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Coaston TN, Sakowitz S, Chervu NL, Branche C, Shuch BM, Benharash P, Revels S. Social determinants as predictors of resection and long-term mortality in Black patients with non-small cell lung cancer. Surgery 2024; 175:505-512. [PMID: 37949695 DOI: 10.1016/j.surg.2023.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/27/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Minorities diminished returns theory posits that socioeconomic attainment conveys fewer health benefits for Black than White individuals. The current study evaluates the effects of social constructs on resection rates and survival for non-small cell lung cancer (NSCLC). METHODS Patients with potentially resectable NSCLC stage IA to IIIA were identified using the 2004 to 2017 National Cancer Database. Patients were stratified into quartiles based on population-level education and income. Logistic regression was used to predict risk-adjusted resection rates. Mortality was assessed with Cox proportional hazard modeling. RESULTS Of the 416,025 patients identified, 213,643 (51.4%) underwent resection. Among White patients, the lowest income (adjusted odds ratio 0.76, 95% confidence interval 0.74-0.78, P < .01) and education quartiles (adjusted odds ratio 0.82, 95% confidence interval 0.79-0.84, P < .01) were associated with decreased odds of resection. The lowest education quartile among Black patients was not associated with lower resection rates. The lowest income quartile (adjusted odds ratio 0.67, 95% CI 0.61-0.74, P < .01) was associated with reduced resection. White patients in the lowest education and income quartiles experienced increased hazard of 5-year mortality (adjusted hazard ratio 1.13, 95% CI 1.11-1.15, P < .01 and adjusted hazard ratio 1.08, 95% CI 1.06-1.11, P < .01 respectively). In Black patients, there were no significant differences in 5-year survival between Black patients in the highest education and income quartiles and those in the lowest quartiles. CONCLUSION Among Black patients with NSCLC, educational attainment is not associated with increased resection rates. In addition, higher education and income were not associated with improved 5-year survival. The diminished gains experienced by Black patients, compared to Whites patients, illustrate the presence of pervasive race-specific mechanisms in observed inequalities in cancer outcomes.
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Affiliation(s)
- Troy N Coaston
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. https://twitter.com/SaraSakowiz
| | - Nikhil L Chervu
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Corynn Branche
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Brian M Shuch
- Division of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sha'Shonda Revels
- Division of Thoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Bilani N, Itani M, Soweid L, Iska S, Bertasi T, Bertasi R, Yaghi M, Mohanna M, Dominguez B, Saravia D, Alley E, Nahleh Z, Arteta-Bulos R. Geographic Origin may Affect Outcomes for Hispanic Patients with Non-Small Cell Lung Cancer in the United States. Clin Lung Cancer 2023; 24:e219-e225. [PMID: 37271715 DOI: 10.1016/j.cllc.2023.04.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Social determinants of health thoroughly explored in the literature include insurance status, race, and ethnicity. There are over 50 million self-identifying Hispanics in the United States. This, however, represents a heterogeneous population. We used a national registry to investigate for significant differences in outcomes of Hispanic patients with non-small cell lung cancer (NSCLC) in the Unites states, by geographic region of origin. MATERIALS AND METHODS We identified a cohort of Hispanic patients in the Unites states with NSCLC for which region of origin was documented within the 2004 to 2016 National Cancer Database (NCDB) registry. This included patients from Cuba, Puerto Rico, Mexico, South and Central America, and the Dominican Republic. We performed multivariate logistic regression modeling to determine whether origin was a significant predictor of cancer staging at diagnosis, adjusting for age, sex, histology, grade, insurance status, and facility type. Race was not included due to a nonsignificant association with stage at diagnosis at the bivariate level in this cohort. Subsequently, we used Kaplan-Meier modeling to identify whether overall survival (OS) of Hispanic patients differed by origin. RESULTS A total of 12,557 Hispanic patients with NSCLC were included in this analysis. The breakdown by origin was as follows: n = 2071 (16.5%) Cuban, n = 2360 (18.8%) Puerto Rican, n = 4950 (39.4%) Mexican, n = 2329 (18.5%) from South or Central America, and n = 847 (6.7%) from the Dominican Republic. After controlling for age, sex, histology, grade, insurance status and treating facility type, we found that geographic origin was a significant predictor of advanced stage at diagnosis (P = .015). Compared to Cubans, patients of Puerto Rican origin were less likely to present with advanced disease (68.4% vs. 71.9%; OR: 0.82; 95%CI: 0.69-0.98; P = .026). We also identified a significant (log-rank P-value<.001) difference in OS by geographic origin, even at early-stages of diagnosis. Dominican patients with NSCLC exhibited the highest 5-year OS rate (63.3%), followed by patients from South/Central America (59.7%), Puerto Rico (52.3%), Mexico (45.9%), and Cuba (43.8%). CONCLUSION This study showed that for Hispanic individuals living in the Unites states, region/country of origin is significantly associated with outcomes, even after accounting for other known determinants of health. We suggest that region of origin should be studied further as a potential determinant of outcomes in patients with cancer.
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Affiliation(s)
- Nadeem Bilani
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY.
| | - Mira Itani
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | | | - Sindu Iska
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Tais Bertasi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY
| | - Raphael Bertasi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside-West, New York, NY
| | - Marita Yaghi
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Mohamed Mohanna
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Barbara Dominguez
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Diana Saravia
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Evan Alley
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Zeina Nahleh
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
| | - Rafael Arteta-Bulos
- Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL
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Sun L, Bleiberg B, Hwang WT, Marmarelis ME, Langer CJ, Singh A, Cohen RB, Mamtani R, Aggarwal C. Association Between Duration of Immunotherapy and Overall Survival in Advanced Non-Small Cell Lung Cancer. JAMA Oncol 2023; 9:1075-1082. [PMID: 37270700 PMCID: PMC10240399 DOI: 10.1001/jamaoncol.2023.1891] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/03/2023] [Indexed: 06/05/2023]
Abstract
Importance For patients with advanced non-small cell lung cancer (NSCLC) treated with frontline immunotherapy-based treatment, the optimal duration of immune checkpoint inhibitor (ICI) treatment is unknown. Objective To assess practice patterns surrounding ICI treatment discontinuation at 2 years and to evaluate the association of duration of therapy with overall survival in patients who received fixed-duration ICI therapy for 2 years vs those who continued therapy beyond 2 years. Design, Setting, and Participants This retrospective, population-based cohort study included adult patients in a clinical database diagnosed with advanced NSCLC from 2016 to 2020, who received frontline immunotherapy-based treatment. The data cutoff was August 31, 2022; data analysis was conducted from October 2022 to January 2023. Exposures Treatment discontinuation at 2 years (between 700 and 760 days, fixed duration) vs continued treatment beyond 2 years (greater than 760 days, indefinite duration). Main Outcomes and Measures Overall survival from 760 days was analyzed using Kaplan-Meier methods. Multivariable Cox regression that adjusted for patient-specific and cancer-specific factors was used to compare survival beyond 760 days between the fixed-duration group and the indefinite-duration group. Results Of 1091 patients in the analytic cohort who were still on ICI treatment at 2 years after exclusion criteria for death and progression were applied, 113 patients (median [IQR] age, 69 [62-75] years; 62 [54.9%] female; 86 [76.1%] White) were in the fixed-duration group, and 593 patients (median [IQR] age, 69 [62-76] years; 282 [47.6%] female; 414 [69.8%] White) were in the indefinite-duration group. Patients in the fixed-duration group were more likely to have a history of smoking (99% vs 93%; P = .01) and be treated at an academic center (22% vs 11%; P = .001). Two-year overall survival from 760 days was 79% (95% CI, 66%-87%) in the fixed-duration group and 81% (95% CI, 77%-85%) in the indefinite-duration group. There was no statistically significant difference in overall survival between patients in the fixed-duration and indefinite-duration groups, either on univariate (hazard ratio [HR] 1.26; 95% CI, 0.77-2.08; P = .36) or multivariable (HR 1.33; 95% CI, 0.78-2.25; P = .29) Cox regression. Approximately 1 in 5 patients discontinued immunotherapy at 2 years in the absence of progression. Conclusions and Relevance In a retrospective clinical cohort of patients with advanced NSCLC who were treated with immunotherapy and were progression-free at 2 years, approximately only 1 in 5 discontinued treatment. The lack of statistically significant overall survival advantage for the indefinite-duration cohort on adjusted analysis provides reassurance to patients and clinicians who wish to discontinue immunotherapy at 2 years.
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Affiliation(s)
- Lova Sun
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Benjamin Bleiberg
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Melina E. Marmarelis
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Corey J. Langer
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Aditi Singh
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Roger B. Cohen
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Ronac Mamtani
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Charu Aggarwal
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Tsuboi M, Herbst RS, John T, Kato T, Majem M, Grohé C, Wang J, Goldman JW, Lu S, Su WC, de Marinis F, Shepherd FA, Lee KH, Le NT, Dechaphunkul A, Kowalski D, Poole L, Bolanos A, Rukazenkov Y, Wu YL. Overall Survival with Osimertinib in Resected EGFR-Mutated NSCLC. N Engl J Med 2023; 389:137-147. [PMID: 37272535 DOI: 10.1056/nejmoa2304594] [Citation(s) in RCA: 69] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Among patients with resected, epidermal growth factor receptor (EGFR)-mutated, stage IB to IIIA non-small-cell lung cancer (NSCLC), adjuvant osimertinib therapy, with or without previous adjuvant chemotherapy, resulted in significantly longer disease-free survival than placebo in the ADAURA trial. We report the results of the planned final analysis of overall survival. METHODS In this phase 3, double-blind trial, we randomly assigned eligible patients in a 1:1 ratio to receive osimertinib (80 mg once daily) or placebo until disease recurrence was observed, the trial regimen was completed (3 years), or a discontinuation criterion was met. The primary end point was investigator-assessed disease-free survival among patients with stage II to IIIA disease. Secondary end points included disease-free survival among patients with stage IB to IIIA disease, overall survival, and safety. RESULTS Of 682 patients who underwent randomization, 339 received osimertinib and 343 received placebo. Among patients with stage II to IIIA disease, the 5-year overall survival was 85% in the osimertinib group and 73% in the placebo group (overall hazard ratio for death, 0.49; 95.03% confidence interval [CI], 0.33 to 0.73; P<0.001). In the overall population (patients with stage IB to IIIA disease), the 5-year overall survival was 88% in the osimertinib group and 78% in the placebo group (overall hazard ratio for death, 0.49; 95.03% CI, 0.34 to 0.70; P<0.001). One new serious adverse event, pneumonia related to coronavirus disease 2019, was reported after the previously published data-cutoff date (the event was not considered by the investigator to be related to the trial regimen, and the patient fully recovered). Adjuvant osimertinib had a safety profile consistent with that in the primary analysis. CONCLUSIONS Adjuvant osimertinib provided a significant overall survival benefit among patients with completely resected, EGFR-mutated, stage IB to IIIA NSCLC. (Funded by AstraZeneca; ADAURA ClinicalTrials.gov number, NCT02511106.).
