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WANG J, LIU P, YING L, ZHU R, YANG C, YANG Y, SU D. [Research Progress on the Combination Therapy of EGFR-TKIs and Metformin
in Acquired Resistance to EGFR-TKIs in Non-small Cell Lung Cancer]. Zhongguo Fei Ai Za Zhi 2023; 26:874-880. [PMID: 38061889 PMCID: PMC10714045 DOI: 10.3779/j.issn.1009-3419.2023.106.22] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Indexed: 12/18/2023]
Abstract
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) targeting EGFR are effective in EGFR mutation-positive non-small cell lung cancer (NSCLC) patients, but drug resistance is inevitable. With the application and expansion of individualized and combined therapy, more and more studies have shown that combined administration of Metformin effectively solves the problem of acquired drug resistance to EGFR-TKIs in clinical treatment and prolongs the survival of patients with NSCLC. EGFR-TKIs combined with Metformin is expected to be the treatment method of choice for NSCLC patients with EGFR-TKIs resistance. This paper intends to summarize the research progress of EGFR-TKIs combined with Metformin in the treatment of EGFR-TKIs acquired resistance in NSCLC, in order to provide a new idea for the treatment of NSCLC patients with acquired resistance to EGFR-TKIs.
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Hsieh HH, Wu TY, Chen CH, Kuo YH, Hour MJ. Clinical impact of tetracyclines and/or proton pump inhibitors on the efficacy of epidermal growth factor receptor inhibitors in non-small cell lung cancer: a retrospective cohort study. BMC Cancer 2023; 23:151. [PMID: 36782147 PMCID: PMC9926858 DOI: 10.1186/s12885-023-10623-w] [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: 04/02/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND This retrospective cohort study examined the impact of tetracyclines (TCs) and proton pump inhibitors (PPIs) alone or in combination on the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in patients with non-small cell lung cancer (NSCLC). METHODS Patients with NSCLC treated with gefitinib or erlotinib for at least 1 week between January 2009 and October 2021 were enrolled and divided into four groups based on the presence/absence of TC and/or PPI in the therapeutic regimen: TC-/PPI-, TC + /PPI-, TC-/PPI + , TC + /PPI + . Progression-free survival (PFS) and overall survival (OS) were the primary and secondary endpoints, respectively. RESULTS The estimated median PFS and OS of 347 included patients with NSCLC were 8.57 (95% confidence interval [CI]: 7.66-9.48) months and 13.10 (95% CI: 11.03-15.17) months, respectively. Co-administration of EGFR-TKIs with PPIs decreased the PFS and OS, while that with TCs improved the PFS and OS. However, the concomitant use of EGFR-TKIs, TCs, and PPIs yielded survival rates similar to that of EGFR-TKI therapy alone. CONCLUSIONS The administration of EGFR-TKIs with other drugs poses a challenge in managing patients with NSCLC. Therefore, reassessing the indications and necessity of TC or PPI therapy is essential for patients receiving erlotinib or gefitinib. The benefits and risks of possible discontinuation due to the clinical relevance of this interaction should be considered.
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Affiliation(s)
- Hui-Hsia Hsieh
- grid.414692.c0000 0004 0572 899XDepartment of Pharmacy, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan ,grid.254145.30000 0001 0083 6092School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Tien-Yuan Wu
- grid.414692.c0000 0004 0572 899XDepartment of Pharmacy, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan ,grid.411824.a0000 0004 0622 7222Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien, Taiwan
| | - Chi-Hua Chen
- grid.414692.c0000 0004 0572 899XDepartment of Pharmacy, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Yu-Hung Kuo
- grid.414692.c0000 0004 0572 899XDepartment of Research, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Mann-Jen Hour
- School of Pharmacy, China Medical University, Taichung, Taiwan.
