LB per patient was 3.0. The T790M prevalence through LB was 34.5%. Over time, significantly more LBs were requested "at clinical and radiological PD" and "at radiological PD" compared to "arbitrarily". The probability of finding the T790M mutation for a patient across each subsequent LB did not significantly change. Liver and lymph node PD were significantly correlated to T790M positivity. Notably, "at PD" compared to "arbitrarily" LB request and liver, bone or lymph node PD were correlated to the detection of any EGFR mutation in cfDNA. TB was performed in 59.7% of patients with a T790M negative LB and 18.8% of them were T790M positive. In most cases, TB was not feasible due to anatomical reasons. In our study population, the overall T790M prevalence-detected with both LB and TB-was 42.7%. Conclusions Repeated LB testing can be useful in a real-life scenario to detect EGFR T790M mutation.
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Affiliation(s)
- Alessandro Dal Maso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy;,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Francesco Cortiula
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giorgia Nardo
- Basic Experimental and Translational Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Elisabetta Zulato
- Basic Experimental and Translational Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Laura Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Alessandro Follador
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giovanna De Maglio
- Department of Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Giulia Pasello
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy;,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy;,Basic Experimental and Translational Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
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8
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Li M, Qin J, Xie F, Gong L, Han N, Lu H. L718Q/V mutation in exon 18 of EGFR mediates resistance to osimertinib: clinical features and treatment. Discov Oncol 2022; 13:72. [PMID: 35943592 PMCID: PMC9363540 DOI: 10.1007/s12672-022-00537-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022] Open
Abstract
Osimertinib, a mutant-specific third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), is emerging as the preferred first-line of treatment for EGFR-mutant lung cancer. However, osimertinib resistance inevitably develops among patients treated with the drug. The modal resistance mechanisms of osimertinib include the occurrence of epithelial transition factor (c-MET) amplification and C797S mutation, whereas rare mutations are presented as case reports. Recently, the L718Q/V mutation in exon 18 of EGFR has been reported to contribute to one of the possible mechanisms of resistance. The clinical features and subsequent treatment strategies for this mutation require further research. This study retrospectively enrolled NSCLC patients with the L718Q/V mutation from 2017 to 2021 at the Cancer Hospital of the University of the Chinese Academy of Sciences (Zhejiang Cancer Hospital), as well as additional patients with the same mutation from PubMed literature, to summarize the clinical features of the mutation. The association between the detection of L718Q/V and resistance to osimertinib, as well as impacts on the therapeutic process and outcome, was analyzed. We included a total of two patients diagnosed at Zhejiang Cancer Hospital and twelve patients from the literature. Of the fourteen total patients, 64.3% were male and 35.7% were female. The average age of the group was 60.2 years (range 45-72). A history of tobacco use was common among the group. In all of the cases we considered, the L718Q/V mutation was secondary to the L858R mutation. The second-generation TKI afatinib was found to provide a high disease control rate (DCR) (85.7%, 6/7) and relatively low objective response rate (ORR) (42/9%, 3/7). The median progression free survival (mPFS) for this treatment reached 2 months (1-6 months). The patients failed to benefit from chemotherapy combined with immunotherapy or other TKI medications. Due to the limited number of cases considered in this study, future studies should explore drugs that more precisely target the L718Q/V mutation of EGFR exon 18.
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Affiliation(s)
- Meihui Li
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology On Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022 Hangzhou, P.R. China
- The First Clinical Medical College, Wenzhou Medical University, 325035 Wenzhou, P. R. China
| | - Jing Qin
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology On Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022 Hangzhou, P.R. China
| | - Fajun Xie
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology On Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022 Hangzhou, P.R. China
| | - Lei Gong
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology On Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022 Hangzhou, P.R. China
| | - Na Han
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology On Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022 Hangzhou, P.R. China
| | - Hongyang Lu
- Zhejiang Key Laboratory of Diagnosis & Treatment Technology On Thoracic Oncology (Lung and Esophagus), Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Department of Thoracic Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), 310022 Hangzhou, P. R. China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022 Hangzhou, P.R. China
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9
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Shi Y, Li B, Wu L, Pan Y, Pan Z, Liu Y, Fan Y, Ji Y, Fang J, Shi Q, Shi J, Gao H, Hu Y, Wang X, He Z, Ma R, Zhang Y, Jiang D, Bai Y, Zhang Y, Huang L, Zhou T, Liu H, Wang D, Wen Q, Chen G, Zang A, Wang X, Zhang X, Hu J, Yang R, Zhang G, Gu K, Lin W, Qiming W, Wei Z, Zeng L, Lu H, Helong Z, Chen H, Song T. Efficacy and safety of Limertinib (ASK120067) in patients with locally advanced or metastatic EGFR T790M mutated non-small cell lung cancer: a multicenter, single-arm, phase 2b study. J Thorac Oncol 2022; 17:1205-1215. [PMID: 35659581 DOI: 10.1016/j.jtho.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Limertinib (ASK120067) is a newly developed third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) targeting both sensitizing EGFR and EGFR T790M mutations. This study aimed to evaluate the efficacy and safety of limertinib in patients with locally advanced or metastatic EGFR T790M mutated non-small cell lung cancer (NSCLC). METHODS This is a single-arm, open-label, phase 2b study conducted at 62 hospitals across China. Patients with locally advanced or metastatic NSCLC with centrally confirmed EGFR T790M mutations in tumor tissue or blood plasma who progressed after first or second-generation EGFR-TKIs or with primary EGFR T790M mutations were enrolled. Patients received limertinib 160mg orally twice daily, until disease progression, or unacceptable toxicity. The primary endpoint was objective response rate (ORR) assessed by Independent Review Committee (IRC) per the Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints included disease control rate (DCR), progression-free survival (PFS), duration of response (DoR), overall survival (OS), and safety. Safety was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. RESULTS From June 24, 2019 to Feb 25, 2021, a total of 301 patients were enrolled and received the treatment of limertinib. All patients entered the full analysis set (FAS) and safety set (SS). By the data cutoff date on Sept 9, 2021, 76 (25.2%) remained on treatment. The median follow-up time was 10.4 months (range 0.3-26.3). Based on FAS, the IRC-assessed ORR was 68.8% (95%CI 63.2%-74.0%) and DCR was 92.4% (95%CI 88.8%-95.1%). The median PFS was 11.0 months (95%CI 9.7-12.4), median DoR was 11.1 months (95%CI 9.6-13.8), and median OS was not reached (NR) (95%CI 19.7 months-NR). Objective responses were achieved across all pre-specified subgroups. For 99 (32.9%) patients with central nervous system (CNS) metastases, the ORR was 64.6% (95%CI 54.4%-74.0%), median PFS was 9.7 months (95%CI 5.9-11.6), and median DoR was 9.6 months (95%CI 8.1-15.2). For 41 patients who had evaluable CNS lesion, the confirmed CNS-ORR was 56.1% (95%CI 39.7%-71.5%) and median CNS-PFS was 10.6 months (95%CI 5.6-NE). In SS, 289 (96.0%) patients experienced at least one treatment related adverse event (TRAE), with the most common being diarrhea (81.7%), anemia (32.6%), rash (29.9%) and appetite decrease (28.2%). Grade ≥3 TRAEs occurred in 104 (34.6%) patients, with the most common including diarrhea (13.0%), hypokalemia (4.3%), anemia (4.0%) and rash (3.3%). TRAEs leading to dose interruption and dose discontinuation occurred in 24.6% and 2% of patients, respectively. No TRAE leading to death occurred. CONCLUSION Limertinib (ASK120067) demonstrated promising efficacy and an acceptable safety profile for the treatment of patients with locally advanced or metastatic EGFR T790M mutated NSCLC. CLINICAL TRIAL INFORMATION NCT03502850.
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Affiliation(s)
- Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China.
| | - Baolan Li
- Integrated Department, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Lin Wu
- Department of Medical Oncology-chest (2), Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yueyin Pan
- Cancer chemotherapy Department, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China
| | - Zhijie Pan
- Department of Respiratory Diseases, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yunpeng Liu
- Department of Medical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yun Fan
- Department of Thoracic Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yinghua Ji
- Medical Oncology ward 2, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Jian Fang
- Department of Thoracic Oncology II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/ Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Qin Shi
- Oncology Department, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | - Jianhua Shi
- Department II of Medical Oncology, Linyi Cancer Hospital, Linyi, China
| | - Hongjun Gao
- Pulmonary Oncology Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanping Hu
- Department of Thoracic Oncology, Hubei Cancer Hospital, The Affiliated Cancer Hospital of Tongji School of Medicine , Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wang
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, China
| | - Zhiyong He
- Department of thoracic oncology, Fujian Cancer Hospital, The Affiliated Cancer Hospital of Fujian Medical University, Fuzhou, China
| | - Rui Ma
- Department II of Chest physicians , Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yu Zhang
- Department I of Respiratory Medicine, Nanjing Chest Hospital, Medical School of Southeast University, Nanjing, China
| | - Da Jiang
- Medical of oncology, The fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuansong Bai
- Oncology Hematology Department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yi Zhang
- Thoracic Surgery Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Linian Huang
- Department Of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Tong Zhou
- Oncology Department, Changzhou Tumor Hospital, Changzhou, China
| | - Hailong Liu
- Department of Thoracic Medical Oncology, First People's Hospital of Chenzhou City, Chenzhou, China
| | - Daqing Wang
- Department of Medical Oncology, Harrison International Peace Hospital, Hengshui, China
| | - Qinglian Wen
- Oncology Department, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gongyan Chen
- Department of Medical Oncology, Tumor Hospital of Harbin Medical University, Harbin, China
| | - Aimin Zang
- medicine oncology, Affiliated Hospital of Hebei University, Baoding, China
| | - Xiuwen Wang
- Department of Medical Oncology, Qilu HospItal of Shandong University, Jinan, China
| | - Xinri Zhang
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianbing Hu
- Oncology Department, Yueyang Central hospital, Yueyang, China
| | - Runxiang Yang
- Internal second Department, Yunnan Cancer hospital, Kunming, China
| | - Guojun Zhang
- Dept.1 of pulmonary & critical care medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kangsheng Gu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wang Lin
- Department of Medical Oncology, Hainan General Hospital, Haikou, China
| | - Wang Qiming
- Department of Medical Oncology, Henan Cancer Hospital, Zhengzhou, China
| | - Zonghui Wei
- Pulmonary and Critical Care Medicine Dept, The People's Hospital of Nanchuan, Chongqing, China
| | - Li Zeng
- Department of Oncology, 3201 Hospital, Langfang, China
| | - Hongda Lu
- Department of Oncology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhang Helong
- Department of Oncology, Tangdu Hospital, The fourth Military Medical University, Xi'an, China
| | - Hongyu Chen
- Jiangsu Aosaikang Pharmaceutical Co. Ltd, Nanjing, China
| | - Tingting Song
- Jiangsu Aosaikang Pharmaceutical Co. Ltd, Nanjing, China
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Abstract
INTRODUCTION Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) can significantly improve patient prognosis when used on patients with EGFR-mutant non-small cell lung cancer (NSCLC), but those patients often develop acquired resistance after 9-14 months of treatment. These resistance mechanisms are complex and diverse, with the EGFR T790M mutation being the most common. Aumolertinib is a new third-generation EGFR-TKI that is highly selective for EGFR-sensitizing mutations and EGFR T790M resistance mutation. AREAS COVERED This review summarizes the mechanism of action, efficacy, and safety of aumolertinib for EGFR T790M mutation-positive NSCLC. The authors provide their expert opinions on the use of this drug, including its future prospects. EXPERT OPINION Aumolertinib has shown good efficacy and safety for advanced EGFR T790M mutation-positive NSCLC patients who have progressed after EGFR-TKI treatment. It is expected to become a new treatment option, and to aid the establishment of new treatment standards. A phase III clinical study is currently underway to evaluate the suitability of aumolertinib as a first-line treatment. At present, more drug combinations and different applicable populations are being further explored. Future challenges include exploring mechanisms of aumolertinib resistance and determining its efficacy in European and American populations.