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Affiliation(s)
- Masahiro Tsuboi
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Roy S Herbst
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Thomas John
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Terufumi Kato
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Margarita Majem
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Christian Grohé
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Jie Wang
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Jonathan W Goldman
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Shun Lu
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Wu-Chou Su
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Filippo de Marinis
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Frances A Shepherd
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Ki Hyeong Lee
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Nhieu Thi Le
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Arunee Dechaphunkul
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Dariusz Kowalski
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Lynne Poole
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Ana Bolanos
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Yuri Rukazenkov
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
| | - Yi-Long Wu
- From the Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa (M.T.), the Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama (T.K.) - both in Japan; the Section of Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT (R.S.H.); the Department of Medical Oncology, Peter MacCallum Cancer Centre, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia (T.J.); the Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona (M.M.); Klinik für Pneumologie, Evangelische Lungenklinik Berlin Buch, Berlin (C.G.); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing (J.W.), Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai (S.L.), and Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou (Y.-L.W.) - all in China; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (J.W.G.); the Department of Oncology, National Cheng Kung University, Tainan, Taiwan (W.-C.S.); the Division of Thoracic Oncology, European Institute of Oncology, IRCCS, Milan (F.M.); the Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre (F.A.S.), and Oncology Research and Development, AstraZeneca (A.B.) - both in Toronto; the Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, South Korea (K.H.L.); Ho Chi Minh City Oncology Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam (N.T.L.); the Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (A.D.); the Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland (D.K.); and Oncology Biometrics (L.P.), and Oncology Research and Development (Y.R.), AstraZeneca, Cambridge, United Kingdom
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Abstract
The CodeBreaK 200 trial showed that sotorasib led to a 34% decrease in relative risk of disease progression or death compared with docetaxel but yielded no improvement in overall survival. Despite the KRAS inhibitor's high cost, less toxicity likely tips the balance in its favor. Subgroup analyses and combination trials are underway to optimize treatment with sotorasib and other KRAS inhibitors.
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Cavagna RDO, Pinto IA, Escremim de Paula F, Berardinelli GN, Sant'Anna D, Santana I, da Silva VD, Da Silva ECA, Miziara JE, Mourão Dias J, Antoniazzi A, Jacinto A, De Marchi P, Molina-Vila MA, Ferro Leal L, Reis RM. Disruptive and Truncating TP53 Mutations Are Associated with African-Ancestry and Worse Prognosis in Brazilian Patients with Lung Adenocarcinoma. Pathobiology 2023; 90:344-355. [PMID: 37031678 DOI: 10.1159/000530587] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/27/2022] [Accepted: 04/03/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION TP53 is the most frequently mutated gene in lung tumors, but its prognostic role in admixed populations, such as Brazilians, remains unclear. In this study, we aimed to evaluate the frequency and clinicopathological impact of TP53 mutations in non-small cell lung cancer (NSCLC) patients in Brazil. METHODS We analyzed 446 NSCLC patients from Barretos Cancer Hospital. TP53 mutational status was evaluated through targeted next-generation sequencing (NGS) and the variants were biologically classified as disruptive/nondisruptive and as truncating/nontruncating. We also assessed genetic ancestry using 46 ancestry-informative markers. Analysis of lung adenocarcinomas from the cBioportal dataset was performed. We further examined associations of TP53 mutations with patients' clinicopathological features. RESULTS TP53 mutations were detected in 64.3% (n = 287/446) of NSCLC cases, with a prevalence of 60.4% (n = 221/366) in lung adenocarcinomas. TP53 mutations were associated with brain metastasis at diagnosis, tobacco consumption, and higher African ancestry. Disruptive and truncating mutations were associated with a younger age at diagnosis. Additionally, cBioportal dataset revealed that TP53 mutations were associated with younger age and Black skin color. Patients harboring disruptive/truncating TP53 mutations had worse overall survival than nondisruptive/nontruncating and wild-type patients. CONCLUSION TP53 mutations are common in Brazilian lung adenocarcinomas, and their biological characterization as disruptive and truncating mutations is associated with African ancestry and shorter overall survival.
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Affiliation(s)
| | - Icaro Alves Pinto
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
| | | | | | - Débora Sant'Anna
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
| | - Iara Santana
- Department of Pathology, Barretos Cancer Hospital, São Paulo, Brazil
| | | | | | - José Elias Miziara
- Department Thoracic Surgery, Barretos Cancer Hospital, São Paulo, Brazil
- Department of Medical Oncology, Barretos Cancer Hospital, São Paulo, Brazil
| | | | - Augusto Antoniazzi
- Department of Medical Oncology, Barretos Cancer Hospital, São Paulo, Brazil
- Department of Oncogenetics / Barretos Cancer Hospital, São Paulo, Brazil
| | - Alexandre Jacinto
- Department of Radiotherapy, Barretos Cancer Hospital, São Paulo, Brazil
| | - Pedro De Marchi
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
- Department of Medical Oncology, Barretos Cancer Hospital, São Paulo, Brazil
- Department of Medical Oncology, Oncoclinicas, Rio de Janeiro, Brazil
| | | | - Leticia Ferro Leal
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
- Barretos School of Health Sciences Dr. Paulo Prata, FACISB, São Paulo, Brazil
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo, Brazil
- Molecular Diagnostic Laboratory, Barretos Cancer Hospital, São Paulo, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga-Guimarães, Portugal
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7
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Voruganti T, Soulos PR, Mamtani R, Presley CJ, Gross CP. Association Between Age and Survival Trends in Advanced Non-Small Cell Lung Cancer After Adoption of Immunotherapy. JAMA Oncol 2023; 9:334-341. [PMID: 36701150 PMCID: PMC9880865 DOI: 10.1001/jamaoncol.2022.6901] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/21/2022] [Indexed: 01/27/2023]
Abstract
Importance The introduction of immune checkpoint inhibitors (ICIs) has transformed the care of advanced non-small cell lung cancer (NSCLC). Although clinical trials suggest substantial survival benefits, it is unclear how outcomes have changed in clinical practice. Objective To assess temporal trends in ICI use and survival among patients with advanced NSCLC across age strata. Design, Setting, and Participants This cohort study was performed in approximately 280 predominantly community-based US cancer clinics and included patients aged 18 years or older who had stage IIIB, IIIC, or IV NSCLC diagnosed between January 1, 2011, and December 31, 2019, with follow-up through December 31, 2020. Data were analyzed April 1, 2021, to October 19, 2022. Main Outcomes and Measures Median overall survival and 2-year survival probability. The predicted probability of 2-year survival was calculated using a mixed-effects logit model adjusting for demographic and clinical characteristics. Results The study sample included 53 719 patients (mean [SD] age, 68.5 [9.3] years; 28 374 men [52.8%]), the majority of whom were White individuals (36 316 [67.6%]). The overall receipt of cancer-directed therapy increased from 69.0% in 2011 to 77.2% in 2019. After the first US Food and Drug Administration approval of an ICI for NSCLC, the use of ICIs increased from 4.7% in 2015 to 45.6% in 2019 (P < .001). Use of ICIs in 2019 was similar between the youngest and oldest patients (aged <55 years, 45.2% vs aged ≥75 years, 43.8%; P = .59). From 2011 to 2018, the predicted probability of 2-year survival increased from 37.7% to 50.3% among patients younger than 55 years and from 30.6% to 36.2% in patients 75 years or older (P < .001). Similarly, median survival in patients younger than 55 years increased from 11.5 months to 16.0 months during the study period, while survival among patients 75 years or older increased from 9.1 months in 2011 to 10.2 months in 2019. Conclusions and Relevance This cohort study found that, among patients with advanced NSCLC, the uptake of ICIs after US Food and Drug Administration approval was rapid across all age groups. However, corresponding survival gains were modest, particularly in the oldest patients.
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Affiliation(s)
- Teja Voruganti
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pamela R. Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
| | - Ronac Mamtani
- Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Carolyn J. Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Cary P. Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut
- Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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8
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Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D, Port J, Jones DR, Conti M, Ashrafi AS, Liberman M, Yasufuku K, Yang S, Mitchell JD, Pass H, Keenan R, Bauer T, Miller D, Kohman LJ, Stinchcombe TE, Vokes E. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med 2023; 388:489-498. [PMID: 36780674 PMCID: PMC10036605 DOI: 10.1056/nejmoa2212083] [Citation(s) in RCA: 205] [Impact Index Per Article: 205.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The increased detection of small-sized peripheral non-small-cell lung cancer (NSCLC) has renewed interest in sublobar resection in lieu of lobectomy. METHODS We conducted a multicenter, noninferiority, phase 3 trial in which patients with NSCLC clinically staged as T1aN0 (tumor size, ≤2 cm) were randomly assigned to undergo sublobar resection or lobar resection after intraoperative confirmation of node-negative disease. The primary end point was disease-free survival, defined as the time between randomization and disease recurrence or death from any cause. Secondary end points were overall survival, locoregional and systemic recurrence, and pulmonary functions. RESULTS From June 2007 through March 2017, a total of 697 patients were assigned to undergo sublobar resection (340 patients) or lobar resection (357 patients). After a median follow-up of 7 years, sublobar resection was noninferior to lobar resection for disease-free survival (hazard ratio for disease recurrence or death, 1.01; 90% confidence interval [CI], 0.83 to 1.24). In addition, overall survival after sublobar resection was similar to that after lobar resection (hazard ratio for death, 0.95; 95% CI, 0.72 to 1.26). The 5-year disease-free survival was 63.6% (95% CI, 57.9 to 68.8) after sublobar resection and 64.1% (95% CI, 58.5 to 69.0) after lobar resection. The 5-year overall survival was 80.3% (95% CI, 75.5 to 84.3) after sublobar resection and 78.9% (95% CI, 74.1 to 82.9) after lobar resection. No substantial difference was seen between the two groups in the incidence of locoregional or distant recurrence. At 6 months postoperatively, a between-group difference of 2 percentage points was measured in the median percentage of predicted forced expiratory volume in 1 second, favoring the sublobar-resection group. CONCLUSIONS In patients with peripheral NSCLC with a tumor size of 2 cm or less and pathologically confirmed node-negative disease in the hilar and mediastinal lymph nodes, sublobar resection was not inferior to lobectomy with respect to disease-free survival. Overall survival was similar with the two procedures. (Funded by the National Cancer Institute and others; CALGB 140503 ClinicalTrials.gov number, NCT00499330.).