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Hsu HT, Yu CC, Lee YH, Chan JC, Chu CY. Association between dermatologic adverse events and quality of life in lung cancer patients treated with epidermal growth factor receptor-tyrosine kinase inhibitors. Support Care Cancer 2022. [PMID: 36056941 DOI: 10.1007/s00520-022-07347-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are frequently associated with dermatologic adverse events (dAEs), having great impacts on patients' health-related quality of life (HRQoL) and treatment adherence. We aimed to examine the association between various dAEs and HRQoL in patients treated with EGFR-TKI therapy. METHODS This was a cross-sectional study including 132 non-small-cell lung cancer (NSCLC) patients treated with gefitinib, erlotinib, afatinib, or osimertinib in Taiwan. The severity level of dAEs was graded by NCI-CTCAE v4.03 and PRO-CTCAE ITEMS v1.0. All participants answered the Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitors (FACT-EGFRI-18) HRQoL questionnaire. RESULTS The clinician-reported severity of pruritus, photosensitivity, alopecia, and Karnofsky performance status was associated with HRQoL (β = - 6.773, p = 0.046; β = - 5.250, p = 0.032; β = - 8.121, p = 0.001; β = 0.327, p = 0.002; respectively). The clinician-reported severity of all dAEs except paronychia had negative correlations with HRQoL. The symptom gradings of CTCAE and PRO-CTCAE had positive correlation. CONCLUSIONS The severity of pruritus, photosensitivity, and alopecia was associated with HRQoL of patients receiving EGFR-TKI therapy. Using patient-reported outcome measurements helps clinicians to capture the actual impact of symptoms on physical, social-emotional, and functional well-being.
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Liu Y, Li Y, Wang J. [Research Progress of New Generation EGFR-TKIs after Third-generation]. Zhongguo Fei Ai Za Zhi 2020; 23:970-975. [PMID: 32773008 PMCID: PMC7679226 DOI: 10.3779/j.issn.1009-3419.2020.102.28] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
肺癌是全球死亡率最高的癌种。第一、二代表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors, EGFR-TKIs)的出现,在一定程度上极大地提高了非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的生存期及生活质量,但大多数患者在经过一段时间的无进展生存期后会产生耐药性,其中以T790M突变为主要耐药机制。针对此耐药突变出现的是以奥希替尼为代表的第三代EGFR-TKIs,其效果显著,然而仍不可避免的出现耐药性,如:C797S突变、间质表皮转化(mesenchymal-epithelial transition, MET)、RAS突变、BRAF突变、小细胞肺癌(small cell lung cancer, SCLC)转化、上皮间质细胞转化(epithelial mesenchymal transition, EMT)等。但是目前第三代EGFR-TKIs耐药后并没有标准有效的治疗方案。故本文主要阐述三代后的新一代EGFR-TKIs的研究进展,为后续的研究及治疗提供一定的参考。
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Affiliation(s)
- Yuanyuan Liu
- First Department of Comprehensive Treatment of Tumors, Tangshan People's Hospital,
North China University of Science and Technology, Tangshan 063000, China
| | - Yihui Li
- First Department of Comprehensive Treatment of Tumors, Tangshan People's Hospital,
North China University of Science and Technology, Tangshan 063000, China
| | - Jiangong Wang
- First Department of Comprehensive Treatment of Tumors, Tangshan People's Hospital,
North China University of Science and Technology, Tangshan 063000, China
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Abstract
Introduction: Lung cancer is the most prevalent malignant tumors worldwide. Over the past decade, the emergence of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) has ushered in a new era of lung cancer treatment. Therefore, clinical trials investigating the efficacy and safety of these drugs are important.Areas covered: This review provides an overview on the safety of three classes of EGFR-TKIs and discusses the adverse events (AEs) and reactions reported in the literature.Expert opinion: EGFR-TKIs significantly improve progression-free survival and overall survival in non-small cell lung cancer (NSCLC) patients with an activating mutation of EGFR. However, EGFR-TKIs also block the EGFR-regulating pathways in the skin and gastrointestinal tract and cause AEs, including diarrhea, liver toxicity, skin disease, stomatitis, interstitial lung disease, and ocular toxicity, which have detrimental effects on quality of life and drug compliance. Clinicians should understand how to prevent and control these adverse reactions, which can often be achieved by dose reduction, discontinuation of treatment, or switching to another drug.