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Affiliation(s)
- Jingyi Wang
- The Second Department of Thoracic Oncology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, P. R. China
| | - Lin Wu
- The Second Department of Thoracic Oncology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, P. R. China
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Shi Y, Zhao Y, Yang S, Zhou J, Zhang L, Chen G, Fang J, Zhu B, Li X, Shu Y, Shi J, Zheng R, Wang D, Yu H, Huang J, Zhuang Z, Wu G, Zhang L, Guo Z, Greco M, Li X, Zhang Y. Safety, Efficacy and Pharmacokinetics of Rezivertinib (BPI-7711) in Advanced Non-Small Cell Lung Cancer Patients with EGFR T790M Mutation: a Phase 1 Dose-Escalation and Dose-Expansion Study. J Thorac Oncol 2022; 17:708-717. [PMID: 35181498 DOI: 10.1016/j.jtho.2022.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/14/2021] [Revised: 01/11/2022] [Accepted: 01/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Rezivertinib (BPI-7711) is a novel third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor selective for EGFR-sensitizing and T790M mutations. This study was designed to assess the safety, efficacy and pharmacokinetics of rezivertinib for patients having advanced non-small cell lung cancer (NSCLC) with EGFR T790M mutation. METHODS This phase 1 study (NCT03386955) was conducted across 20 sites in China. Patients received rezivertinib at six oral dose levels (30 mg, 60 mg, 120 mg, 180 mg, 240 mg, 300 mg) once daily until disease progression, unacceptable toxicity, or patient withdrawal. The primary end points were safety for the dose-escalation phase and objective response rate (ORR) by the blinded independent central review (BICR) for the total study population. RESULTS A total of 19 patients in dose-escalation phase using the standard 3+3 design principle and 153 patients in dose-expansion phase were enrolled from September 11, 2017 to August 23, 2019. The data cut-off date was on June 15, 2020. No dose limiting toxicity occurred in the dose-escalation phase. The treatment-related adverse events were observed in 82.0% (141 of 172) of patients and 17.4% (30 of 172) had ≥ grade 3, among which neutrophil count decreased (2.9%), leukopenia (2.9%) and pneumonia (2.9%) were the most common. The overall BICR-assessed ORR was 59.3% (102/172, 95% confidence interval [CI]: 51.6, 66.7), and the median progression-free survival was 9.7 (95% CI: 8.3, 11.1) months. CONCLUSIONS Rezivertinib showed promising efficacy with a manageable safety profile in patients with EGFR T790M-mutated advanced NSCLC. Further study is warranted.
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Affiliation(s)
- Yuankai Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China.
| | | | - Sheng Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Jianying Zhou
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Jian Fang
- Beijing Cancer Hospital, Beijing, China
| | - Bo Zhu
- Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xingya Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | | | - Rongsheng Zheng
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | | | - Huiqing Yu
- Chongqing Cancer Hospital, Chongqing, China
| | - Jianan Huang
- The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhixiang Zhuang
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | | | | | - Xiao Li
- Beta Pharma (Shanghai) Co., Ltd, Shanghai, China
| | - Yu Zhang
- Beta Pharma (Shanghai) Co., Ltd, Shanghai, China
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12
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Lee C, Kim M, Kim DW, Kim TM, Kim S, Im SW, Jeon YK, Keam B, Ku JL, Heo DS. Acquired Resistance Mechanism of EGFR Kinase Domain Duplication to EGFR TKIs in Non-Small Cell Lung Cancer. Cancer Res Treat 2022; 54:140-149. [PMID: 33940786 PMCID: PMC8756122 DOI: 10.4143/crt.2021.385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Epidermal growth factor receptor kinase domain duplication (EGFR-KDD) is a rare and poorly understood oncogenic mutation in non-small cell lung cancer (NSCLC). We aimed to investigate the acquired resistance mechanism of EGFR-KDD against EGFR-TKIs. MATERIALS AND METHODS We identified EGFR-KDD in tumor tissue obtained from a patient with stage IV lung adenocarcinoma and established the patient-derived cell line SNU-4784. We also established several EGFR-KDD Ba/F3 cell lines: EGFR-KDD wild type (EGFR-KDDWT), EGFR-KDD domain 1 T790M (EGFR-KDDD1T), EGFR-KDD domain 2 T790M (EGFR-KDDD2T), and EGFR-KDD both domain T790M (EGFR-KDDBDT). We treated the cells with EGFR tyrosine kinase inhibitors (TKIs) and performed cell viability assays, immunoblot assays, and ENU (N-ethyl-N-nitrosourea) mutagenesis screening. RESULTS In cell viability assays, SNU-4784 cells and EGFR-KDDWT Ba/F3 cells were sensitive to 2nd generation and 3rd generation EGFR TKIs. In contrast, the T790M-positive EGFR-KDD Ba/F3 cell lines (EGFR-KDDT790M) were only sensitive to 3rd generation EGFR TKIs. In ENU mutagenesis screening, we identified the C797S mutation in kinase domain 2 of EGFR-KDDBDT Ba/F3 cells. Based on this finding, we established an EGFR-KDD domain 1 T790M/domain 2 cis-T790M+C797S (EGFR-KDDT/T+C) Ba/F3 model, which was resistant to EGFR TKIs and anti-EGFR monoclonal antibody combined with EGFR TKIs. CONCLUSION Our study reveals that the T790M mutation in EGFR-KDD confers resistance to 1st and 2nd generation EGFR TKIs, but is sensitive to 3rd generation EGFR TKIs. In addition, we identified that the C797S mutation in kinase domain 2 of EGFR-KDDT790M mediates a resistance mechanism against 3rd generation EGFR TKIs.
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Affiliation(s)
- Chaelin Lee
- Cancer Research Institute, Seoul National University, Seoul,
Korea
| | - Miso Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Dong-Wan Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul,
Korea
| | - Tae Min Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Soyeon Kim
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul,
Korea
| | - Sun-Wha Im
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul,
Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Bhumsuk Keam
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Ja-Lok Ku
- Cancer Research Institute, Seoul National University, Seoul,
Korea
| | - Dae Seog Heo
- Cancer Research Institute, Seoul National University, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
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13
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Lu S, Wang Q, Zhang G, Dong X, Yang CT, Song Y, Chang GC, Lu Y, Pan H, Chiu CH, Wang Z, Feng J, Zhou J, Xu X, Guo R, Chen J, Yang H, Chen Y, Yu Z, Shiah HS, Wang CC, Yang N, Fang J, Wang P, Wang K, Hu Y, He J, Wang Z, Shi J, Chen S, Wu Q, Sun C, Li C, Wei H, Cheng Y, Su WC, Hsia TC, Cui J, Sun Y, Ou SHI, Zhu VW, Chih-Hsin Yang J. Efficacy of Aumolertinib (HS-10296) in Patients With Advanced EGFR T790M+ NSCLC: Updated Post-National Medical Products Administration Approval Results From the APOLLO Registrational Trial. J Thorac Oncol 2021; 17:411-422. [PMID: 34801749 DOI: 10.1016/j.jtho.2021.10.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Aumolertinib (formerly almonertinib; HS-10296) is a novel third-generation EGFR tyrosine kinase inhibitor (TKI) with revealed activity against EGFR-sensitizing mutations and EGFR T790M mutation. METHODS Patients with locally advanced or metastatic NSCLC who developed an EGFR T790M mutation after progression on first- or second-generation EGFR TKI therapy were enrolled in this registrational phase 2 trial of aumolertinib at 110 mg orally once daily (NCT02981108). The primary end point was objective response rate (ORR) by independent central review. RESULTS A total of 244 patients with EGFR T790M-positive NSCLC were enrolled. The ORR by independent central review was 68.9% (95% confidence interval [CI]: 62.6-74.6). The disease control rate was 93.4% (95% CI: 89.6-96.2). The median duration of response was 15.1 months (95% CI: 12.5-16.6). The median progression-free survival was 12.4 months (95% CI: 9.7-15.0). Among 23 patients with assessable central nervous system (CNS) metastases, the CNS-ORR and CNS-disease control rate were 60.9% (95% CI: 38.5-80.3) and 91.3% (95% CI: 72.0-98.9), respectively. The median CNS-duration of response was 12.5 months (95% CI: 5.6-not reached). Treatment-related adverse events of more than or equal to grade 3 occurred in 16.4% of the patients, with the most common being increased blood creatine phosphokinase level (7%) and increased alanine aminotransferase level (1.2%). The relative dose density of aumolertinib was 99.2% in this study. CONCLUSIONS Aumolertinib is an effective and well-tolerated third-generation EGFR TKI for patients with EGFR T790M-positive advanced NSCLC after disease progression on first- and second-generation EGFR TKI therapy. On the basis of these findings, aumolertinib was approved in the People's Republic of China for patients positive for EGFR T790M NSCLC.