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Affiliation(s)
- Nasser Altorki
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Xiaofei Wang
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - David Kozono
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Colleen Watt
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Rodney Landrenau
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Dennis Wigle
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Jeffrey Port
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - David R Jones
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Massimo Conti
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Ahmad S Ashrafi
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Moishe Liberman
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Kazuhiro Yasufuku
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Stephen Yang
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - John D Mitchell
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Harvey Pass
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Robert Keenan
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Thomas Bauer
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Daniel Miller
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Leslie J Kohman
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Thomas E Stinchcombe
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
| | - Everett Vokes
- From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.)
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9
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Rakaee M, Adib E, Ricciuti B, Sholl LM, Shi W, Alessi JV, Cortellini A, Fulgenzi CAM, Viola P, Pinato DJ, Hashemi S, Bahce I, Houda I, Ulas EB, Radonic T, Väyrynen JP, Richardsen E, Jamaly S, Andersen S, Donnem T, Awad MM, Kwiatkowski DJ. Association of Machine Learning-Based Assessment of Tumor-Infiltrating Lymphocytes on Standard Histologic Images With Outcomes of Immunotherapy in Patients With NSCLC. JAMA Oncol 2023; 9:51-60. [PMID: 36394839 PMCID: PMC9673028 DOI: 10.1001/jamaoncol.2022.4933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022]
Abstract
Importance Currently, predictive biomarkers for response to immune checkpoint inhibitor (ICI) therapy in lung cancer are limited. Identifying such biomarkers would be useful to refine patient selection and guide precision therapy. Objective To develop a machine-learning (ML)-based tumor-infiltrating lymphocytes (TILs) scoring approach, and to evaluate TIL association with clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC). Design, Setting, and Participants This multicenter retrospective discovery-validation cohort study included 685 ICI-treated patients with NSCLC with median follow-up of 38.1 and 43.3 months for the discovery (n = 446) and validation (n = 239) cohorts, respectively. Patients were treated between February 2014 and September 2021. We developed an ML automated method to count tumor, stroma, and TIL cells in whole-slide hematoxylin-eosin-stained images of NSCLC tumors. Tumor mutational burden (TMB) and programmed death ligand-1 (PD-L1) expression were assessed separately, and clinical response to ICI therapy was determined by medical record review. Data analysis was performed from June 2021 to April 2022. Exposures All patients received anti-PD-(L)1 monotherapy. Main Outcomes and Measures Objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were determined by blinded medical record review. The area under curve (AUC) of TIL levels, TMB, and PD-L1 in predicting ICI response were calculated using ORR. Results Overall, there were 248 (56%) women in the discovery cohort and 97 (41%) in the validation cohort. In a multivariable analysis, high TIL level (≥250 cells/mm2) was independently associated with ICI response in both the discovery (PFS: HR, 0.71; P = .006; OS: HR, 0.74; P = .03) and validation (PFS: HR = 0.80; P = .01; OS: HR = 0.75; P = .001) cohorts. Survival benefit was seen in both first- and subsequent-line ICI treatments in patients with NSCLC. In the discovery cohort, the combined models of TILs/PD-L1 or TMB/PD-L1 had additional specificity in differentiating ICI responders compared with PD-L1 alone. In the PD-L1 negative (<1%) subgroup, TIL levels had superior classification accuracy for ICI response (AUC = 0.77) compared with TMB (AUC = 0.65). Conclusions and Relevance In these cohorts, TIL levels were robustly and independently associated with response to ICI treatment. Patient TIL assessment is relatively easily incorporated into the workflow of pathology laboratories at minimal additional cost, and may enhance precision therapy.
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Affiliation(s)
- Mehrdad Rakaee
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Department of Clinical Pathology, University Hospital of North Norway, Tromso, Norway
| | - Elio Adib
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Biagio Ricciuti
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Lynette M. Sholl
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Weiwei Shi
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joao V. Alessi
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Alessio Cortellini
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Claudia A. M. Fulgenzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Medical Oncology, University Campus Bio-Medico, Rome, Italy
| | - Patrizia Viola
- Department of Cellular Pathology, Imperial College London NHS Trust, London, United Kingdom
| | - David J. Pinato
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Sayed Hashemi
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Idris Bahce
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ilias Houda
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Ezgi B. Ulas
- Department of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Juha P. Väyrynen
- Cancer and Translational Medicine Research Unit, Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Elin Richardsen
- Department of Clinical Pathology, University Hospital of North Norway, Tromso, Norway
| | - Simin Jamaly
- Department of Medical Biology, UiT The Arctic University of Norway, Tromso, Norway
| | - Sigve Andersen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
| | - Tom Donnem
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromso, Norway
- Department of Oncology, University Hospital of North Norway, Tromso, Norway
| | - Mark M. Awad
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - David J. Kwiatkowski
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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10
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Shah M, Hubbard RA, Mamtani R, Marmarelis ME, Hennessy S. Very high PD-L1 expression as a prognostic indicator of overall survival among patients with advanced non-small cell lung cancer receiving anti-PD-(L)1 monotherapies in routine practice. Pharmacoepidemiol Drug Saf 2022; 31:1121-1126. [PMID: 35670103 PMCID: PMC9464674 DOI: 10.1002/pds.5487] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/04/2022] [Accepted: 06/05/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Programmed death or ligand-1 (PD-(L)1) pathway inhibitors confer improved survival as the first-line treatment for advanced non-small cell lung cancer (aNSCLC) in patients with PD-L1 expression (PD-L1 + e ≥ 50%) compared to platinum-doublet chemotherapy and have become a standard therapy. Some recent evidence suggests that among aNSCLC patients with PD-L1 + e of ≥50% receiving pembrolizumab monotherapy, very high levels of PD-L1 + e (≥90%) may be associated with better outcomes. We sought to assess whether very high PD-L1 + e (≥90%) compared to high PD-L1 + e (50%-89%) is associated with an overall survival benefit in aNSCLC patients receiving anti-PD-(L)1 monotherapies. METHODS We conducted a single-site retrospective cohort study of aNSCLC patients who initiated PD-(L)1 inhibitor monotherapy as the first-line treatment from October 24, 2016, to August 25, 2021, and had a PD-L1 + e ≥ 50%. The primary outcome was overall survival, measured from the start of the first-line PD-(L)1 inhibitor monotherapy (index date) to date of death or last confirmed activity prior to the cohort exit date. Propensity score-based inverse probability weighting (IPW) was used to control for confounding in Kaplan-Meier curves and Cox proportional hazard regression analysis. RESULTS One hundred sixty-six patients with aNSCLC receiving PD-(L)1 inhibitor monotherapy met inclusion criteria. 54% were female, 90% received pembrolizumab, median age was 68 years, 70% had non-squamous cell carcinoma, 94% had a history of smoking, 29% had a KRAS mutation, and 37% had very high PD-L1 + e. Unweighted covariates at cohort entry were similar between groups (absolute standardized mean differences [SMDs] <0.1) except for race (SMD = 0.2); age at therapy initiation (SMD = 0.13); smoking status (SMD = 0.13), and BRAF mutation status (SMD = 0.11). After weighting, baseline covariates were well balanced (all absolute SMDs <0.1). In the weighted analysis, having a very high PD-L1 + e was associated with lower mortality (weighted hazard ratio 0.57, 95% CI 0.36-0.90) and longer median survival: 3.85 versus 1.49 years. CONCLUSIONS Very high PD-L1 + e (≥90%) was associated with an overall survival benefit over high PD-L1 + e (50%-89%) in patients receiving the first-line PD-(L)1 inhibitor monotherapy in a model controlling for potential confounders. These findings should be confirmed in a larger real-world data set.
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Affiliation(s)
- Mohsin Shah
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA 19104
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA 19104
| | - Ronac Mamtani
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA 19104
| | - Melina E Marmarelis
- Division of Hematology and Oncology, Department of Medicine, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA 19104
| | - Sean Hennessy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA 19104
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11
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Chow LQM, Barlesi F, Bertino EM, van den Bent MJ, Wakelee HA, Wen PY, Chiu CH, Orlov S, Chiari R, Majem M, McKeage M, Yu CJ, Garrido P, Hurtado FK, Arratia PC, Song Y, Branle F, Shi M, Kim DW. ASCEND-7: Efficacy and Safety of Ceritinib Treatment in Patients with ALK-Positive Non-Small Cell Lung Cancer Metastatic to the Brain and/or Leptomeninges. Clin Cancer Res 2022; 28:2506-2516. [PMID: 35091443 DOI: 10.1158/1078-0432.ccr-21-1838] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/25/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Central nervous system metastases are a prominent cause of morbidity and mortality in patients with ALK-positive (ALK+) non-small cell lung cancer (NSCLC). The phase II ASCEND-7 (NCT02336451) study was specifically designed to assess the efficacy and safety of the ALK inhibitor (ALKi) ceritinib in patients with ALK+ NSCLC metastatic to the brain and/or leptomeninges. PATIENTS AND METHODS Patients with active brain metastases were allocated to study arms 1 to 4 based on prior exposure to an ALKi and/or prior brain radiation (arm 1: prior radiotherapy/ALKi-pretreated; arm 2: no radiotherapy/ALKi-pretreated; arm 3: prior radiotherapy/ALKi-naïve; arm 4: no radiotherapy/ALKi-naïve). Arm 5 included patients with leptomeningeal carcinomatosis. Patients received ceritinib 750 mg once daily (fasted condition). Primary endpoint was investigator-assessed whole-body overall response rate (ORR) per RECIST v1.1. Secondary endpoints included disease control rate (DCR) and intracranial/extracranial responses. RESULTS Per investigator assessment, in arms 1 (n = 42), 2 (n = 40), 3 (n = 12), and 4 (n = 44), respectively: whole-body ORRs [95% confidence interval (CI)] were 35.7% (21.6-52.0), 30.0% (16.6-46.5), 50.0% (21.1-78.9), and 59.1% (43.2-73.7); whole-body DCR (95% CI): 66.7% (50.5-80.4), 82.5% (67.2-92.7), 66.7% (34.9-90.1), and 70.5% (54.8-83.2); intracranial ORRs (95% CI): 39.3% (21.5-59.4), 27.6% (12.7-47.2), 28.6% (3.7-71.0), and 51.5% (33.5-69.2). In arm 5 (n = 18), whole-body ORR was 16.7% (95% CI, 3.6-41.4) and DCR was 66.7% (95% CI, 41.0-86.7). Paired cerebrospinal fluid and plasma sampling revealed that ceritinib penetrated the human blood-brain barrier. CONCLUSIONS Ceritinib showed antitumor activity in patients with ALK+ NSCLC with active brain metastases and/or leptomeningeal disease, and could be considered in the management of intracranial disease. See related commentary by Murciano-Goroff et al., p. 2477.