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Affiliation(s)
- Jia-Ying Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
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Yang CS, Chen WD, Gong GZ, Li ZJ, Qiu QT, Yin Y. [Application of radiomics captured from CT to predict the EGFR mutation status and TKIs therapeutic sensitivity of advanced lung adenocarcinoma]. Zhonghua Zhong Liu Za Zhi 2019; 41:282-287. [PMID: 31014053 DOI: 10.3760/cma.j.issn.0253-3766.2019.04.007] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the ability of computed-tomography (CT) radiomic features to predict the Epidermal growth factor receptor (EGFR) mutation status and the therapeutic response of advanced lung adenocarcinoma to EGFR- Tyrosine kinase inhibitors (TKIs) treatment. Methods: A retrospective analysis was performed on 253 patients diagnosed as advanced lung adenocarcinoma, who underwent EGFR mutation detection, and those with EGFR sensitive mutation were treated with TKIs. Using the Lasso regression model and the 10 fold cross-validation method, the radiomic features of predicted EGFR mutation status and the screening of TKIs for sensitive populations were obtained. 715 radiomic features were extracted from unenhanced, arterial phase and venous phase, respectively. Results: The area under curve (AUC) values of the multi-phases including unenhanced, arterial phase and venous phase of the EGFR mutation status validation group were 0.763, 0.807 and 0.808, respectively. The number of radiomic features extracted from the multi-phases were 5, 18 and 23, respectively, which could distinguish the EGFR mutation status. The AUC values of the multi-phases of the EGFR-TKIs sensitive validation group were 0.730, 0.833 and 0.895, respectively. The number of radiomic features extracted from the multi-phases were 3, 7 and 22, respectively, which can be used to screen the superior population for TKIs treatment. The efficiency of radiomic features extracted from venous phase in predicting EGFR mutant status and EGFR-TKIs sensitivity was significantly superior than those of unenhanced and arterial phase. Conclusions: The radiomic features of CT scanning can be used as the radiomics biomarker to predict the EGFR mutation status of lung adenocarcinoma and to further screen the dominant population in TKIs therapy, which provides the basis for targeted therapy.
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Affiliation(s)
- C S Yang
- Department of Oncology, Jining First People's Hospital, Jining 272000, China
| | - W D Chen
- Department of Oncology, Jining First People's Hospital, Jining 272000, China
| | - G Z Gong
- Department of Radiophysical Technology, Shandong Cancer Hospital, Jinan 250117, China
| | - Z J Li
- Department of Radiophysical Technology, Shandong Cancer Hospital, Jinan 250117, China
| | - Q T Qiu
- Department of Radiophysical Technology, Shandong Cancer Hospital, Jinan 250117, China
| | - Y Yin
- Department of Radiophysical Technology, Shandong Cancer Hospital, Jinan 250117, China
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Xu HY, Lai QQ, Su SS, Zhou LP, Ye JR, Zhang DQ, Xie YP, Li YP. [Plasma relative abundance of epidermal growth factor receptor mutations predicts clinical response to epidermal growth factor receptor-tyrosine kinase inhibitors in patients with advanced lung adenocarcinoma]. Zhonghua Nei Ke Za Zhi 2019; 58:49-55. [PMID: 30605951 DOI: 10.3760/cma.j.issn.0578-1426.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To determine whether relative abundance of epidermal growth factor receptor (EGFR) mutations in plasma predicts clinical response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced lung adenocarcinoma. Methods: In this prospective study, adult patients with advanced lung adenocarcinoma were enrolled in our hospital from 1 April 2016 to 1 January 2017. EGFR mutations in tumor tissues were detected by ADx-amplification refractory mutation system (ADx-ARMS). EGFR mutations of plasma free tumor DNA were detected by ADx-ARMS and ADx-super amplification refractory mutation system (ADx-SuperARMS) at the same time. Patients with EGFR-mutant in tumor tissues and receiving EGFR-TKIs were finally enrolled. Plasma mutation-positive patients with both methods