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Affiliation(s)
- Shun Lu
- Department of Medical Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, People's Republic of China
| | - Guojun Zhang
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Xiaorong Dong
- Cancer Center, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yong Song
- Department of Respiration, General Hospital of The PLA Eastern Theater Command, Nanjing, People's Republic of China
| | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - You Lu
- Department of Thoracic Oncology, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Hongming Pan
- Department of Oncology, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Chao-Hua Chiu
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Zhehai Wang
- Department of Oncology, Shandong Cancer Hospital, Jinan, People's Republic of China
| | - Jifeng Feng
- Department of Internal Medicine, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xingxiang Xu
- Department of Respiration, Northern Jiangsu People's Hospital, The Affiliated Hospital to Yangzhou University, Yangzhou, People's Republic of China
| | - Renhua Guo
- Department of Medical Oncology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Jianhua Chen
- Department of Medical Oncology-Chest, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Haihua Yang
- Department of Radiotherapy, Taizhou Hospital of Zhejiang Province, Taizhou, People's Republic of China
| | - Yuan Chen
- Department of Oncology, Tongji Medical College Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Zhuang Yu
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Her-Shyong Shiah
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chin-Chou Wang
- Department of Occupational Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Nong Yang
- Department of Pulmonary Gastroenterology, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Jian Fang
- Department of Chest Medicine, Beijing Cancer Hospital, Beijing, People's Republic of China
| | - Ping Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China
| | - Kai Wang
- Department of Respiration, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yanping Hu
- Department of Thoracic Oncology, Hubei Cancer Hospital, Wuhan, People's Republic of China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Ziping Wang
- Department of Chest Medicine, Beijing Cancer Hospital, Beijing, People's Republic of China
| | - Jianhua Shi
- Department of Internal Medicine, Linyi Cancer Hospital, Linyi, People's Republic of China
| | - Shaoshui Chen
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, People's Republic of China
| | - Qiong Wu
- Clinical Medical Group, Jiangsu Hansoh Pharmaceutical Group Co. Ltd., Shanghai, People's Republic of China
| | - Changan Sun
- Clinical Operation Group, Jiangsu Hansoh Pharmaceutical Group Co. Ltd., Shanghai, People's Republic of China
| | - Chuan Li
- Clinical Medical Group, Jiangsu Hansoh Pharmaceutical Group Co. Ltd., Shanghai, People's Republic of China
| | - Hongying Wei
- Clinical Medical Group, Jiangsu Hansoh Pharmaceutical Group Co. Ltd., Shanghai, People's Republic of China
| | - Ying Cheng
- Department of Internal Medicine, Jilin Cancer Hospital, Changchun, People's Republic of China
| | - Wu-Chou Su
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Taipei, Taiwan
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jiuwei Cui
- Department of Oncology, The First Bethune Hospital of Jilin University, Changchun, People's Republic of China
| | - Yuping Sun
- Department of Oncology, Jinan Central Hospital, Jinan, People's Republic of China
| | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, Department of Medicine, Division of Hematology and Oncology, University of California, Irvine School of Medicine, Orange, California
| | - Viola W Zhu
- Chao Family Comprehensive Cancer Center, Department of Medicine, Division of Hematology and Oncology, University of California, Irvine School of Medicine, Orange, California
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14
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Wang CC, Lai CH, Chang YP, Chang HC, Tseng CC, Huang KT, Lin MC. Comparing survival and treatment response of patients with acquired T790M mutation second-line osimertinib versus sequential treatment of chemotherapy followed by osimertinib: A real-world study. Thorac Cancer 2021; 12:3263-3272. [PMID: 34704378 PMCID: PMC8636197 DOI: 10.1111/1759-7714.14198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate the survival benefit with first/second generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKIs) and osimertinib in different treatment sequences. Methods We retrospectively screened 3807 patients diagnosed with cancer between 2013 and 2019 at Kaohsiung Chang Gung Memorial Hospital. In total, 76 patients with EGFR T790M mutation who received osimertinib after re‐biopsy or liquid biopsy were enrolled for the analysis. Results The median progression‐free survival (PFS), median overall survival (OS), and median OS2 of the 76 patients were 11.93, 66.53, and 29.57 months, respectively. A significant difference was observed in the disease control rate between those who received osimertinib treatment after chemotherapy (group A) and those who received osimertinib immediately following EGFR‐TKI therapy (group B) (34 [94.4%] vs. 31 [77.5%], p = 0.036). In addition, chronic obstructive pulmonary disease tended to be a poor prognostic factor for PFS and OS. Conclusion This real‐world analysis revealed that previous chemotherapy could affect the treatment outcomes of patients with non‐small cell lung cancer treated with osimertinib. Osimertinib treatment following first/second generation EGFR‐TKI treatment or chemotherapy resulted in improved survival benefit.
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Affiliation(s)
- Chin-Chou Wang
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Chien-Hao Lai
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ping Chang
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huang-Chih Chang
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Cheng Tseng
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Chih Lin
- Divisions of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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15
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Magios N, Bozorgmehr F, Volckmar AL, Kazdal D, Kirchner M, Herth FJ, Heussel CP, Eichhorn F, Meister M, Muley T, Elshafie RA, Fischer JR, Faehling M, Kriegsmann M, Schirmacher P, Bischoff H, Stenzinger A, Thomas M, Christopoulos P. Real-world implementation of sequential targeted therapies for EGFR-mutated lung cancer. Ther Adv Med Oncol 2021; 13:1758835921996509. [PMID: 34408792 PMCID: PMC8366107 DOI: 10.1177/1758835921996509] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/27/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Epidermal growth factor receptor-mutated (EGFR+) non-small-cell lung cancer (NSCLC) patients failing tyrosine kinase inhibitors (TKI) can benefit from next-line targeted therapies, but implementation is challenging. Methods: EGFR+ NSCLC patients treated with first/second-generation (1G/2G) TKI at our institution with a last follow-up after osimertinib approval (February 2016), were analyzed retrospectively, and the results compared with published data under osimertinib. Results: A total of 207 patients received erlotinib (37%), gefitinib (16%) or afatinib (47%). The median age was 66 years, with a predominance of female (70%), never/light-smokers (69%). T790M testing was performed in 174/202 progressive cases (86%), positive in 93/174 (53%), and followed by osimertinib in 87/93 (94%). Among the 135 deceased patients, 94 (70%) received subsequent systemic treatment (43% chemotherapy, 39% osimertinib), while 30% died without, either before (4%) or after progression, due to rapid clinical deterioration (22%), patient refusal of further therapy (2%), or severe competing illness (2%). Lack of subsequent treatment was significantly (4.5x, p < 0.001) associated with lack of T790M testing, whose most frequent cause (in approximately 50% of cases) was also rapid clinical decline. Among the 127 consecutive patients with failure of 1G/2G TKI started after November 2015, 47 (37%) received osimertinib, with a median overall survival of 36 months versus 24 and 21 months for patients with alternative and no subsequent therapies (p = 0.003). Conclusion: Osimertinib after 1G/2G TKI failure prolongs survival, but approximately 15% and 30% of patients forego molecular retesting and subsequent treatment, respectively, mainly due to rapid clinical deterioration. This is an important remediable obstacle to sequential TKI treatment for EGFR+ NSCLC. It pertains also to other actionable resistance mechanisms emerging under 1G/2G inhibitors or osimertinib, whose rate for lack of next-line therapy is similar (approximately 35% in the FLAURA/AURA3 trials), and highlights the need for closer monitoring alongside broader profiling of TKI-treated EGFR+ NSCLC in the future.
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Affiliation(s)
- Nikolaus Magios
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg
| | - Anna-Lena Volckmar
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Kazdal
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martina Kirchner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix J Herth
- Department of Pneumology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Claus-Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg
| | - Florian Eichhorn
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Meister
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Muley
- Translational Research Unit, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Rami A Elshafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen R Fischer
- Department of Thoracic Oncology, Lungenklinik Löwenstein, Löwenstein, Germany
| | - Martin Faehling
- Department of Cardiology, Angiology and Pneumology, Klinikum Esslingen, Esslingen, Germany
| | - Mark Kriegsmann
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Helge Bischoff
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg
| | | | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Röntgenstraße 1, Heidelberg, Baden-Württemberg 69126, Germany
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16
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Dal Maso A, Lorenzi M, Ferro A, Pilotto S, Cecere F, Follador A, Polo V, Del Conte A, Sartori G, Giavarra M, Scattolin D, Indraccolo S, Frega S, De Maglio G, Menis J, Bonanno L, Calabrese F, Guarneri V, Conte P, Pasello G. Real-world data on treatment outcomes in EGFR-mutant non-small-cell lung cancer patients receiving osimertinib in second or further lines. Future Oncol 2021; 17:2513-2527. [PMID: 33988036 DOI: 10.2217/fon-2021-0356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aims: This study describes real-world outcomes of pretreated EGFR T790M-positive (T790M+) advanced non-small-cell lung cancer patients progressing after first- or second-generation tyrosine kinase inhibitors and receiving osimertinib, compared with T790M-negative (T790M-) patients. We have also described progression patterns and treatment sequences. Patients & methods: This is a retrospective multicenter Italian observational study including consecutive Caucasian patients referred between 2014 and 2018. Results: 167 patients were included. Median progression-free survival was 9.8 months (95% CI: 8.3-13.3) for T790M+ and 6.0 months (95% CI: 4.9-7.2) for T790M- patients, respectively. Median overall survival was 20.7 months (95% CI: 18.9-28.4) for T790M+ and 10.6 months (95% CI: 8.6-23.6) for T790M- patients, respectively. The T790M mutation correlated with absence of new sites of disease. After progression, most T790M+ patients continued osimertinib, whereas most T790M- patients received a different treatment line. Conclusion: Better outcomes were shown in patients receiving osimertinib. A more limited progression pattern for T790M+ was suggested.