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Affiliation(s)
- Laura Q M Chow
- University of Washington, Seattle, Washington and University of Texas at Austin, Dell Medical School, Department of Oncology, Austin, Texas
| | - Fabrice Barlesi
- Aix-Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | - Erin M Bertino
- The Ohio State University Comprehensive Cancer Centre, Arthur G James Cancer Hospital and Richard J Solove Research Institute, Columbus, Ohio
| | - Martin J van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Patrick Y Wen
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Sergey Orlov
- State Pavlov Medical University, St. Petersburg, Russia
| | - Rita Chiari
- Department of Oncology, AULSS6 Euganea, Padova, Italy
| | | | | | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Pilar Garrido
- Department of Medical Oncology, Hospital Universitario Ramon Y Cajal, Madrid, Spain
| | | | | | - Yuanbo Song
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Michael Shi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
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12
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Mayne NR, Bajaj SS, Powell J, Elser HC, Civiello BS, Fintelmann FJ, Li X, Yang CFJ. Extended Delay to Treatment for Stage III-IV Non-Small-Cell Lung Cancer and Survival: Balancing Risks During the COVID-19 Pandemic. Clin Lung Cancer 2022; 23:e362-e376. [PMID: 35660355 PMCID: PMC9068243 DOI: 10.1016/j.cllc.2022.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/17/2022]
Affiliation(s)
| | - Simar S Bajaj
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Joseph Powell
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Holly C Elser
- Stanford University School of Medicine, Stanford, CA; Division of Epidemiology and Biostatistics, UC Berkeley School of Public Health, Berkeley, CA
| | | | | | - Xiao Li
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Chi-Fu Jeffrey Yang
- Department of Surgery, Massachusetts General Hospital, Boston, MA; Seacoast Cancer Center at Wentworth Douglass Hospital, Dover, NH.
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13
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Abstract
In this issue of Cancer Cell, Patil et al. report that increased plasma cell signatures are predictive of an extended overall survival in non-small-cell lung cancer patients treated with a PD-L1 inhibitor and that these cells are associated with the presence of tertiary lymphoid structures.
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Affiliation(s)
- Jean-Luc Teillaud
- Sorbonne Université, UMRS 1135, Faculté de Médecine Sorbonne Université, Paris, France; INSERM U1135, Faculté de Médecine Sorbonne Université, Paris, France; Laboratory "Immune microenvironment and immunotherapy," Centre of Immunology and Microbial Infections-Paris (CIMI-Paris), Paris, France
| | - Marie-Caroline Dieu-Nosjean
- Sorbonne Université, UMRS 1135, Faculté de Médecine Sorbonne Université, Paris, France; INSERM U1135, Faculté de Médecine Sorbonne Université, Paris, France; Laboratory "Immune microenvironment and immunotherapy," Centre of Immunology and Microbial Infections-Paris (CIMI-Paris), Paris, France.
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14
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Patel YS, Hanna WC, Fahim C, Shargall Y, Waddell TK, Yasufuku K, Machuca TN, Pipkin M, Baste JM, Xie F, Shiwcharan A, Foster G, Thabane L. RAVAL trial: Protocol of an international, multi-centered, blinded, randomized controlled trial comparing robotic-assisted versus video-assisted lobectomy for early-stage lung cancer. PLoS One 2022; 17:e0261767. [PMID: 35108265 PMCID: PMC8809527 DOI: 10.1371/journal.pone.0261767] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background Retrospective data demonstrates that robotic-assisted thoracoscopic surgery provides many benefits, such as decreased postoperative pain, lower mortality, shorter length of stay, shorter chest tube duration, and reductions in the incidence of common postoperative pulmonary complications, when compared to video-assisted thoracoscopic surgery. Despite the potential benefits of robotic surgery, there are two major barriers against its widespread adoption in thoracic surgery: lack of high-quality prospective data, and the perceived higher cost of it. Therefore, in the face of these barriers, a prospective randomized controlled trial comparing robotic- to video-assisted thoracoscopic surgery is needed. The RAVAL trial is a two-phase, international, multi-centered, blinded, parallel, randomized controlled trial that is comparing robotic- to video-assisted lobectomy for early-stage non-small cell lung cancer that has been enrolling patients since 2016. Methods The RAVAL trial will be conducted in two phases: Phase A will enroll 186 early-stage non-small cell lung cancer patients who are candidates for minimally invasive pulmonary lobectomy; while Phase B will continue to recruit until 592 patients are enrolled. After consent, participants will be randomized in a 1:1 ratio to either robotic- or video-assisted lobectomy, and blinded to the type of surgery they are allocated to. Health-related quality of life questionnaires will be administered at baseline, postoperative day 1, weeks 3, 7, 12, months 6, 12, 18, 24, and years 3, 4, 5. The primary objective of the RAVAL trial is to determine the difference in patient-reported health-related quality of life outcomes between the robotic- and video-assisted lobectomy groups at 12 weeks. Secondary objectives include determining the differences in cost-effectiveness, and in the 5-year survival data between the two arms. The results of the primary objective will be reported once Phase A has completed accrual and the 12-month follow-ups are completed. The results of the secondary objectives will be reported once Phase B has completed accrual and the 5-year follow-ups are completed. Discussion If successfully completed, the RAVAL Trial will have studied patient-reported outcomes, cost-effectiveness, and survival of robotic- versus video-assisted lobectomy in a prospective, randomized, blinded fashion in an international setting. Trial registration ClinicalTrials.gov, NCT02617186. Registered 22-September-2015. https://clinicaltrials.gov/ct2/show/NCT02617186
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Affiliation(s)
- Yogita S. Patel
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Waël C. Hanna
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christine Fahim
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas K. Waddell
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tiago N. Machuca
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Mauricio Pipkin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Jean-Marc Baste
- Division of Thoracic Surgery, Department of Surgery, Rouen Normandy University, Rouen Cedex, France
| | - Feng Xie
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Shiwcharan
- Funding Reform and Case Costing, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Gary Foster
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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15
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F Smit E, Dooms C, Raskin J, Nadal E, Tho LM, Le X, Mazieres J, S Hin H, Morise M, W Zhu V, Tan D, H Holmberg K, Ellers-Lenz B, Adrian S, Brutlach S, Schumacher KM, Karachaliou N, Wu YL. INSIGHT 2: a phase II study of tepotinib plus osimertinib in MET-amplified NSCLC and first-line osimertinib resistance. Future Oncol 2022; 18:1039-1054. [PMID: 34918545 DOI: 10.2217/fon-2021-1406] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
MET amplification (METamp), a mechanism of acquired resistance to EGFR tyrosine kinase inhibitors, occurs in up to 30% of patients with non-small-cell lung cancer (NSCLC) progressing on first-line osimertinib. Combining osimertinib with a MET inhibitor, such as tepotinib, an oral, highly selective, potent MET tyrosine kinase inhibitor, may overcome METamp-driven resistance. INSIGHT 2 (NCT03940703), an international, open-label, multicenter phase II trial, assesses tepotinib plus osimertinib in patients with advanced/metastatic EGFR-mutant NSCLC and acquired resistance to first-line osimertinib and METamp, determined centrally by fluorescence in situ hybridization (gene copy number ≥5 and/or MET/CEP7 ≥2) at time of progression. Patients will receive tepotinib 500 mg (450 mg active moiety) plus osimertinib 80 mg once-a-day. The primary end point is objective response, and secondary end points include duration of response, progression-free survival, overall survival and safety. Trial registration number: NCT03940703 (clinicaltrials.gov).