were high abundance group.Patients with positive mutations by ADx-SuperARMS but negative by ADx-ARMS were medium abundance group. Mutation-negative patients with both methods were recognized as low abundance group. The correlation between EGFR mutation abundance and clinical response to EGFR-TKIs were analyzed. Results: Among 71 patients enrolled, 42 harbored EGFR mutations in plasma were detected by ADx-ARMS, while 53 were found by ADx-SuperARMS.There were 42 patients in high abundance group, 11 in medium group while the other 18 in low group. The objective response rates (ORRs) were 69.0%, 7/11 and 10/18 in high, medium and low groups, respectively. The difference was significant between high and low abundances groups (P=0.006). Median progression-free survival (PFS) in high, medium and low groups were 11.0, 8.5 and 9.0 monthes, respectively (P<0.001). In patients with tumor 19-Del, the ORRs were 70.4%, 5/7 and 6/11 in high, medium and low abundance groups, respectively. The median PFS of high abundance group was significantly longer than the other two groups (12.0 monthes vs 9.0, 9.0 monthes). As to subjects with L858R mutation, the ORRs were 10/15, 2/4 and 3/6, respectively, with median PFS 9.6, 5.5 and 9.5 monthes. Conclusions: The relative abundance of EGFR mutations in plasma predicts clinical response to EGFR-TKIs in patients with advanced lung adenocarcinoma. The higher the mutation abundance is, the better the efficacy of EGFR-TKIs is.
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Affiliation(s)
- H Y Xu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
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李 树, 于 鸿, 张 耿. [Advances in Long Non-coding RNAs on Resistant to EGFR-TKIs
in Non-small Cell Lung Cancer]. Zhongguo Fei Ai Za Zhi 2018; 21:121-128. [PMID: 29526180 PMCID: PMC5973017 DOI: 10.3779/j.issn.1009-3419.2018.02.06] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/25/2017] [Accepted: 12/29/2017] [Indexed: 11/30/2022]
Abstract
Most non-small cell lung cancer patients with active epidermal growth factor receptor (EGFR) mutation will eventually acquire drug resistant to EGFR tyrosine kinase inhibitors, such as gefitinib, resulting in disease progression, which involves a variety of complex mechanisms. Up to now, the molecular mechanisms of long non-coding RNAs mediated EGFR-TKIs resistance remains poorly understood. This review aims to outline the current state of information on lncRNAs and progress on its role in EGFR-TKIs resistance in non-small cell lung cancer.
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Affiliation(s)
- 树斌 李
- 102600 北京, 中国中医科学院广安门医院南区内科Department of Internal Medicine, Southern Branch of Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 102600, China
| | - 鸿 于
- 130012 长春, 吉林省肿瘤医院吉林省肿瘤防治研究所细胞生物研究室Cell Biology Laboratory, Jilin Province Institute of Cancer Prevention and Treatment, Jilin Cancer Hospital, Changchun 130012, China
| | - 耿月 张
- 130012 长春, 吉林省肿瘤医院吉林省肿瘤防治研究所细胞生物研究室Cell Biology Laboratory, Jilin Province Institute of Cancer Prevention and Treatment, Jilin Cancer Hospital, Changchun 130012, China
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Gao H, Yang Z, Yang X, Rao Y. Synthesis and evaluation of osimertinib derivatives as potent EGFR inhibitors. Bioorg Med Chem 2017; 25:4553-4559. [PMID: 28716641 DOI: 10.1016/j.bmc.2017.06.004] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/29/2017] [Accepted: 06/04/2017] [Indexed: 01/17/2023]
Abstract
Osimertinib has been identified as a promising therapeutic drug targeting for EGFR T790M mutant non-small cell lung cancer (NSCLC). A new series of N-oxidized and fluorinated osimertinib derivatives were designed and synthesized. The cellular anti-proliferative activity, kinase inhibitory activity and the activation of EGFR signaling pathways of 1-6 in vitro were determined against L858R/T790M and wild-type EGFR, the antitumor efficacy in NCI-H1975 xenografts in vivo were further studied. Compound 2, the newly synthesized N-oxide metabolite in N,N,N'-trimethylethylenediamine side chain of osimertinib, showed a comparable kinase selectivity in vitro and a slightly better antitumor efficacy in vivo to osimertinib, making it valuable and suitable for the potential lung cancer therapy.