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Affiliation(s)
- Alessandro Dal Maso
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Martina Lorenzi
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Alessandra Ferro
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Sara Pilotto
- Medical Oncology, University of Verona, AOUI Verona, Verona, 37126, Italy
| | - Fabiana Cecere
- Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, 00144, Italy
| | - Alessandro Follador
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, 31100, Italy
| | - Alessandro Del Conte
- Medical Oncology & Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), 33081, Italy
| | - Giulia Sartori
- Medical Oncology, University of Verona, AOUI Verona, Verona, 37126, Italy
| | - Marco Giavarra
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Stefano Indraccolo
- Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy.,Immunology & Molecular Oncology Unit, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Stefano Frega
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Giovanna De Maglio
- Department of Pathology, Azienda Sanitaria Universitaria Friuli Centrale, Udine Hospital, Udine, 33100, Italy
| | - Jessica Menis
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Laura Bonanno
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic & Vascular Sciences, University of Padova, Padova, 35128, Italy
| | - Valentina Guarneri
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - PierFranco Conte
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
| | - Giulia Pasello
- Oncology 2, Istituto Oncologico Veneto IOV - IRCCS, Padova, 35128, Italy.,Department of Surgery, Oncology & Gastroenterology, University of Padova, Padova, 35128, Italy
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17
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Li C, Nie W, Guo J, Xiong A, Zhong H, Chu T, Zhong R, Xu J, Lu J, Zheng X, Zhang B, Shen Y, Pan F, Han B, Zhang X. Osimertinib alone as second-line treatment for brain metastases (BM) control may be more limited than for non-BM in advanced NSCLC patients with an acquired EGFR T790M mutation. Respir Res 2021; 22:145. [PMID: 33975616 PMCID: PMC8114713 DOI: 10.1186/s12931-021-01741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/07/2021] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND This study was designed to investigate the difference between brain metastases (BM) and non-brain metastases (non-BM) treated by osimertinib in advanced patients with an acquired EGFR T790M mutation after obtaining first-generation EGFR-TKI resistance. METHODS A total number of 135 first-generation EGFR-TKI-resistant patients with an acquired EGFR T790M mutation were retrospectively analyzed. The patients were divided into BM and non-BM groups. According to the type of treatment (whether brain radiotherapy), the BM patients were divided into an osimertinib combined with brain radiotherapy group and an osimertinib without brain radiotherapy group. In addition, according to the type of BM (the sequence between BM and osimertinib), the BM patients were subdivided into an osimertinib after BM group (initial BM developed after obtaining first-generation EGFR-TKI resistance) and an osimertinib before BM group (first-generation EGFR-TKI resistance then osimertinib administration performed; initial BM was not developed until osimertinib resistance). The progression-free survival (PFS) and overall survival (OS) were evaluated. The primary endpoint was OS between BM and no-BM patients. The secondary endpoints were PFS of osimertinib, and OS between brain radiotherapy and non-brain radiotherapy patients. RESULTS A total of 135 patients were eligible and the median follow-up time of all patients was 50 months. The patients with BM (n = 54) had inferior OS than those without BM (n = 81) (45 months vs. 55 months, P = 0.004). And in BM group, the OS was longer in patients that received osimertinib combined with brain radiotherapy than in those without brain radiotherapy (53 months vs. 40 months, P = 0.014). In addition, the PFS was analysed according to whether developed BM after osimertinib resistance. The PFS of the patients that developed BM after acquiring osimertinib resistance was shorter than that without BM development, whether patients developed initial BM after first-generation EGFR-TKI resistance (7 months vs. 13 months, P = 0.003), or developed non-BM after first-generation EGFR-TKI resistance (13 months vs. 17 months, P < 0.001). CONCLUSIONS In advanced patients with an acquired EGFR T790M mutation after obtaining first-generation EGFR-TKI resistance, osimertinib may be more limited in its control in BM than in non-BM. Also, osimertinib combined with brain radiotherapy may improve the survival time of BM patients.
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Affiliation(s)
- Changhui Li
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Wei Nie
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Jingdong Guo
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Anning Xiong
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Hua Zhong
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Tianqing Chu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Runbo Zhong
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Jianlin Xu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Jun Lu
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Xiaoxuan Zheng
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Bo Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Yinchen Shen
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Feng Pan
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Baohui Han
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China.
| | - Xueyan Zhang
- Department of Pulmonary, Shanghai Chest Hospital, Shanghai Jiao Tong University, No.241 Huaihai West Road, Xuhui District, Shanghai, 200030, China.
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18
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Fernandes MGO, Sousa C, Jacob M, Almeida L, Santos V, Araújo D, Novais Bastos H, Magalhães A, Cirnes L, Moura CS, Queiroga H, Cruz-Martins N, Hespanhol V. Resistance Profile of Osimertinib in Pre-treated Patients With EGFR T790M-Mutated Non-small Cell Lung Cancer. Front Oncol 2021; 11:602924. [PMID: 34026599 PMCID: PMC8136429 DOI: 10.3389/fonc.2021.602924] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/23/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Osimertinib efficacy in pre-treated patients with epidermal growth factor receptor (EGFR) T790M-mutated non-small cell lung cancer (NSCLC) has been demonstrated in clinical trials, but real-world data, particularly regarding resistance profile, remains limited. This study aims to analyze the resistance mechanisms acquired after treatment with Osimertinib. Methods: Clinical outcomes and molecular results from re-biopsies at the time of osimertinib progression of EGFR T790M-mutated NSCLC patient were analyzed. Results: Twenty-one patients with stage IV adenocarcinoma were included [median 69 years; 57.1% female; 85.7% never-smokers; 23.8% ECOG performance status (PS) ≥2]. Median PFS and OS were 13.4 (95% CI: 8.0–18.9) and 26.4 (95% IC: 8.9–43.8) months, respectively. At the time of analysis, 10 patients had tumor progression (47.6%). T790M loss occurred in 50%, being associated with earlier progression (median PFS 8.1 vs. 21.4 months, p = 0.011). Diverse molecular alterations were identified, including C797S mutation (n = 1), PIK3CA mutation (n = 2), MET amplification (n = 1), CTNNB1 mutation (n = 1), and DCTN1-ALK fusion (n = 1). Histological transformation into small cell carcinoma occurred in one patient. Conclusions: This real-world life study highlights the relevance of re-biopsy at the time of disease progression, contributing to understand resistance mechanisms and to guide treatment strategies.
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Affiliation(s)
- Maria Gabriela O Fernandes
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Catarina Sousa
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Maria Jacob
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Leonor Almeida
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Vanessa Santos
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - David Araújo
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Hélder Novais Bastos
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
| | - Adriana Magalhães
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Luís Cirnes
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.,Escola Superior de Saúde (ESS), Instituo Politécnico do Porto (IPP), Porto, Portugal
| | | | - Henrique Queiroga
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.,Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Venceslau Hespanhol
- Pulmonology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
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19
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Silveira C, Sousa AC, Janeiro A, Malveiro S, Teixeira E, Brysch E, Pantarotto M, Felizardo M, Madureira R, Nogueira F, Guimarães C, Matos C, Canário D, Bruges-Armas J, Carmo-Fonseca M. Detection and quantification of EGFR T790M mutation in liquid biopsies by droplet digital PCR. Transl Lung Cancer Res 2021; 10:1200-1208. [PMID: 33889502 PMCID: PMC8044487 DOI: 10.21037/tlcr-20-1010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Liquid biopsy allows the identification of targetable cancer mutations in a minimally invasive manner. In patients with advanced non-small cell lung cancer (NSCLC), droplet digital PCR (ddPCR) is increasingly used to genotype the epidermal growth factor receptor (EGFR) gene in circulating cell-free DNA (cfDNA). However, the sensitivity of this method is still under debate. The aim of this study was to implement and assess the performance of a ddPCR assay for detecting the EGFR T790M mutation in liquid biopsies. Methods A ddPCR assay was optimized to detect the EGFR T790M mutation in plasma samples from 77 patients with NSCLC in progression. Results Our ddPCR assay enabled the detection and quantification of the EGFR T790M mutation at cfDNA allele frequency as low as 0.5%. The mutation was detected in 40 plasma samples, corresponding to a positivity rate of 52%. The number of mutant molecules per mL of plasma ranged from 1 to 6,000. A re-biopsy was analyzed for 12 patients that had a negative plasma test and the mutation was detected in 2 cases. A second liquid biopsy was performed for 6 patients and the mutation was detected in 3 cases. Conclusions This study highlights the value of ddPCR to detect and quantify the EGFR T790M mutation in liquid biopsies in a real-world clinical setting. Our results suggest that repeated ddPCR tests in cfDNA may obviate tissue re-biopsy in patients unable to provide a tumor tissue sample suitable for molecular analysis.
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Affiliation(s)
| | - Ana Carla Sousa
- GenoMed - Molecular Medicine Diagnostics, S.A., Lisbon, Portugal
| | - André Janeiro
- GenoMed - Molecular Medicine Diagnostics, S.A., Lisbon, Portugal
| | - Sara Malveiro
- GenoMed - Molecular Medicine Diagnostics, S.A., Lisbon, Portugal
| | | | - Eva Brysch
- Hospital Pulido Valente, Department of Pulmonary Oncology, Lisbon, Portugal
| | | | | | - Rosa Madureira
- Hospital Beatriz Ângelo, Department of Pathology, Lisbon, Portugal
| | | | - Cátia Guimarães
- Hospital Egas Moniz, Department of Pulmonology, Lisbon, Portugal
| | - Cristina Matos
- Hospital Egas Moniz, Department of Pulmonology, Lisbon, Portugal
| | - Dolores Canário
- Hospital Garcia de Orta, Department of Pulmonology, Almada, Portugal
| | - Jácome Bruges-Armas
- Hospital de Santo Espírito, Department of Specialized Service of Epidemiology and Molecular Biology (SEEBMO), Angra do Heroísmo, Azores, Portugal
| | - Maria Carmo-Fonseca
- Instituto de Medicina Molecular João Lobo Antunes, University of Lisbon Medical School, Lisbon, Portugal
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20
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Yang JCH, Camidge DR, Yang CT, Zhou J, Guo R, Chiu CH, Chang GC, Shiah HS, Chen Y, Wang CC, Berz D, Su WC, Yang N, Wang Z, Fang J, Chen J, Nikolinakos P, Lu Y, Pan H, Maniam A, Bazhenova L, Shirai K, Jahanzeb M, Willis M, Masood N, Chowhan N, Hsia TC, Jian H, Lu S. Safety, Efficacy, and Pharmacokinetics of Almonertinib (HS-10296) in Pretreated Patients With EGFR-Mutated Advanced NSCLC: A Multicenter, Open-label, Phase 1 Trial. J Thorac Oncol 2020; 15:1907-1918. [PMID: 32916310 DOI: 10.1016/j.jtho.2020.09.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [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: 05/18/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Almonertinib (HS-10296) is a novel, third-generation EGFR tyrosine kinase inhibitor (EGFR TKI) that targets both EGFR-sensitizing and T790M resistance mutations. This first-in-human trial aimed to evaluate the safety, efficacy, and pharmacokinetics of almonertinib in patients with locally advanced or metastatic EGFR mutation-positive NSCLC that had progressed after pevious EGFR TKI therapy. METHODS This phase 1, open-label, multicenter clinical trial (NCT0298110) included dose-escalation (55, 110, 220, and 260 mg) and dose-expansion cohorts (55, 110, and 220 mg) with once daily oral administration of almonertinib. In each expansion cohort, tumor biopsies were obtained for the determination of EGFR T790M status. The safety, tolerability, antitumor activity, and pharmacokinetics of almonertinib were evaluated. RESULTS A total of 120 patients (26 patients in the dose-escalation cohort and 94 patients in the dose-expansion cohort) were enrolled. The maximum tolerated dose was not defined in the dose-escalation phase; the 260 mg regimen was not further evaluated in the dose-expansion phase owing to safety concerns and saturation of exposure. The most common treatment-related grade greater than or equal to 3 adverse events were increased blood creatine phosphokinase (10%) and increased alanine aminotransferase (3%). Among 94 patients with the EGFR T790M mutation in the dose-expansion cohort, the investigator-assessed objective response rate and disease control rate were 52% (95% confidence interval [CI]: 42-63) and 92% (95% CI: 84-96), respectively. Median progression-free survival was 11.0 months (95% CI: 9.5-not reached) months. CONCLUSIONS Almonertinib is safe, tolerable and effective for patients with locally advanced or metastatic NSCLC harboring the EGFR T790M mutation who were pretreated with EGFR TKIs.