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Affiliation(s)
- Egbert F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christophe Dooms
- Department of Respiratory Diseases & Respiratory Oncology Unit, University Hospitals Leuven, Leuven, Belgium
| | - Jo Raskin
- Department of Pulmonology & Thoracic Oncology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ernest Nadal
- Department of Medical Oncology, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Lye M Tho
- Department of Oncology, Pantai Hospital, Kuala Lumpur, Malaysia
| | - Xiuning Le
- Department of Thoracic Head & Neck Medical Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Julien Mazieres
- CHU de Toulouse, Institut Universitaire du Cancer, Toulouse, France
| | - How S Hin
- Hospital Tengku Ampuan Afzan, Pahang, Malaysia
| | - Masahire Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Viola W Zhu
- University of California Irvine, Chao Family Comprehensive Cancer Center, Orange, CA, USA
| | - Daniel Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kristina H Holmberg
- EMD Serono Research & Development Institute, Inc., MA, USA, an affiliate of Merck KGaA
| | | | - Svenja Adrian
- Global Clinical Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Sabine Brutlach
- Late Stage Development Operations, Merck Healthcare KGaA, Darmstadt, Germany
| | - Karl M Schumacher
- Global Clinical Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Niki Karachaliou
- Global Clinical Development, Merck Healthcare KGaA, Darmstadt, Germany
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
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Takumida H, Horinouchi H, Masuda K, Shinno Y, Okuma Y, Yoshida T, Goto Y, Yamamoto N, Ohe Y. Comparison of time to failure of pembrolizumab plus chemotherapy versus pembrolizumab monotherapy: a consecutive analysis of patients having NSCLC with high PD-L1 expression. Cancer Immunol Immunother 2022; 71:737-746. [PMID: 34389874 PMCID: PMC8854243 DOI: 10.1007/s00262-021-03029-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There are two treatment strategies for non-small cell lung cancer (NSCLC) exhibiting a high expression level of programmed death-ligand 1 (tumor proportion score ≥ 50%): pembrolizumab plus chemotherapy and monotherapy. We retrospectively compared their efficacy and safety. MATERIALS AND METHODS We reviewed the efficacy and safety of first-line pembrolizumab-containing regimens administered between 2017 and 2020 to consecutive patients. The patients were divided into a pembrolizumab plus chemotherapy group (Combo group) or monotherapy group (Mono group). To compare the efficacy, we monitored the time to failure of strategy (TFS) defined as the time from the start of treatment to the occurrence of one of the following events: the addition of any drug not included in the primary strategy, progression of cancer after complete therapy, progression and no subsequent therapy, or death, whichever occurred first. We used the propensity score matching (PSM) to reduce the bias. RESULTS A total of 126 patients were identified (89 in the Mono group and 37 in the Combo group). PSM matched 36 individuals from each of the two groups. The overall response rate and median progression-free survival of the Combo group were better than those of the Mono group. However, the median TFS was almost the same (11.3 months vs. 14.9 months; hazard ratio 1.40 [95% confidence interval 0.62-3.15]). The frequency of all serious adverse effects was higher in the Combo group than in the Mono group. DISCUSSION Due to similar efficacy in TFS, both pembrolizumab plus chemotherapy and monotherapy are valid options for NSCLC.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/genetics
- Biomarkers, Tumor
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Disease Management
- Female
- Humans
- Kaplan-Meier Estimate
- Lung Neoplasms/diagnosis
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Male
- Middle Aged
- Molecular Targeted Therapy
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Affiliation(s)
- Hiroshi Takumida
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Ken Masuda
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuki Shinno
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tatsuya Yoshida
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Kuznik A, Smare C, Chen CI, Venkatachalam M, Keeping S, Atsou K, Xu Y, Wilson F, Guyot P, Chan K, Glowienka E, Konidaris G. Cost-Effectiveness of Cemiplimab Versus Standard of Care in the United States for First-Line Treatment of Advanced Non-small Cell Lung Cancer With Programmed Death-Ligand 1 Expression ≥50. Value Health 2022; 25:203-214. [PMID: 35094793 DOI: 10.1016/j.jval.2021.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness, from a US commercial payer perspective, of cemiplimab versus other first-line treatments for advanced non-small cell lung cancer with programmed death-ligand 1 expression ≥50%. METHODS A 30-year "partitioned survival" model was constructed. Overall survival and progression-free survival were estimated by applying time-varying hazard ratios from a network meta-analysis of randomized clinical trials. Overall survival and progression-free survival were estimated from EMPOWER-Lung 1 (cemiplimab monotherapy vs chemotherapy) and KEYNOTE-024 and KEYNOTE-042 (pembrolizumab monotherapy vs chemotherapy). Drug acquisition costs were based on published 2020 US list prices. A 3% discount rate was applied to life-years, quality-adjusted life-years (QALYs), and costs. A deterministic analysis was performed on the base case; 1-way sensitivity and probabilistic sensitivity analyses assessed model and parameter uncertainties. RESULTS Cemiplimab was associated with increased time in the "preprogression" (13.08 vs 7.90 and 6.08 months) and "postprogression" (47.30 vs 29.49 and 14.78 months) health states versus pembrolizumab and chemotherapy, respectively. Compared with pembrolizumab and chemotherapy, cemiplimab generated 1.00 (95% CI -0.266 to 2.440) and 1.78 (95% CI 0.607-3.20) incremental QALYs, respectively, with incremental cost-effectiveness ratios of $68 254 and $89 219 per QALY for cemiplimab versus pembrolizumab and cemiplimab versus chemotherapy, respectively. The probability of cemiplimab being cost-effective at a willingness-to-pay threshold of $100 000 to $150 000 per QALY was 62% to 76% versus pembrolizumab and 56% to 84% versus chemotherapy. CONCLUSIONS Findings suggest that cemiplimab, versus pembrolizumab or versus chemotherapy, is a cost-effective first-line treatment option for advanced non-small cell lung cancer with programmed death-ligand 1 expression ≥50%.
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Affiliation(s)
| | | | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | - Yingxin Xu
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Zhou Q, Chen M, Jiang O, Pan Y, Hu D, Lin Q, Wu G, Cui J, Chang J, Cheng Y, Huang C, Liu A, Yang N, Gong Y, Zhu C, Ma Z, Fang J, Chen G, Zhao J, Shi A, Lin Y, Li G, Liu Y, Wang D, Wu R, Xu X, Shi J, Liu Z, Cui N, Wang J, Wang Q, Zhang R, Yang J, Wu YL. Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced, unresectable, stage III non-small-cell lung cancer in China (GEMSTONE-301): interim results of a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncol 2022; 23:209-219. [PMID: 35038429 DOI: 10.1016/s1470-2045(21)00630-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND A substantial proportion of patients with unresectable stage III non-small-cell lung cancer (NSCLC) cannot either tolerate or access concurrent chemoradiotherapy, so sequential chemoradiotherapy is commonly used. We assessed the efficacy and safety of sugemalimab, an anti-PD-L1 antibody, in patients with stage III NSCLC whose disease had not progressed after concurrent or sequential chemoradiotherapy. METHODS GEMSTONE-301 is a randomised, double-blind, placebo-controlled, phase 3 trial in patients with locally advanced, unresectable, stage III NSCLC, done at 50 hospitals or academic research centres in China. Eligible patients were aged 18 years or older with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 who had not progressed after concurrent or sequential chemoradiotherapy. We randomly assigned patients (2:1, using an interactive voice-web response system) to receive sugemalimab 1200 mg or matching placebo, intravenously every 3 weeks for up to 24 months. Stratification factors were ECOG performance status, previous chemoradiotherapy, and total radiotherapy dose. The investigators, trial coordination staff, patients, and study sponsor were masked to treatment allocation. The primary endpoint was progression-free survival as assessed by blinded independent central review (BICR) in the intention-to-treat population. Safety was assessed in all participants who received at least one dose of assigned study treatment. The study has completed enrolment and the results of a preplanned analysis of the primary endpoint are reported here. The trial is registered with ClinicalTrials.gov, NCT03728556. FINDINGS Between Aug 30, 2018 and Dec 30, 2020, we screened 564 patients of whom 381 were eligible. Study treatment was received by all patients randomly assigned to sugemalimab (n=255) and to placebo (n=126). At data cutoff (March 8, 2021), median follow-up was 14·3 months (IQR 6·4-19·4) for patients in the sugemalimab group and 13·7 months (7·1-18·4) for patients in the placebo group. Progression-free survival assessed by BICR was significantly longer with sugemalimab than with placebo (median 9·0 months [95% CI 8·1-14·1] vs 5·8 months [95% CI 4·2-6·6]; stratified hazard ratio 0·64 [95% CI 0·48-0·85], p=0·0026). Grade 3 or 4 treatment-related adverse events occurred in 22 (9%) of 255 patients in the sugemalimab group versus seven (6%) of 126 patients in the placebo group, the most common being pneumonitis or immune-mediated pneumonitis (seven [3%] of 255 patients in the sugemalimab group vs one [<1%] of 126 in the placebo group). Treatment-related serious adverse events occurred in 38 (15%) patients in the sugemalimab group and 12 (10%) in the placebo group. Treatment-related deaths were reported in four (2%) of 255 patients (pneumonia in two patients, pneumonia with immune-mediated pneumonitis in one patient, and acute hepatic failure in one patient) in the sugemalimab group and none in the placebo group. INTERPRETATION Sugemalimab after definitive concurrent or sequential chemoradiotherapy could be an effective consolidation therapy for patients with stage III NSCLC whose disease has not progressed after sequential or concurrent chemoradiotherapy. Longer follow-up is needed to confirm this conclusion. FUNDING CStone Pharmaceuticals and the National Key Research and Development Program of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Qing Zhou
- Guangdong Lung Cancer Insitute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ming Chen
- The Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China; Sun Yat-sen University Cancer Centre, Guangzhou, China
| | - Ou Jiang
- The Second People's Hospital of Neijiang, Neijiang, China
| | - Yi Pan
- Guangdong Lung Cancer Insitute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Qin Lin
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Gang Wu
- Cancer Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiuwei Cui
- The First Hospital of Jilin University, Changchun, China
| | - Jianhua Chang
- Fudan University Cancer Centre, Shanghai, China; Cancer Hospital, Chinese Academy of Medical Sciences, Shenzhen Centre, Shenzhen, China
| | - Yufeng Cheng
- Qilu Hospital of Shandong University, Jinan, China
| | - Cheng Huang
- Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Anwen Liu
- The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nong Yang
- Hunan Cancer Hospital, Changsha, China
| | - Youling Gong
- West China Hospital of Sichuan University, Chengdu, China
| | - Chuan Zhu
- Chongqing University Three Gorges Hospital, Chongqing, China
| | - Zhiyong Ma
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jian Fang
- Beijing Cancer Hospital, Beijing, China
| | - Gongyan Chen
- Harbin Medical University Cancer Hospital, Harbin, China
| | - Jun Zhao
- Beijing Cancer Hospital, Beijing, China
| | - Anhui Shi
- Beijing Cancer Hospital, Beijing, China
| | - Yingcheng Lin
- Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Guanghui Li
- Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yunpeng Liu
- The First Hospital of China Medical University, Shenyang, China
| | - Dong Wang
- Army Medical Centre of PLA, Chongqing, China
| | - Rong Wu
- Shengjing Hospital of China Medical University, Shenyang, China
| | - Xinhua Xu
- The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, China
| | | | - Zhihua Liu
- Jiangxi Cancer Hospital, Nanchang, China
| | - Na Cui
- CStone Pharmaceuticals Suzhou, Shanghai, China
| | - Jingru Wang
- CStone Pharmaceuticals Suzhou, Shanghai, China
| | - Qiang Wang
- CStone Pharmaceuticals Suzhou, Shanghai, China
| | - Ran Zhang
- CStone Pharmaceuticals Suzhou, Shanghai, China
| | - Jason Yang
- CStone Pharmaceuticals Suzhou, Shanghai, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Insitute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Lu Y, Lu C, Xu D, Huang F, He Z, Lei J, Sun H, Zeng J. Computed Tomography-Guided Percutaneous Radiofrequency Ablation in Older Adults With Early-Stage Peripheral Lung Cancer: A Retrospective Cohort Study. Cancer Control 2022; 29:10732748211070702. [PMID: 35076322 PMCID: PMC8793422 DOI: 10.1177/10732748211070702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives To evaluate the feasibility, safety, and efficacy of computed tomography(CT)-guided percutaneous radiofrequency ablation (RFA) in medically inoperable older adults with clinical stage I non-small cell lung cancer (NSCLC). Patients and Methods We retrospectively reviewed the records of medically inoperable older adults (≥70 years) with clinical stage I NSCLC who underwent percutaneous multi-tined electrode RFA at our institution between January 2014 and December 2018. We analyzed the patients’ characteristics, therapy response, survival, as well as the procedure-related complications. Results Eighteen patients (10 men and 8 women) with a mean age of 75.9 (71−85) years were treated in during the study period. The median tumor size was 25 mm (range, 19−43 mm); 10 and 8 cases involved stage T1 and T2a disease, respectively. The median follow-up duration was 25 (11–45) months. RFA was technically successful for all 18 lesions, with no treatment-related mortality. The disease control rate was 83.3% (15/18 lesions). There were 6 cases of pneumothorax: one symptomatic case requiring thoracic drainage, and five requiring no treatment. Minor complications, including pulmonary infection, chest pain, fever, and cough, were treated within 4 days (range, 1−4 days). The progression-free survival rates were 83.3%, 64.9%, and 51.9% 1, 2, and 3 years, respectively. The corresponding overall survival rates were 92.2%, 81.5%, and 54.3%, respectively. Conclusions CT-guided percutaneous RFA is safe and effective in medically inoperable patients with stage I NSCLC and could be an alternative therapeutic strategy, particularly in older adults with early-stage peripheral lung cancer.