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Affiliation(s)
- Hongying Gao
- Tsinghua University-Peking University Joint Center for Life Sciences, Beijing 100084, PR China; MOE Key Laboratory of Protein Sciences, School of Life Sciences, Tsinghua University, Beijing 100084, PR China
| | - Zimo Yang
- MOE Key Laboratory of Protein Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, PR China
| | - Xinglin Yang
- MOE Key Laboratory of Protein Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, PR China
| | - Yu Rao
- MOE Key Laboratory of Protein Sciences, School of Pharmaceutical Sciences, Tsinghua University, Beijing 100084, PR China.
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Chen XX, Zhou CC. [Mechanism and clinical efficacy of third-generation epidermal growth factor receptor tyrosine kinase inhibitor in non-small cell lung cancer]. Zhonghua Zhong Liu Za Zhi 2017; 39:401-4. [PMID: 28635227 DOI: 10.3760/cma.j.issn.0253-3766.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register]
Abstract
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are the standard treatment for non-small cell lung cancer (NSCLC) patients with EGFR activating mutations. However, most of patients will develop resistance to TKIs treatment due to the emergence of the T790M mutation. The third-generation EGFR-TKI is highly selective and efficient for activating mutants (EGFR sensitive mutations) and resistance mutant (T790M+ ). This review summarizes the mechanism and clinical efficacy of the third-generation EGFR-TKI in NSCLC patients.
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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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Wada Y, Koyama S, Kuraishi H, Miyahara T, Yoshiike F, Agatsuma T, Yamamoto R, Ono Y, Suzuki T, Hachiya T, Gomi D, Tateishi K, Hanaoka M, Koizumi T. Clinical analysis of patients treated with afatinib for advanced non-small cell lung cancer: A Nagano Lung Cancer Research Group observational study. Respir Investig 2016; 54:462-467. [PMID: 27886858 DOI: 10.1016/j.resinv.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Afatinib has been available in Japan for the treatment of epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) since May 2014. We conducted an observational study in patients treated with afatinib in Nagano prefecture, focusing on response and associated toxicities. METHODS We analyzed the clinical records of NSCLC patients treated with afatinib between May 2014 and February 2015. RESULTS The records of a total of 73 patients (27 men, 46 women) with a median age of 69 years (range: 42-85 years) were analyzed. Afatinib was administered to 11 patients as a first-line therapy, but it was predominantly administered as a fifth-line or beyond therapy (32 cases, 43.8%). The overall response rates for afatinib as a first-line therapy and beyond second-line therapy were 80% (95% confidence interval [CI]: 55.2-100.0%) and 27.1% (95% CI: 14.5-39.7%), respectively. The main toxicities grade >3 included diarrhea (8.2%), skin rash (6.8%), nausea (6.8%), and appetite loss (6.8%). A low body surface area (BSA) (<1.5m2) was significantly associated with a higher frequency of diarrhea grade >2, compared with a higher BSA (≥ 1.5m2). Forty-eight patients (63.0%) were treated without a dose reduction of afatinib. CONCLUSIONS Although the survival benefit with afatinib remains unclear, our observational analysis demonstrated the feasibility of using afatinib for EGFR-mutated NSCLC in clinical practice. In particular, a relatively high level of drug delivery is possible. In addition, a lower BSA may be a predictor of diarrhea in patients treated with afatinib.