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Affiliation(s)
- James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
| | - D Ross Camidge
- Department of Medicine Division of Medical Oncology, University of Colorado Health, Aurora, Colorado
| | - Cheng-Ta Yang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Renhua Guo
- Department of Medical Oncology, Jiangsu Province Hospital, Nanjing, Jiangsu, People's Republic of China
| | - Chao-Hua Chiu
- Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | - Her-Shyong Shiah
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Yuan Chen
- Department of Oncology, Tongji Medical College of HUST, Wuhan, Hubei, China
| | - Chin-Chou Wang
- Department of Occupational Medicine, Chang Gung Memorial Hospital- Kaohsiung, Kaohsiung, Taiwan, Republic of China
| | - David Berz
- Department of Cellular Therapeutics, Beverly Hills Cancer Center, Beverly Hills, California
| | - Wu-Chou Su
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China
| | - Nong Yang
- Department of Medical Oncology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Ziping Wang
- Department of Chest Medicine, Beijing Cancer Hospital, Beijing, China
| | - Jian Fang
- Department of Chest Medicine, Beijing Cancer Hospital, Beijing, China
| | - Jianhua Chen
- Department of Medical Oncology, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Petros Nikolinakos
- Department of Research, University Cancer & Blood Center, LLC, Athens, Georgia
| | - You Lu
- Department of Oncology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hongming Pan
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ajit Maniam
- Division of Hematology and Oncology, Pacific Cancer Medical Center Inc., Anaheim, California
| | - Lyudmila Bazhenova
- Department of Medicine, Moores Cancer Center, University of California San Diego Health, La Jolla, California
| | - Keisuke Shirai
- Department of Hematology and Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Mohammad Jahanzeb
- Department of Clinical Medicine, Hematology-Oncology, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Maurice Willis
- Department of Oncology, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Nehal Masood
- Department of Medical Oncology, MultiCare Regional Cancer Center, MultiCare Institute for Research and Innovation, Tacoma, Washington
| | - Naveed Chowhan
- Department of Research, Baptist Healthcare Systems Inc., Baptist Health Floyd, New Albany, Indiana
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Hong Jian
- Department of Oncology, Shanghai Chest Hospital, Shanghai, People's Republic of China
| | - Shun Lu
- Department of Oncology, Shanghai Chest Hospital, Shanghai, People's Republic of China
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21
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Vicente-Baz D, Paredes A, Morán T, Massuti B, Reguart N, Álvarez R, Insa A, Juan-Vidal O, Artal Á, Esteban E, García-Campelo R, Ortega-Granados AL, Diz P, González-Larriba JL, Terrasa J, de Las Peñas R, Rodríguez-Abreu D, Callejo Á, Márquez G, Provencio M. ASTRIS, a large real-world study to evaluate the efficacy of osimertinib in epidermal growth factor receptor T790M mutation-positive non-small cell lung cancer patients: Clinical characteristics and genotyping methods in a Spanish cohort. Rev Esp Patol 2020; 53:140-148. [PMID: 32650965 DOI: 10.1016/j.patol.2019.11.002] [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] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/06/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Osimertinib has proven efficacy in EGFR T790M mutation-positive non-small cell lung cancer (NSCLC) patients; however, its benefits have not been evaluated in a real-world setting. METHODS ASTRIS is a single-arm, open-label, multinational study to evaluate the efficacy and safety of osimertinib for the treatment of EGFR T790M mutation-positive NSCLC. We present the study design and preliminary cut-off analysis results (as of October 2017) describing the baseline characteristics and methodology for T790M mutation detection in the Spanish cohort. RESULTS The Spanish cohort included 131 patients from a total 3014 patients. Forty patients (28.1%) were still undergoing therapy at the time of cut-off; 68.7% were women and 97.7% were Caucasian, with a mean age of 64.8 (SD 11.7) years. The most common type of sample for evaluating T790M mutations was tissue (55.0%), and samples were obtained from the primary tumor in 61.1% of cases. Mutation analysis was performed by the local laboratory in 60.3% of cases and using the Roche Cobas® EGFR assay in 43.5% of cases. CONCLUSIONS ASTRIS is expected to confirm the benefits of osimertinib in a real-world setting. Data on real-world practices for the detection of the EGFR T790M mutation may provide additional information for the designing of guidelines for best practices.
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Affiliation(s)
| | | | - Teresa Morán
- ICO - Badalona Hospital Universitari Germans Trias I Pujol, Universitat Autònoma de Barcelona (UAB), IGTP, B-ARGOS, Badalona, Spain
| | | | | | - Rosa Álvarez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Amelia Insa
- Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Ángel Artal
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Emilio Esteban
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Pilar Diz
- Complejo Asistencial Universitario de León, León, Spain
| | | | - Josefa Terrasa
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | - Mariano Provencio
- Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain.
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22
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Long Y, Zhang K, Li Y, Yu M, Zhu J, Huang M. Durable complete response after afatinib and crizotinib in an advanced non-small cell lung cancer patient with EGFR L861Q mutation and acquired MET amplification: a case report. Ann Palliat Med 2020; 9:3609-3613. [PMID: 32648452 DOI: 10.21037/apm-19-482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/27/2019] [Indexed: 02/05/2023]
Abstract
Epidermal growth factor receptor (EGFR) L861Q mutation is a non-classical mutation, with a low incidence, poor response, and uncertain resistance mechanisms when treated by an EGFR tyrosine kinase inhibitor (EGFR-TKI). The liver is one of the most common distant organs to metastasize in nonsmall cell lung cancer (NSCLC), and achieving complete remission treatment for the liver is difficult. In this report, a patient was diagnosed with advanced lung adenocarcinoma harboring the EGFR L861Q mutation and responded well to afatinib for 16 months. Complete response and partial response (PR) appeared in the liver metastasis and primary lesion respectively. Following this, afatinib plus crizotinib overcame the acquired resistance of MET amplification and brought about the complete remission of the liver for 10 months. Interestingly, the liver remission endured for 22 months and persisted even when the disease progressed and the EGFR T790M mutation emerged. To our knowledge, this is the first time that afatinib induced longterm liver remission in a patient with an EGFR non-classical mutation, and in whom crizotinib with afatinib proved to be a reliable treatment for overcoming MET amplification resistance with an EGFR non-classical mutation. This precise and individualized gene-based treatment significantly prolonged the survival time of this stage IV case with brain metastases yielding 26 months of progression-free survival (PFS) time and more than 3 years of overall survival time.
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Affiliation(s)
- Yaling Long
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Kai Zhang
- Department of Radiology, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Yanying Li
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Min Yu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Jiao Zhu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China
| | - Meijuan Huang
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Medical School, Sichuan University, Chengdu, China.
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23
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Yin W, Zhao Y, Kang X, Zhao P, Fu X, Mo X, Wan Y, Huang Y. BBB-penetrating codelivery liposomes treat brain metastasis of non-small cell lung cancer with EGFR T790M mutation. Am J Cancer Res 2020; 10:6122-6135. [PMID: 32483443 PMCID: PMC7255027 DOI: 10.7150/thno.42234] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/17/2020] [Indexed: 01/06/2023] Open
Abstract
EGFR TKI therapy has become a first-line regimen for non-small cell lung cancer (NSCLC) patients with EGRF mutations. However, there are two big challenges against effective therapy--the secondary EGFR mutation-associated TKI resistance and brain metastasis (BMs) of lung cancer. The BMs is a major cause of death for advanced NSCLC patients, and the treatment of BMs with TKI resistance remains difficult. Methods: Tumor-associated macrophages (TAM) is a promising drug target for inhibiting tumor growth, overcoming drug resistance, and anti-metastasis. TAM also plays an essential role in regulating tumor microenvironment. We developed a dual-targeting liposomal system with modification of anti-PD-L1 nanobody and transferrin receptor (TfR)-binding peptide T12 for codelivery of simvastatin/gefitinib to treat BMs of NSCLC. Results: The dual-targeting liposomes could efficiently penetrate the blood-brain barrier (BBB) and enter the BMs, acting on TAM repolarization and reversal of EGFRT790M-associated drug resistance. The treatment mechanisms were related to the elevating ROS and the suppression of the EGFR/Akt/Erk signaling pathway. Conclusion: The dual-targeting liposomal codelivery system offers a promising strategy for treating the advanced EGFRT790M NSCLC patients with BMs.