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Affiliation(s)
- Yanda Lu
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Caiwei Lu
- Department of Rehabilitation Medicines, Hainan Medical University, Hainan, China
| | - Danni Xu
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Fen Huang
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Zhihui He
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Junhua Lei
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Huamao Sun
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Jiangzheng Zeng
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
- Jiangzheng Zeng, Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan 571199, China. E-mail:
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Nyein AF, Bari S, Hogue S, Zhao Y, Maller B, Sha S, Gomez MF, Rollison DE, Robinson LA. Effect of prior antibiotic or chemotherapy treatment on immunotherapy response in non-small cell lung cancer. BMC Cancer 2022; 22:101. [PMID: 35073876 PMCID: PMC8787935 DOI: 10.1186/s12885-022-09210-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 05/25/2021] [Accepted: 01/05/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatment outcomes of advanced non-small cell lung cancer (NSCLC) have substantially improved with immune checkpoint inhibitors (ICI), although only approximately 19% of patients respond to immunotherapy alone, increasing to 58% with the addition of chemotherapy. The gut microbiome has been recognized as a modulator of ICI response via its priming effect on the host immune response. Antibiotics as well as chemotherapy reduce gut microbial diversity, hence altering composition and function of the gut microbiome. Since the gut microbiome may modify ICI efficacy, we conducted a retrospective study evaluating the effects of prior antibiotic or chemotherapy use on NSCLC patient response to ICI. METHODS We retrospectively evaluated 256 NSCLC patients treated between 2011-2017 at Moffitt Cancer Center with ICI ± chemotherapy, examining the associations between prior antibiotic or chemotherapy use, overall response rate and survival. Relative risk regression using a log-link with combinatorial expectation maximization algorithm was performed to analyze differences in response between patients treated with antibiotics or chemotherapy versus patients who didn't receive antibiotics or chemotherapy. Cox proportional hazards models were constructed to evaluate associations between risk factors and overall survival. RESULTS Only 46 (18% of 256) patients used antibiotics prior to and/or during ICI treatment, and 146 (57%) had prior chemotherapy. Antibiotic users were 8% more likely to have worse overall response rate (RR:1.08; CI:0.93-1.26; p = 0.321), as well as a 35% worse overall survival (HR:1.35; CI:0.91-2.02; p = 0.145), although results were not statistically significant. However, prior use of chemotherapy was significantly associated with poor ICI response (RR:1.24; CI:1.05-1.47; p = 0.013) and worse overall survival (HR:1.47; CI:1.07-2.03; p = 0.018). CONCLUSIONS Patients receiving antibiotics prior to and/or during ICI therapy might experience worse treatment outcomes and survival than unexposed patients, although these associations were not statistically significant and hence warrant further prospective study. Prior chemotherapy significantly reduced ICI response and overall survival. Antibiotic or chemotherapy exposure may negatively impact ICI response, perhaps through disruption of the eubiotic gut microbiome.
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Affiliation(s)
- Andrew F Nyein
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Shahla Bari
- Division of Hematology & Oncology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Stephanie Hogue
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
- Department of Thoracic Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Yayi Zhao
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Bradley Maller
- Morsani College of Medicine, University of South Florida, Tampa, FL, 33612, USA
| | - Sybil Sha
- Cornell University, Ithaca, NY, 14853, USA
| | - Maria F Gomez
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Dana E Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Lary A Robinson
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, 33612, USA.
- Department of Thoracic Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
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Liu N, Mao J, Tao P, Chi H, Jia W, Dong C. The relationship between NLR/PLR/LMR levels and survival prognosis in patients with non-small cell lung carcinoma treated with immune checkpoint inhibitors. Medicine (Baltimore) 2022; 101:e28617. [PMID: 35060536 PMCID: PMC8772656 DOI: 10.1097/md.0000000000028617] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) and the dire prognosis of non-small cell lung carcinoma patients who received immune checkpoint inhibitors (ICIs) are not known yet. METHODS We screened the articles that meet the criteria from the database. The relationship between NLR/PLR/LMR levels and the survival and prognosis of non-small cell lung cancer patients treated with ICIs was analyzed. Summarize hazard ratio (HR) with 95% confidence interval (CI) to study progression-free survival (PFS) and overall survival (OS). RESULTS Thirty-four studies involving 3124 patients were enrolled in the final analysis. In short, high pre-treatment NLR was related to poor OS (HR = 2.13, 95% CI:1.74-2.61, P < .001, I2 = 83.3%, P < .001) and PFS (HR = 1.77, 95% CI:1.44-2.17, P < .001, I2 = 79.5%, P < .001). Simultaneously, high pre-treatment PLR was related to poor OS (HR = 1.49, 95% CI:1.17-1.91, P < .001, I2 = 57.6%, P = .003) and PFS (HR = 1.62, 95% CI:1.38-1.89, P < .001, I2 = 47.1%, P = .036). In all subgroup analysis, most subgroups showed that low LMR was related to poor OS (HR = 0.45, 95% CI: 0.34-0.59, P < .001) and PFS (HR = 0.60, 95% CI: 0.47-0.77, P < 0.001, I2 = 0.0%, P < .001). CONCLUSION High pre-treatment NLR and pre-treatment PLR in non-small cell lung carcinoma patients treated with ICIs are associated with low survival rates. Low pre-treatment and post-treatment LMR are also related to unsatisfactory survival outcomes. However, the significance of post-treatment NLR and post-treatment PLR deserve further prospective research to prove.
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22
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Li BT, Smit EF, Goto Y, Nakagawa K, Udagawa H, Mazières J, Nagasaka M, Bazhenova L, Saltos AN, Felip E, Pacheco JM, Pérol M, Paz-Ares L, Saxena K, Shiga R, Cheng Y, Acharyya S, Vitazka P, Shahidi J, Planchard D, Jänne PA. Trastuzumab Deruxtecan in HER2-Mutant Non-Small-Cell Lung Cancer. N Engl J Med 2022; 386:241-251. [PMID: 34534430 PMCID: PMC9066448 DOI: 10.1056/nejmoa2112431] [Citation(s) in RCA: 348] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Human epidermal growth factor receptor 2 (HER2)-targeted therapies have not been approved for patients with non-small-cell lung cancer (NSCLC). The efficacy and safety of trastuzumab deruxtecan (formerly DS-8201), a HER2 antibody-drug conjugate, in patients with HER2-mutant NSCLC have not been investigated extensively. METHODS We conducted a multicenter, international, phase 2 study in which trastuzumab deruxtecan (6.4 mg per kilogram of body weight) was administered to patients who had metastatic HER2-mutant NSCLC that was refractory to standard treatment. The primary outcome was objective response as assessed by independent central review. Secondary outcomes included the duration of response, progression-free survival, overall survival, and safety. Biomarkers of HER2 alterations were assessed. RESULTS A total of 91 patients were enrolled. The median duration of follow-up was 13.1 months (range, 0.7 to 29.1). Centrally confirmed objective response occurred in 55% of the patients (95% confidence interval [CI], 44 to 65). The median duration of response was 9.3 months (95% CI, 5.7 to 14.7). Median progression-free survival was 8.2 months (95% CI, 6.0 to 11.9), and median overall survival was 17.8 months (95% CI, 13.8 to 22.1). The safety profile was generally consistent with those from previous studies; grade 3 or higher drug-related adverse events occurred in 46% of patients, the most common event being neutropenia (in 19%). Adjudicated drug-related interstitial lung disease occurred in 26% of patients and resulted in death in 2 patients. Responses were observed across different HER2 mutation subtypes, as well as in patients with no detectable HER2 expression or HER2 amplification. CONCLUSIONS Trastuzumab deruxtecan showed durable anticancer activity in patients with previously treated HER2-mutant NSCLC. The safety profile included interstitial lung disease that was fatal in two cases. Observed toxic effects were generally consistent with those in previously reported studies. (Funded by Daiichi Sankyo and AstraZeneca; DESTINY-Lung01 ClinicalTrials.gov number, NCT03505710.).
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Affiliation(s)
- Bob T Li
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Egbert F Smit
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Yasushi Goto
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Kazuhiko Nakagawa
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Hibiki Udagawa
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Julien Mazières
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Misako Nagasaka
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Lyudmila Bazhenova
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Andreas N Saltos
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Enriqueta Felip
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Jose M Pacheco
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Maurice Pérol
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Luis Paz-Ares
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Kapil Saxena
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Ryota Shiga
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Yingkai Cheng
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Suddhasatta Acharyya
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Patrik Vitazka
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Javad Shahidi
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - David Planchard
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
| | - Pasi A Jänne
- From Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York (B.T.L.); the Netherlands Cancer Institute, Amsterdam (E.F.S); the National Cancer Center Hospital, Tokyo (Y.G.), Kindai University Hospital, Osaka (K.N.), and the National Cancer Center East, Kashiwa (H.U.) - all in Japan; Centre Hospitalier Universitaire, Toulouse (J.M.), Centre Léon Bérard, Lyon (M.P.), and the Department of Medical Oncology, Thoracic Group, Gustave Roussy, Villejuif (D.P.) - all in France; Karmanos Cancer Institute, Detroit (M.N.); the University of California, San Diego, Moores Cancer Center, San Diego (L.B.); Moffitt Cancer Center, Tampa, FL (A.N.S.); Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona (E.F.); University of Colorado, Aurora (J.M.P.); Hospital Universitario 12 de Octubre, H12O-Centro Nacional de Investigaciones Oncológicas (CNIO) Lung Cancer Clinical Research Unit, and Complutense University, Madrid (L.P.-A.); Daiichi Sankyo, Basking Ridge, NJ (K.S., R.S., Y.C., S.A., P.V., J.S.); and Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston (P.A.J.)