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Affiliation(s)
- Yosuke Wada
- Department of Pulmonary Diseases, Nagano Red Cross Hospital, Nagano City, Japan; First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Shigeru Koyama
- Department of Pulmonary Diseases, Nagano Red Cross Hospital, Nagano City, Japan.
| | - Hiroshi Kuraishi
- Department of Pulmonary Diseases, Nagano Red Cross Hospital, Nagano City, Japan.
| | - Takashige Miyahara
- Department of Pulmonary Diseases, Nagano Matsushiro General Hospital, Nagano City, Japan.
| | - Fumiaki Yoshiike
- Department of Pulmonary Diseases, Nagano Municipal Hospital, Nagano City, Japan.
| | - Toshihiko Agatsuma
- Department of Respiratory Medicine, National Hospital Organization Shinshu Ueda Medical Center, Ueda City, Japan.
| | - Ryouhei Yamamoto
- Division of Thoracic Surgery, Saku Central Hospital Advanced Care Center, Saku City, Japan.
| | - Yasushi Ono
- Treatment Center, Aizawa Hospital, Matsumoto City, Japan.
| | - Toshiro Suzuki
- Department of Pulmonary Diseases, Matsumoto Medical Center, Matsumoto City, Japan.
| | - Tsutomu Hachiya
- Department of Pulmonary Diseases, Suwa Red Cross Hospital, Suwa City, Japan.
| | - Daisuke Gomi
- Department of Medical Oncology, Iida Municipal Hospital, Iida City, Japan; Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto City, Japan.
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto City, Japan.
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Macedo JE. New era of epidermal growth factor receptor-tyrosine kinase inhibitors for lung cancer. World J Respirol 2016; 6:57-62. [DOI: 10.5320/wjr.v6.i2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
Lung cancer is the leading cause of death globally, besides recent advances in its management; it maintains a low 5-year survival rate of 15%. The discovery of epidermal growth factor receptor (EGFR) activating mutations and the introduction of its tyrosine kinase inhibitors (TKIs) have expanded the treatment options for patients with non-small cell lung cancer. Nowadays, EGFR mutation testing is now a common routine for newly diagnosed lung cancer. First generation TKIs developed, erlotinib and gefitinib, were reversible ones. After a median of 14 mo, eventually all EGFR mutated patients develop resistance to reversible TKIs. Afatinib, dacomitinib and neratinib, second generation inhibitors, are selective and irreversible TKIs. Finally, third generation phase I clinical trials were performed, with lower toxicity profiles, and targeting with more precision the driving clone of this heterogeneous disease.
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Kaira R, Kaira K, Shukuya T, Kenmotsu H, Ono A, Murakami H, Tsuya A, Nakamura Y, Naito T, Endo M, Yamamoto N, Takahashi T. Long-term survival of more than 3 years among patients with advanced non-small cell lung cancer treated with chemotherapy. World J Respirol 2013; 3:110-115. [DOI: 10.5320/wjr.v3.i3.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/12/2013] [Accepted: 10/12/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the prognostic factors of long-term survival of more than 3 years in patients with advanced non-small cell lung cancer (NSCLC).
METHODS: We retrospectively analyzed the records of 474 patients with advanced IIIB/IV NSCLC who received chemotherapy as initial treatment between September 2002 and March 2007.
RESULTS: The median survival time (MST) was 12.5 mo and the 3 year and 5 year survival rates were 14.6% and 5.3%, respectively. Long-term survival of more than 3 and 5 years was observed in 65 and 16 patients, respectively. The MST for the 65 patients was 61.5 mo (range, 60.1-81.0 mo). In the 474 patients, a good performance status (PS), female sex, non-smoking status and adenocarcinoma histology were significantly associated with a favorable outcome. Furthermore, female sex, a good PS, non-smoking status and adenocarcinoma histology were significantly correlated with long-term survival of more than 3 years and most of these patients (89.2%, 58/65) received epidermal growth factor receptor-tyrosine kinase inhibitors as any line treatment. Survival analysis of long-term survivors showed that a PS of 0 was an independent prognostic factor for predicting favorable outcomes.
CONCLUSION: Our results suggest that a good PS and adenocarcinoma histology play an important role in long-term survival of more than 3 years. A PS of 0 was an independent prognostic factor for predicting favorable outcomes in patients with advanced NSCLC who survived for more than 3 years.
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