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24
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Zhao Z, Li L, Wang Z, Duan J, Bai H, Wang J. The Status of the EGFR T790M Mutation is associated with the Clinical Benefits of Osimertinib Treatment in Non-small Cell Lung Cancer Patients: A Meta-Analysis. J Cancer 2020; 11:3106-3113. [PMID: 32231715 PMCID: PMC7097959 DOI: 10.7150/jca.38411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/30/2019] [Indexed: 01/26/2023] Open
Abstract
Background and Purpose: Pervious studies have demonstrated that the loss of EGFR T790M after Osimertinib treatment may be the cause of Osimertinib resistance. Here, we conducted a meta-analysis to evaluate the association between the persistence of EGFR T790M and the clinical benefits of Osimertinib in non-small cell lung cancer (NSCLC) patients with baseline EGFR T790M mutation. Experimental design and Methods: PUBMED, EMBASE, and Cochrane databases were searched for eligible studies that provided the survival outcomes including overall survival (OS), progression-free survival (PFS) or time to discontinuation (TTD) data for each patient treated with Osimertinib with the status of the T790M mutation tested after Osimertinib resistance. The hazard ratios (HRs) and their 95% confidence intervals (CI) were calculated for each study. Results: In total, eight eligible studies were included in the analysis, among which six studies provided the data on PFS, and the other two studies provided the TTD data. Overall, 312 patients (151 patients with the persistence of T790M) were identified. The persistence of T790M was associated with longer PFS (HR, 0.40; 95% CI, 0.19-0.84; P=0.01) and TTD (HR, 0.54; 95% CI, 0.39-0.76; P=0.0004). Furthermore, overall analysis the survival outcomes including PFS and TTD subgroups also showed preferable clinical benefits for patients with the T790M persistence (HR, 0.57; 95%CI, 0.45-0.73; P<0.00001). Conclusions: Our findings confirm the persistence of T790M is associated with the clinical benefits of Osimertinib in NSCLC patients with baseline EGFR T790M mutation treated with Osimertinib.
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Affiliation(s)
- Zhe Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lu Li
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, 100017, China
| | - Zhijie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jianchun Duan
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hua Bai
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jie Wang
- State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
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Ma S, He Z, Fu H, Wang L, Wu X, Zhang Z, Wang Q. Dynamic changes of acquired T790M mutation and small cell lung cancer transformation in a patient with EGFR-mutant adenocarcinoma after first- and third-generation EGFR-TKIs: a case report. Transl Lung Cancer Res 2020; 9:139-143. [PMID: 32206560 PMCID: PMC7082284 DOI: 10.21037/tlcr.2020.01.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Epithelial growth factor receptor (EGFR) T790M mutation and small cell lung cancer (SCLC) transformation are well-known resistance mechanisms acquired during treatment with EGFR tyrosine kinase inhibitors (TKIs). Various mechanisms sometimes coexist in patients. Here, we report a 57-year-old female diagnosed with stage IV lung adenocarcinoma, who harbored an EGFR exon 19 deletion mutation. This patient initially received gefitinib and progressed after 14 months. A repeat biopsy was performed, and the original EGFR exon 19 deletion and acquired exon 20 T790M mutation were identified. Then, pemetrexed plus carboplatin was administered as second-line and osimertinib as third-line treatment. Rapid progression and mixed response were observed after 2 months on osimertinib, with stable disease of the primary lung lesion but rapid growth of a right lower chest mass. The progressive chest lesion underwent biopsy, and the SCLC transformation was revealed. Furthermore, the patient was treated with etoposide and cisplatin, and she achieved disease control for 4 months. A fourth biopsy both for the primary lung lesion and the chest mass were finally conducted. Interestingly, the histopathology of the two different lesions showed adenocarcinoma and SCLC, respectively. The patient then rapidly suffered brain metastasis, and no EGFR mutations were detected in her cerebrospinal fluid (CSF). Overall survival (OS) of the patient was 29 months. This patient experienced concomitant resistance mechanisms of T790M mutation and SCLC transformation, which might have resulted from intra-tumor heterogeneity and drug-induced selection. Ultimately, this case reminds us that repeat biopsies are essential for patients receiving EGFR-TKIs in order to make appropriate treatment decisions according to the diverse mechanisms of acquired resistance.
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Affiliation(s)
- Shuxiang Ma
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Zhen He
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Hongyong Fu
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Lili Wang
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Xuan Wu
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Zhe Zhang
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Qiming Wang
- Department of Internal Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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26
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Cho BC, Kim DW, Park K, Lee JS, Yoo SS, Kang JH, Lee SY, Kim CH, Jang SH, Kim YC, Yoon HK, Han JY, Kim SW. Real-world use of osimertinib in non-small cell lung cancer: ASTRIS study Korean subgroup analysis. Curr Med Res Opin 2020; 36:477-482. [PMID: 31581843 DOI: 10.1080/03007995.2019.1676708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: ASTRIS is a large real-world, open-label, multinational clinical study of osimertinib in patients with epidermal growth factor receptor (EGFR) T790M mutation-positive advanced non-small cell lung cancer (NSCLC) who have previously received a tyrosine kinase inhibitor (TKI). We report data from the Korean ASTRIS subgroup.Methods: Adult patients with locally advanced or metastatic NSCLC with a confirmed T790M mutation, WHO performance status of 0-2 and prior EGFR-TKI therapy, received osimertinib 80 mg once daily. Efficacy outcomes were overall survival (OS), investigator-assessed response rate (RR) and progression-free survival (PFS), and time to treatment discontinuation (TTD).Results: At data cut-off (20 October 2017), 466 Korean patients were enrolled. Baseline EGFR molecular testing was mainly performed on biopsied tissue (75.1%). Baseline mutations co-occurring with T790M included exon 19 deletions (60.7%) and L858R (32.8%). 1-year OS was 82.7% (OS data not matured at data cut-off). Overall, RR was 71.0%, median PFS was 12.4 months and median TTD was 15.0 months. In patients with/without CNS metastases, RR was 68.0% and 79.6%, respectively; median PFS, 10.8 and 11.0 months, respectively; and median TTD, 11.2 and 14.7 months, respectively. Overall, 31.1% of patients experienced ≥1 adverse event (AE), leading to dose modification (12.0%), discontinuation (5.2%) or death (2.8%). Serious AEs (24.9%) included pulmonary embolism (1.7%), pleural effusion (1.7%), and pneumonia (1.5%).Conclusion: In this real-world subgroup analysis of Korean patients in the ASTRIS study, osimertinib demonstrated comparable clinical efficacy to that attained in the global ASTRIS study and other clinical trials, with no new safety concerns.
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Affiliation(s)
- Byoung Chul Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine Seoul, Seoul, The Republic of Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, The Republic of Korea
| | - Keunchil Park
- Division of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Jong-Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, The Republic of Korea
| | - Seung Soo Yoo
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, The Republic of Korea
| | - Jin Hyoung Kang
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Sung Yong Lee
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, The Republic of Korea
| | - Cheol Hyeon Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, The Republic of Korea
| | - Seung Hun Jang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, The Republic of Korea
| | - Young-Chul Kim
- Lung Cancer Clinic, Hwasun Hospital, Chonnam National University Medical School, Jeonnam, The Republic of Korea
| | - Hyoung-Kyu Yoon
- Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Ji-Youn Han
- Center for Lung Cancer, National Cancer Center, Goyang, The Republic of Korea
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, The Republic of Korea
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Lettig L, Sahnane N, Pepe F, Cerutti R, Albeni C, Franzi F, Veronesi G, Ogliari F, Pastore A, Tuzi A, Pinotti G, Bovio A, Verusio C, Giordano M, Troncone G, Sessa F, Malapelle U, Furlan D. EGFR T790M detection rate in lung adenocarcinomas at baseline using droplet digital PCR and validation by ultra-deep next generation sequencing. Transl Lung Cancer Res 2019; 8:584-592. [PMID: 31737495 DOI: 10.21037/tlcr.2019.09.18] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Routine testing of baseline EGFR T790M mutation may have important clinical impact but many discordant data have been reported regarding the diagnostic, prognostic and predictive role of this marker. In this study we aimed to assess T790M frequency in 164 untreated EGFR-mutated NSCLCs using methods with different sensitivity as well as to analyze the relationship between baseline T790M mutation status, patient's clinicopathologic features and tyrosine kinase inhibitors (TKI) treatment outcomes. Methods We compared the diagnostic performance, sensitivity and specificity of three methods, namely MALDI-TOF mass spectrometry (MS), Allele-Specific Real Time PCR (AS-PCR), droplet digital PCR (ddPCR). Ultra-deep next generation sequencing (NGS) validation of T790M-mutant NSCLCs was performed using SiRe® panel. Results Baseline T790M occurred in 17% of the tumors. Intermediately sensitive techniques such as MALDI-TOF MS (detection limit of T790M ≥5%) allow to detect T790M in 2% of cases exhibiting mutant-allele fractions ranging from 11.5% to 17%. Median overall survival (OS) in these patients was poor (7.3 months) and progression free survival (PFS) was of 3.3 months in patients treated with a 1st generation EGFR TKI. The remaining T790M-positive cases showed very low mutant-allele fractions ranging from 0.07% to 0.38% and required highly sensitive methods such as ddPCR and NGS to be identified. All these cases showed a concurrent sensitizing EGFR mutation (mainly exon 19 deletion), and clinicopathological features similar to those observed in EGFR mutant cancers. Median OS of these patients was 27 months while median PFS after TKI treatment was 20 months. Conclusions Routine test of baseline EGFR T790M may have an important role in the prediction to EGFR TKI therapy response and should be performed using highly sensitive and quantitative methods, such as ddPCR and NGS, in order to reliably distinguish NSCLCs with high or very low T790M mutant-allele fraction.