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Chen C, Liu SYM, Chen Y, Ou Q, Bao H, Xu L, Zhang Y, Zhong W, Zhou Q, Yang XN, Shao Y, Wu YL, Liu SY, Li Y. Predictive value of TCR Vβ-Jβ profile for adjuvant gefitinib in EGFR mutant NSCLC from ADJUVANT-CTONG 1104 trial. JCI Insight 2022; 7:e152631. [PMID: 35014626 PMCID: PMC8765044 DOI: 10.1172/jci.insight.152631] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 06/24/2021] [Accepted: 11/17/2021] [Indexed: 12/21/2022] Open
Abstract
Herein, we characterize the landscape and prognostic significance of the T cell receptor (TCR) repertoire of early-stage non-small cell lung cancer (NSCLC) for patients with an epidermal growth factor receptor (EGFR) mutation. β Chain TCR sequencing was used to characterize the TCR repertoires of paraffin-preserved pretreatment tumor and tumor-adjacent tissues from 57 and 44 patients with stage II/III NSCLC with an EGFR mutation treated with gefitinib or chemotherapy in the ADJUVANT-CTONG 1104 trial. The TCR diversity was significantly decreased in patients with an EGFR mutation, and patients with high TCR diversity had a favorable overall survival (OS). A total of 10 TCR Vβ-Jβ rearrangements were significantly associated with OS. Patients with a higher frequency of Vβ5-6Jβ2-1, Vβ20-1Jβ2-1, Vβ24-1Jβ2-1, and Vβ29-1Jβ2-7 had significantly longer OS. Weighted combinations of the 4 TCRs were significantly associated with OS and disease-free survival (DFS) of patients, which could further stratify the high and low TCR diversity groups. Importantly, Vβ5-6Jβ2-1, Vβ20-1Jβ2-1, and Vβ24-1Jβ2-1 had a significant relationship with gefitinib treatment, while Vβ29-1Jβ2-7 was associated with chemotherapy. Four TCR Vβ-Jβ rearrangements related to favorable OS and DFS for adjuvant gefitinib and chemotherapy in patients with an EGFR mutation with stage II/III NSCLC; this may provide a novel perspective for the adjuvant setting for resectable NSCLC.
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Affiliation(s)
- Cunte Chen
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, and
| | - Si-Yang Maggie Liu
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, and
- Department of Hematology, First Affiliated Hospital, Clinical Medicine Postdoctoral Research Station, Jinan University, Guangzhou, China
- Chinese Thoracic Oncology Group (CTONG), Guangzhou, China
| | - Yedan Chen
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Qiuxiang Ou
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Hua Bao
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Ling Xu
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, and
| | - Yikai Zhang
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, and
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yang Shao
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Si-Yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yangqiu Li
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, and
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Wu Y, Zhu PZ, Chen YQ, Chen J, Xu L, Zhang H. Relationship between marital status and survival in patients with lung adenocarcinoma: A SEER-based study. Medicine (Baltimore) 2022; 101:e28492. [PMID: 35029903 PMCID: PMC8735761 DOI: 10.1097/md.0000000000028492] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
Numerous studies have focused on whether the marital status has an impact on the prognosis in patients with non-small cell lung cancer, but none have focused on lung adenocarcinoma.We selected 61,928 eligible cases with lung adenocarcinoma from the Surveillance, Epidemiology, and End Results database from 2004 to 2016 and analyzed the impact of marital status on cancer-specific survival (CSS) using Kaplan-Meier and Cox regression analyses.We confirmed that sex, age, race, cancer TNM stage and grade, therapeutic schedule, household income, and marital status were independent prognostic factors for lung adenocarcinoma CSS. Multivariate Cox regression showed that widowed patients had worse CSS (hazard ratio 1.26, 95% confidence interval 1.20-1.31, P < .001) compared with married patients. Subgroup analysis showed consistent results regardless of sex, age, cancer grade, and TNM stage. However, the trend was not significant for patients with grade IV cancer.These results suggest that marital status is first identified as an independent prognostic factor for CSS in patients with lung adenocarcinoma, with a clear association between widowhood and a high risk of cancer-specific mortality. Psychological and social support are thus important for patients with lung adenocarcinoma, especially unmarried patients.
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Affiliation(s)
- Ying Wu
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Pei-Zhen Zhu
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Yin-Qiao Chen
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Jie Chen
- Department of Respiratory Medicine, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Lu Xu
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
| | - Huayi Zhang
- Department of Oncology, the First People's Hospital of Yongkang City, Yongkang, Zhejiang Province, China
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Le Pechoux C, Pourel N, Barlesi F, Lerouge D, Antoni D, Lamezec B, Nestle U, Boisselier P, Dansin E, Paumier A, Peignaux K, Thillays F, Zalcman G, Madelaine J, Pichon E, Larrouy A, Lavole A, Argo-Leignel D, Derollez M, Faivre-Finn C, Hatton MQ, Riesterer O, Bouvier-Morel E, Dunant A, Edwards JG, Thomas PA, Mercier O, Bardet A. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial. Lancet Oncol 2022; 23:104-114. [PMID: 34919827 DOI: 10.1016/s1470-2045(21)00606-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND In patients with non-small-cell lung cancer (NSCLC), the use of postoperative radiotherapy (PORT) has been controversial since 1998, because of one meta-analysis showing a deleterious effect on survival in patients with pN0 and pN1, but with an unclear effect in patients with pN2 NSCLC. Because many changes have occurred in the management of patients with NSCLC, the role of three-dimensional (3D) conformal PORT warrants further investigation in patients with stage IIIAN2 NSCLC. The aim of this study was to establish whether PORT should be part of their standard treatment. METHODS Lung ART is an open-label, randomised, phase 3, superiority trial comparing mediastinal PORT to no PORT in patients with NSCLC with complete resection, nodal exploration, and cytologically or histologically proven N2 involvement. Previous neoadjuvant or adjuvant chemotherapy was allowed. Patients aged 18 years or older, with an WHO performance status of 0-2, were recruited from 64 hospitals and cancer centres in five countries (France, UK, Germany, Switzerland, and Belgium). Patients were randomly assigned (1:1) to either the PORT or no PORT (control) groups via a web randomisation system, and minimisation factors were the institution, administration of chemotherapy, number of mediastinal lymph node stations involved, histology, and use of pre-treatment PET scan. Patients received PORT at a dose of 54 Gy in 27 or 30 daily fractions, on five consecutive days a week. Three dimensional conformal radiotherapy was mandatory, and intensity-modulated radiotherapy was permitted in centres with expertise. The primary endpoint was disease-free survival, analysed by intention to treat at 3 years; patients from the PORT group who did not receive radiotherapy and patients from the control group with no follow-up were excluded from the safety analyses. This trial is now closed. This trial is registered with ClinicalTrials.gov number, NCT00410683. FINDINGS Between Aug 7, 2007, and July 17, 2018, 501 patients, predominantly staged with 18F-fluorodeoxyglucose (18F-FDG) PET (456 [91%]; 232 (92%) in the PORT group and 224 (90%) in the control group), were enrolled and randomly assigned to receive PORT (252 patients) or no PORT (249 patients). At the cutoff date of May 31, 2019, median follow-up was 4·8 years (IQR 2·9-7·0). 3-year disease-free survival was 47% (95% CI 40-54) with PORT versus 44% (37-51) without PORT, and the median disease-free survival was 30·5 months (95% CI 24-49) in the PORT group and 22·8 months (17-37) in the control group (hazard ratio 0·86; 95% CI 0·68-1·08; p=0·18). The most common grade 3-4 adverse events were pneumonitis (13 [5%] of 241 patients in the PORT group vs one [<1%] of 246 in the control group), lymphopenia (nine [4%] vs 0), and fatigue (six [3%] vs one [<1%]). Late-grade 3-4 cardiopulmonary toxicity was reported in 26 patients (11%) in the PORT group versus 12 (5%) in the control group. Two patients died from pneumonitis, partly related to radiotherapy and infection, and one patient died due to chemotherapy toxicity (sepsis) that was deemed to be treatment-related, all of whom were in the PORT group. INTERPRETATION Lung ART evaluated 3D conformal PORT after complete resection in patients who predominantly had been staged using (18F-FDG PET-CT and received neoadjuvant or adjuvant chemotherapy. 3-year disease-free survival was higher than expected in both groups, but PORT was not associated with an increased disease-free survival compared with no PORT. Conformal PORT cannot be recommended as the standard of care in patients with stage IIIAN2 NSCLC. FUNDING French National Cancer Institute, Programme Hospitalier de Recherche Clinique from the French Health Ministry, Gustave Roussy, Cancer Research UK, Swiss State Secretary for Education, Research, and Innovation, Swiss Cancer Research Foundation, Swiss Cancer League.