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Affiliation(s)
- Lucio Lettig
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Nora Sahnane
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberta Cerutti
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Chiara Albeni
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Francesca Franzi
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | | | | | | | | | | | | | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fausto Sessa
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Daniela Furlan
- Unit of Pathology, Department of Medicine and Surgery, ASST Sette Laghi, University of Insubria, Varese, Italy
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Dal Maso A, Lorenzi M, Roca E, Pilotto S, Macerelli M, Polo V, Cecere FL, Del Conte A, Nardo G, Buoro V, Scattolin D, Monteverdi S, Urso L, Zulato E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Conte P, Pasello G. Clinical Features and Progression Pattern of Acquired T790M-positive Compared With T790M-negative EGFR Mutant Non-small-cell Lung Cancer: Catching Tumor and Clinical Heterogeneity Over Time Through Liquid Biopsy. Clin Lung Cancer 2019; 21:1-14.e3. [PMID: 31601525 DOI: 10.1016/j.cllc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/02/2019] [Revised: 06/18/2019] [Accepted: 07/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical-pathologic predictors of acquired T790M epidermal growth factor receptor (EGFR) mutation in Caucasian patients with non-small-cell lung cancer (NSCLC) progressing after first-/second-generation tyrosine kinase inhibitors (TKIs) is an open field for research. Similarly, the best time point for T790M detection by liquid or tissue biopsy after disease progression is currently matter of debate. PATIENTS AND METHODS This is an observational study at 7 Italian centers enrolling patients with EGFR-mutant NSCLC progressing after first-/second-generation EGFR TKIs, between 2014 and 2018, aiming at comparing baseline clinical-pathologic features and progression patterns in acquired T790M-positive compared with T790M-negative cases. RESULTS A total of 235 patients received first-line treatment with gefitinib (N = 126; 53%), erlotinib (N = 51; 22%), or afatinib (N = 58; 25%). In 120 (51%) cases, T790M was detected in liquid biopsy, tissue biopsy, or both. Age younger than 65 years (P = .037), the presence of common mutations (P = .004), and better response to first-line TKI (P = .023) were correlated with T790M positivity. T790M detection was associated with higher number of new progressing sites (P = .04), liver progression (P = .002), and a lower frequency of lung metastases (P = .027). When serial liquid biopsies were performed (N = 15), an oligoprogressive disease was correlated with a negative test outcome, whereas systemic progression was observed at the time of T790M positivity. CONCLUSION This study on a Caucasian population showed that age, type of EGFR mutation at diagnosis, response to first-line treatment, and peculiar progression pattern are associated with T790M status. Serial liquid biopsy might be useful for treatment selection, especially when tissue rebiopsy is not feasible.
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Affiliation(s)
- Alessandro Dal Maso
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Martina Lorenzi
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Roca
- Department of Medical Oncology, ASST - Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sara Pilotto
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Marianna Macerelli
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - Fabiana Letizia Cecere
- Department of Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology and Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Vanessa Buoro
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Sara Monteverdi
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Loredana Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Frega
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - PierFranco Conte
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy.
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29
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Zhang YC, Chen ZH, Zhang XC, Xu CR, Yan HH, Xie Z, Chuai SK, Ye JY, Han-Zhang H, Zhang Z, Bai XY, Su J, Gan B, Yang JJ, Li WF, Tang W, Luo FR, Xu X, Wu YL, Zhou Q. Analysis of resistance mechanisms to abivertinib, a third-generation EGFR tyrosine kinase inhibitor, in patients with EGFR T790M-positive non-small cell lung cancer from a phase I trial. EBioMedicine 2019; 43:180-187. [PMID: 31027916 PMCID: PMC6558024 DOI: 10.1016/j.ebiom.2019.04.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Resistance to third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) presents a major clinical challenge in advanced non-small cell lung cancer (NSCLC). Here, we report resistance mechanisms to abivertinib, a novel third-generation EGFR TKI, from a phase I dose-escalation/expansion study (NCT02330367). METHODS Patients with EGFR T790M-positive advanced NSCLC and progression on prior EGFR TKIs received abivertinib in dose escalation (50-350 mg twice daily [BID]) or expansion (300 mg BID) cohorts. Patients enrolled at Guangdong Lung Cancer Institute who underwent next-generation sequencing (NGS)-based genomic profiling upon abivertinib progression (prior to October 30, 2018) were enrolled in this exploratory analysis. FINDINGS Thirty of 73 patients enrolled were eligible for resistance analysis. Upon abivertinib progression, 27 patients provided plasma samples (six patients also provided paired samples from the progression sites) and three patients only provided tissue samples from the progression sites for NGS. A heterogeneous landscape of resistance to abivertinib was observed: 15% (4/27) experienced EGFR T790M loss and 13% (4/30) developing EGFR tertiary mutations including C797S. EGFR amplification was observed in 11 patients (37%), and considered a putative resistance mechanism in seven (23%) patients. Other EGFR-independent resistance mechanisms involved CDKN2A, MET, PIK3CA, HER2, TP53, Rb1 and small-cell lung cancer transformation. INTERPRETATION Our findings reveal a heterogenous pattern of resistance mechanisms to abivertinib which is distinct from that previously reported with osimertinib. EGFR amplification was the most common resistance mechanism in this cohort. FUND: The National Key R&D Program of China (Grant No. 2016YFC1303800), Key Lab System Project of Guangdong Science and Technology Department - Guangdong Provincial Key Lab of Translational Medicine in Lung Cancer (Grant No. 2012A061400006/2017B030314120).
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Affiliation(s)
- Yi-Chen Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Hong Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chong-Rui Xu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hong-Hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi Xie
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Jun-Yi Ye
- Burning Rock Biotech, Guangzhou, China
| | | | | | - Xiao-Yan Bai
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Su
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bin Gan
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin-Ji Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Feng Li
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wei Tang
- ACEA Therapeutics Inc., San Diego, CA, USA
| | | | - Xiao Xu
- ACEA Therapeutics Inc., San Diego, CA, USA
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
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30
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Dong J, Zhang RY, Sun N, Smalley M, Wu Z, Zhou A, Chou SJ, Jan YJ, Yang P, Bao L, Qi D, Tang X, Tseng P, Hua Y, Xu D, Kao R, Meng M, Zheng X, Liu Y, Vagner T, Chai X, Zhou D, Li M, Chiou SH, Zheng G, Di Vizio D, Agopian VG, Posadas E, Jonas SJ, Ju SP, Weiss PS, Zhao M, Tseng HR, Zhu Y. Bio-Inspired NanoVilli Chips for Enhanced Capture of Tumor-Derived Extracellular Vesicles: Toward Non-Invasive Detection of Gene Alterations in Non-Small Cell Lung Cancer. ACS Appl Mater Interfaces 2019; 11:13973-13983. [PMID: 30892008 PMCID: PMC6545291 DOI: 10.1021/acsami.9b01406] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Tumor-derived extracellular vesicles (EVs) present in bodily fluids are emerging liquid biopsy markers for non-invasive cancer diagnosis and treatment monitoring. Because the majority of EVs in circulation are not of tumor origin, it is critical to develop new platforms capable of enriching tumor-derived EVs from the blood. Herein, we introduce a biostructure-inspired NanoVilli Chip, capable of highly efficient and reproducible immunoaffinity capture of tumor-derived EVs from blood plasma samples. Anti-EpCAM-grafted silicon nanowire arrays were engineered to mimic the distinctive structures of intestinal microvilli, dramatically increasing surface area and enhancing tumor-derived EV capture. RNA in the captured EVs can be recovered for downstream molecular analyses by reverse transcription Droplet Digital PCR. We demonstrate that this assay can be applied to monitor the dynamic changes of ROS1 rearrangements and epidermal growth factor receptor T790M mutations that predict treatment responses and disease progression in non-small cell lung cancer patients.
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Affiliation(s)
- Jiantong Dong
- Beijing National Laboratory for Molecular Sciences, MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, P. R. China
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Ryan Y. Zhang
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Na Sun
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
- Key Laboratory for Nano-Bio Interface, Suzhou Institute of Nano-Tech and Nano-Bionics, Chinese Academy of Sciences, Suzhou 215123, P. R. China
| | - Matthew Smalley
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Zipeng Wu
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Anqi Zhou
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Shih-Jie Chou
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
- Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan
| | - Yu Jen Jan
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, United States
| | - Peng Yang
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Lirong Bao
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Dongping Qi
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Xinghong Tang
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Patrick Tseng
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Yue Hua
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Dianwen Xu
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Rueihung Kao
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Meng Meng
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Haihe Education Park, 38 Tongyan Road, Tianjin 300353, P. R. China
| | - Xirun Zheng
- Department of Pathology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Ying Liu
- Department of Pathology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Tatyana Vagner
- Division of Cancer Biology and Therapeutics, Departments of Surgery, Biomedical Sciences and Pathology and Laboratory Medicine, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California 90048, United States
| | - Xiaoshu Chai
- Department of Pathology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Dongjing Zhou
- Department of Pathology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Mengyuan Li
- Beijing National Laboratory for Molecular Sciences, MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, P. R. China
| | - Shih-Hwa Chiou
- Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan
| | - Guangjuan Zheng
- Department of Pathology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
| | - Dolores Di Vizio
- Division of Cancer Biology and Therapeutics, Departments of Surgery, Biomedical Sciences and Pathology and Laboratory Medicine, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California 90048, United States
| | - Vatche G. Agopian
- Department of Surgery, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Edwin Posadas
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, United States
| | - Steven J. Jonas
- Department of Pediatrics, David Geffen School of Medicine, Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, and Children’s Discovery and Innovation Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute and Departments of Chemistry and Biochemistry, and of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Shin-Pon Ju
- Department of Mechanical and Electro-Mechanical Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Paul S. Weiss
- California NanoSystems Institute and Departments of Chemistry and Biochemistry, and of Materials Science and Engineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Meiping Zhao
- Beijing National Laboratory for Molecular Sciences, MOE Key Laboratory of Bioorganic Chemistry and Molecular Engineering, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, P. R. China
| | - Hsian-Rong Tseng
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Yazhen Zhu
- California NanoSystems Institute, Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, Los Angeles, California 90095, United States
- Department of Pathology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510120, P. R. China
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31
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Wang S, Yan B, Zhang Y, Xu J, Qiao R, Dong Y, Zhang B, Zhao Y, Zhang L, Qian J, Lu J, Zhao R, Han B. Different characteristics and survival in non-small cell lung cancer patients with primary and acquired EGFR T790M mutation. Int J Cancer 2019; 144:2880-2886. [PMID: 30474188 DOI: 10.1002/ijc.32015] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/13/2018] [Indexed: 12/13/2022]
Abstract
Primary epidermal growth factor receptor (EGFR) T790M mutation can be occasionally identified in previous untreated nonsmall cell lung cancer (NSCLC) patients. To compare clinical characteristics and outcomes in patients with primary and acquired EGFR T790M mutation, we collected the data of patients diagnosed with EGFR mutation from 2012 to 2017 in Shanghai Chest Hospital. Primary EGFR T790M mutation was identified in 61 patients (1.1%; 95% confidence interval (CI): 0.8%-1.3%) of 5685 TKI-naive EGFR mutant patients. Acquired T790M mutation was detected in 98 patients (50.3%; 95%CI: 43.2%-57.3%) of 195 TKI-treated patients. T790M mutation always coexisted with sensitizing EGFR mutations. Primary EGFR T790M always coexisted with 21L858R (46/61) whereas acquired T790M coexisted with 19del (68/98), (p < 0.001). Among them, 18 patients with primary T790M mutation received osimertinib and 72 patients with acquired T790M mutation received osimertinib. The median progression-free survival (PFS) of osimertinib was significantly longer in primary T790M group (17.0 months, 95%CI:14.0-20.0 months) compared to acquired T790M group (10.0 months, 95%CI:8.6-11.4 months, p = 0.022). However, the median overall survival (OS) of acquired T790M mutation patients was significantly longer compared to that of primary T790M mutation patients who received osimertinib (50.4 months vs. 29.9 months, p = 0.016). Our findings suggest that primary T790M mutation likely coexists with 21L858R while acquired mutation likely coexists with 19del. Both mutations showed good response to osimertinib. Patients with primary T790M mutation experienced greater benefits from osimertinib. However, patients with acquired T790M mutation had a better overall survival during the entire clinical treatment.
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Affiliation(s)
- Shuyuan Wang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Yan
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanwei Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianlin Xu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Qiao
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Dong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiming Zhao
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lele Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Qian
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Lu
- Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ruiying Zhao
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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32
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Kim JY, Lee WJ, Park HY, Kim A, Shin DH, Lee CH. Differential MicroRNA Expression between EGFR T790M and L858R Mutated Lung Cancer. J Pathol Transl Med 2018; 52:275-282. [PMID: 30114862 PMCID: PMC6166019 DOI: 10.4132/jptm.2018.07.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/29/2018] [Indexed: 01/07/2023] Open
Abstract
Background MicroRNAs (miRNAs) are short, non-coding RNAs that mediate post-transcriptional gene regulation. They are commonly deregulated in human malignancies, including non-small cell lung cancer (NSCLC). The aim of this study is to investigate miRNA expression in T790M-mutated NSCLC resistant to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors. Methods Six cases of resected NSCLC harboring the T790M mutation were examined. We performed miRNA time polymerase chain reaction (PCR) array profiling using EGFR T790M-mutated NSCLC and L858R-mutated NSCLC. Once identified, miRNAs that were differentially expressed between the two groups were validated by quantitative real-time polymerase chain reaction (qRT-PCR). Results miRNA PCR array profiling revealed three up-regulated miRNAs whose expression levels were altered 4.0-fold or more in the EGFR T790M mutation group than in the L858R group: miR-1 (fold change, 4.384), miR-196a (fold change, 4.138), and miR-124 (fold change, 4.132). The three differentially expressed miRNAs were validated by qRT-PCR, and they were found to be overexpressed in the T790M group relative to L858R group. In particular, expression levels of miR-1 and miR-124 were significantly higher in the T790M group (p-value of miR-1 = .004, miR-124 = .007, miR-196a = .096). Conclusions MiR-1, miR-124, and miR-196a are overexpressed in EGFR T790M mutated NSCLC.
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Affiliation(s)
- Ji Yeon Kim
- Department of Pathology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Woo Jeong Lee
- Pusan National University School of Medicine, Yangsan, Korea
| | - Ha Young Park
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
| | - Ahrong Kim
- Department of Pathology, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Shin
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chang Hun Lee
- Department of Pathology, Pusan National University Hospital, Busan, Korea
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33
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Liang Z, Cheng Y, Chen Y, Hu Y, Liu WP, Lu Y, Wang J, Wang Y, Wu G, Ying JM, Zhang HL, Zhang XC, Wu YL. EGFR T790M ctDNA testing platforms and their role as companion diagnostics: Correlation with clinical outcomes to EGFR-TKIs. Cancer Lett 2017. [PMID: 28642172 DOI: 10.1016/j.canlet.2017.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Somatic mutation in the epidermal growth factor receptor (EGFR) predict clinical response to EGFR tyrosine kinase inhibitors in non-small cell lung cancer (NSCLC) and is a promising target for personalised medicine. EGFR mutations have prognostic value. Initially patients respond well to tyrosine kinase inhibitors but finally they would develop resistance and about 50% of this resistance can be attributed to the emergence of EGFR resistant mutation, T790M. This necessitates the need for genetic testing for clinical management of patients. Molecular testing has become the standard of care in patients with NSCLCs based on the recommendations of standard guidelines. Though there are several platforms for EGFR mutation detection, highly sensitive platforms for clinical applicability as companion diagnostics for ctDNA based testing are emerging. Due to the dynamic changes in the T790M mutation during tyrosine kinase inhibitor (TKI) treatment, real-time monitoring of these genetic alterations is mandate for planning treatment strategies. With the advent of third generation TKIs that potentially target T790M, improvement in clinical outcome is documented in patients with NSCLCs. Managing these outcomes with appropriate companion diagnostics using ctDNA in early detection of these genetic alterations will improve patient care.
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Affiliation(s)
- Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying Cheng
- Department of Oncology, Jilin Provincial Cancer Hospital, Changchun, China
| | - Yuan Chen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanping Hu
- Department of Oncology, Hubei Cancer Hospital, Wuhan, China
| | - Wei-Ping Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Medical Oncology, National Cancer Centre, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Wu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-Ming Ying
- Department of Pathology, National Cancer Centre, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He-Long Zhang
- Department of Oncology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xu-Chao Zhang
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Medical Research Center of Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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34
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Oya Y, Yoshida T, Kuroda H, Shimizu J, Horio Y, Sakao Y, Inaba Y, Hida T, Yatabe Y. Association Between EGFR T790M Status and Progression Patterns During Initial EGFR-TKI Treatment in Patients Harboring EGFR Mutation. Clin Lung Cancer 2017; 18:698-705.e2. [PMID: 28596108 DOI: 10.1016/j.cllc.2017.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Emergence of the T790M point mutation in exon 20 of the epidermal growth factor receptor (EGFR) is the most common mechanism of resistance to EGFR tyrosine kinase inhibitors (EGFR-TKIs). The aim of this study was to investigate the association between T790M mutation status and the progression patterns during EGFR-TKI treatment. METHODS We reviewed 181 patients with advanced non-small-cell lung cancer harboring EGFR mutation, who were evaluated for T790M mutation status after initial EGFR-TKI failure (gefitinib, erlotinib, or afatinib). We retrospectively investigated the patient characteristics, initial EGFR-TKI response, T790M mutation status, subsequent treatment after initial EGFR-TKIs, timing of re-biopsy, and progression patterns during the EGFR-TKI treatment. RESULTS After the resistance to the EGFR-TKIs, the T790M mutation was identified in 87 (48%) of 181 patients. Seventy-three (40%) patients had solitary lesion progression, and 108 (60%) had multiple lesion progression during the initial EGFR-TKI treatment. The prevalence of the T790M mutation was significantly greater in patients with solitary lesion progression than those with multiple lesion progression (58% vs. 24%; P < .0001). The overall response rate and progression-free survival on initial EGFR-TKIs were significantly better in patients who acquired T790M after failure of EGFR-TKIs than those without T790M (overall response rate, 80% vs. 60%; P = .0033 and progression-free survival, 11.4 vs. 9.3 months; P = .0050). The multivariate analysis showed that gender, initial EGFR-TKI response, and progression patterns were significantly associated with T790M mutation status. DISCUSSION The progression patterns during initial EGFR-TKIs and initial EGFR-TKI response are associated with the T790M mutation.
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Affiliation(s)
- Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Tatsuya Yoshida
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan.
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Junichi Shimizu
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yoshitsugu Horio
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Toyoaki Hida
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Aichi, Japan
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35
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Zhao R, Zhou S, Xia B, Zhang CY, Hai P, Zhe H, Wang YY. AT-101 enhances gefitinib sensitivity in non-small cell lung cancer with EGFR T790M mutations. BMC Cancer 2016; 16:491. [PMID: 27431492 PMCID: PMC4950625 DOI: 10.1186/s12885-016-2519-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 06/28/2016] [Indexed: 01/29/2023] Open
Abstract
Background Although epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) have become the standard care of patients with advanced EGFR-mutant non-small cell lung cancer (NSCLC), development of acquired resistance is inevitable. A secondary mutation of threonine 790 (T790M) is associated with approximately half of the cases of acquired resistance. Strategies or agents to overcome this type of resistance are still limited. In this study, enhanced antitumor effect of AT-101, a-pan-Bcl-2 inhibitor, on gefitinib was explored in NSCLC with T790M mutation. Methods The effect of cotreatment with AT-101 and gefitinib on the viability of NSCLC cell lines harboring acquired T790M mutation was investigated using the MTT assay. The cellular apoptosis of NSCLC cells after cotreatment with AT-101 and gefitinib was assessed by FITC-annexin V/PI assay and Western blots analysis. The potential underlying mechanisms of the enhanced therapeutic effect for AT-101 was also studied using Western blots analysis. The in vivo anti-cancer efficacy of the combination with AT-101 and gefitinib was examined in a mouse xenograft model. Results In this study, we found that treatment with AT-101 in combination with gefitinib significantly inhibited cell proliferation, as well as promoted apoptosis of EGFR TKIs resistant lung cancer cells. The apoptotic effects of the use of AT-101 was related to the blocking of antiapoptotic protein: Bcl-2, Bcl-xl, and Mcl-1 and downregrulation of the molecules in EGFR pathway. The observed enhancements of tumor growth suppression in xenografts supported the reverse effect of AT-101 in NSCLC with T790M mutation, which has been found in in vitro studies before. Conclusions AT-101 enhances gefitinib sensitivity in NSCLC with EGFR T790M mutations. The addition of AT-101 to gefitinib is a promising strategy to overcome EGFR TKIs resistance in NSCLC with EGFR T790M mutations.
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Affiliation(s)
- Ren Zhao
- Department of radiation oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Shun Zhou
- Graduated School, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Bing Xia
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Nanjing Medical University, Hangzhou, 310000, Zhejiang, China
| | - Cui-Ying Zhang
- Department of radiation oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Ping Hai
- Department of radiation oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Hong Zhe
- Department of radiation oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.,Cancer Institute, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yan-Yang Wang
- Department of radiation oncology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China. .,Cancer Institute, Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
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