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Affiliation(s)
- Cecile Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
| | - Nicolas Pourel
- Radiation Oncology, Institut Sainte Catherine, Avignon, France
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Aix-Marseille University, Centre National de la Recherche Scientifique, Institut National des Sciences et de la Recherche Médicale, Centre de Recherche en Cancérologie de Marseille, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | | | - Delphine Antoni
- Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France
| | - Bruno Lamezec
- Radiation Oncology, Centre Armoricain de Radiothérapie, d'Imagerie médicale et d'Oncologie, St Brieuc, France
| | - Ursula Nestle
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Pierre Boisselier
- Department of Radiation Oncology, Centre Val d'Aurelle, Montpellier, France
| | - Eric Dansin
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Amaury Paumier
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest Centre Paul Papin, Angers, France
| | - Karine Peignaux
- Department of Radiation Oncology, Centre Georges-Francois Leclerc, Dijon, France
| | - François Thillays
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest Centre René Gauducheau, Nantes, France
| | - Gerard Zalcman
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France; Department of Thoracic Oncology, Université de Paris, Centre d'Investigation Clinique-1425-Bichat-Claude Bernard Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jeannick Madelaine
- Department of Pneumology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Eric Pichon
- Department of Pneumology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Larrouy
- Radiation Oncology, Centre Specialisé Cancerologie Paris Nord, Sarcelles, France
| | - Armelle Lavole
- Department of Thoracic Oncology, Tenon University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - Marc Derollez
- Pneumology, Polyclinique du Val de Sambre, Maubeuge, France
| | - Corinne Faivre-Finn
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Q Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich and Centre for Radiation Oncology, Cantonal Hospitals Aarau and Baden, Aarau, Switzerland
| | - Emilie Bouvier-Morel
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - Ariane Dunant
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France
| | - John G Edwards
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Hôpital Nord, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Institut d'Oncologie Thoracique, Marie-Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France
| | - Aurelie Bardet
- International Center for Thoracic Cancers, and Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France; Oncostat Unité Mixte de Recherche 1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
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Zhuge L, Zhang K, Zhang Z, Guo W, Li Y, Bao Q. A novel model based on liquid-liquid phase separation-Related genes correlates immune microenvironment profiles and predicts prognosis of lung squamous cell carcinoma. J Clin Lab Anal 2022; 36:e24135. [PMID: 34799879 PMCID: PMC8761450 DOI: 10.1002/jcla.24135] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The aim of the study was to construct and validate a robust prognostic model based on liquid-liquid phase separation (LLPS)-related genes in lung squamous cell carcinoma (LUSC). METHODS The Cancer Genome Atlas dataset was used as the discovery set to identify the LLPS-related differentially expressed genes (DEGs) between LUSC and normal tissue. These DEGs were screened by the LASSO Cox regression analysis to identify the genes with nonzero coefficient, which were next included in the multivariate Cox regression analysis to construct the prediction model. The dataset GSE41271 was adopted as the validation set to verify the efficacy of the model. Enrichment analysis and the CIBERSORT were performed to illustrate potential immune mechanisms underlying the prediction model. RESULTS A total of 48 LLPS-related genes were aberrantly expressed in LUSC. Among them, 7 genes were selected by the LASSO Cox regression analysis to construct the prediction model. Risk index (RI) was calculated according to the model for each patient. The prognosis was significantly different between the patients with high and low RI in the discovery set and the validation set (p < 0.001 and p = 0.028, respectively). The multivariate survival analysis confirmed RI as an independent prognostic factor in LUSC (in the discovery set: p < 0.001, HR = 2.643, 95% CI = 1.986-3.518; in the validation set: p = 0.042, HR = 2.144, 95% CI = 1.026-4.480). A series of pathways involving immune cells were found to be related to RI. The distribution pattern of immune cells and chemokines varied according to the value of RI. CONCLUSION The prediction model based on LLPS-related genes was constructed and validated as a robust prognostic tool for LUSC using multiple datasets. LLPS might have an impact on LUSC through immune pathways.
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Affiliation(s)
- Lingdun Zhuge
- Department of Thoracic SurgeryLonghua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Kun Zhang
- Department of Thoracic SurgeryLonghua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Zeliang Zhang
- Department of Thoracic SurgeryLonghua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Wentao Guo
- Department of Thoracic SurgeryLonghua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yang Li
- Department of Thoracic SurgeryLonghua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Qi Bao
- Department of Thoracic SurgeryLonghua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
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Duru Birgi S, Akgun Z, Hurmuz P, Akyurek S, Kaytan Saglam E, Yilmaz MT, Bakirarar B, Cengiz M. Definitive Chemoradiotherapy Results in Synchronous Oligometastatic Non-small Cell Lung Cancer Patients: Turkish Society for Radiation Oncology Group Study (TROD 10-003). Am J Clin Oncol 2022; 45:40-47. [PMID: 34857699 DOI: 10.1097/coc.0000000000000881] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE It is aimed to investigate the survival outcomes and prognostic factors after curative treatment of patients diagnosed with synchronous oligometastatic non-small cell lung carcinoma. MATERIALS AND METHODS Fifty-two patients from 3 centers diagnosed between 2014 and 2019 were analyzed. The treatment results of thoracic and oligometastatic regions were retrospectively evaluated. The Kaplan-Meier method was used to determine the overall survival (OS) and progression-free survival (PFS) and log-rank tests for the factors affecting survival. Cox regression analysis was employed for multivariate analysis. RESULTS Of the 52 patients, 46 (88%) had <2 organ involvement at diagnosis. Treatment of oligometastasis was radiotherapy (RT) in 37, surgery in 4, and surgery with RT in 11 patients. Median 60 Gy were administered to the thoracic tumor. Median RT dose for oligometastasis was 30 Gy in median 5 fractions with either stereotactic body radiation therapy or conventional RT. The median follow-up was 18 months. The median OS and PFS were 35 and 20 months, respectively. The 1-, 2-, and 3-year OS rates were 80.5%, 60.2%, and 41.2%, while the corresponding PFS rates were 75%, 42.5%, and 21.5%, respectively. Multivariate Cox regression analysis revealed that the Eastern Cooperative Oncology Group performance status of "0" and thoracic RT dose over 60 Gy were significant prognostic factors for both the OS and PFS. CONCLUSIONS Definitive chemoradiotherapy to the thoracic tumor and treatment of oligometastasis region indicate promising survival outcomes.
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Affiliation(s)
| | - Zuleyha Akgun
- Department of Radiation Oncology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Pervin Hurmuz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
| | | | - Esra Kaytan Saglam
- Department of Radiation Oncology, Memorial Sisli Hospital, Istanbul, Turkey
| | - Melek Tugce Yilmaz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
| | | | - Mustafa Cengiz
- Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara
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28
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Jiang Z, Zhou Y, Huang J. A Combination of Biomarkers Predict Response to Immune Checkpoint Blockade Therapy in Non-Small Cell Lung Cancer. Front Immunol 2021; 12:813331. [PMID: 35003141 PMCID: PMC8733693 DOI: 10.3389/fimmu.2021.813331] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 12/21/2022] Open
Abstract
Immune checkpoint blockade (ICB) therapy has provided clinical benefits for patients with advanced non-small-cell lung cancer (NSCLC), but the majority still do not respond. Although a few biomarkers of ICB treatment response have been developed, the predictive power of these biomarkers showed substantial variation across datasets. Therefore, predicting response to ICB therapy remains a challenge. Here, we provided a concise combinatorial strategy for predicting ICB therapy response and constructed the ICB treatment signature (ITS) in lung cancer. The prediction performance of ITS has been validated in an independent ICB treatment cohort of NSCLC, where patients with higher ITS score were significantly associated with longer progression-free survival and better response. And ITS score was more powerful than traditional biomarkers, such as TMB and PD-L1, in predicting the ICB treatment response in NSCLC. In addition, ITS scores still had predictive effects in other cancer data sets, showing strong scalability and robustness. Further research showed that a high ITS score represented comprehensive immune activation characteristics including activated immune cell infiltration, increased mutation load, and TCR diversity. In conclusion, our practice suggested that the combination of biomarkers will lead to a better prediction of ICB treatment prognosis, and the ITS score will provide NSCLC patients with better ICB treatment decisions.
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Affiliation(s)
- Zedong Jiang
- Department of Hematology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Yao Zhou
- Department of Hematology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| | - Juan Huang
- Department of Hematology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Abstract
IMPORTANCE Early detection by computed tomography and a more attention-oriented approach to incidentally identified pulmonary nodules in the last decade has led to population stage shift for non-small cell lung cancer (NSCLC). This stage shift could substantially confound the evaluation of newer therapeutics and mortality outcomes. OBJECTIVE To investigate the association of stage shift with population mortality among patients with NSCLC. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was performed from October 2020 to June 2021 and used data from the Surveillance, Epidemiology, and End Results (SEER) registries to assess all patients from 2006 to 2016 with NSCLC. MAIN OUTCOMES AND MEASURES Incidence-based mortality was evaluated by year-of-death. To assess shifts in diagnostic characteristics, clinical stage and histology distributions were examined by year using χ2 tests. Trends were assessed using the average annual percentage change (AAPC), calculated with JoinPoint software. Kaplan-Meier survival analysis assessed overall survival according to stage and compared those missing any stage with those with a reported stage. RESULTS The final sample contained 312 382 patients; 166 657 (53.4%) were male, 38 201 (12.2%) were Black, and 249 062 (79.7%) were White; the median (IQR) age was 68 (60-76) years; 163 086 (52.2%) had adenocarcinoma histology. Incidence-based mortality within 5 years of diagnosis decreased from 2006 to 2016 (AAPC, -3.7; 95% CI, -4.1 to -3.4). When assessing stage shift, there was significant association between year-of-diagnosis and clinical stage, with stage I/II diagnosis increasing from 26.5% to 31.2% (AAPC, 1.5; 95% CI, 0.5 to 2.5); and stage III/IV diagnosis decreasing significantly from 70.8% to 66.1% (AAPC, -0.6; 95% CI, -1.0 to -0.2). Missing staging information was not associated with year-of-diagnosis (AAPC, -1.6; 95% CI, -7.4 to 4.5). Year-of-diagnosis was significantly associated with tumor histology (χ2 = 8990.0; P < .001). There was a significant increase in adenocarcinomas: 42.9% in 2006 to 59.0% in 2016 (AAPC, 3.4; 95% CI, 2.9 to 3.9). Median (IQR) survival for stage I/II was 57 months (18 months to not reached); stage III/IV was 7 (2-19) months; and missing stage was 10 (2-28) months. When compared with those with known stage, those without stage information had significantly worse survival than those with stage I/II, with survival between those with stage III and stage IV (log-rank χ2 = 87 125.0; P < .001). CONCLUSIONS AND RELEVANCE This cohort study found an association between decreased mortality and a corresponding diagnostic shift from later to earlier stage. These findings suggest that studies investigating the effect of treatment on lung cancer must take into account stage shift and the confounding association with survival and mortality outcome.
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Affiliation(s)
- Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Parth Patel
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Naomi Alpert
- Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce Pyenson
- NYU School of Global Public Health, New York, New York
- Milliman Inc, New York, New York
| | - Emanuela Taioli
- Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Imai H, Onozato R, Kaira K, Kawashima S, Masubuchi K, Tajima K, Minato K. Post-Progression Survival Highly Influences Overall Survival in Driver Gene Mutation/Translocation Negative or Unknown Type of Non-Small Cell Lung Cancer. Oncology 2021; 100:89-100. [PMID: 34844253 DOI: 10.1159/000521141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In stage I-III non-small cell lung cancer (NSCLC), which is considered operable, surgical resection is the most efficacious treatment and is considered to provide a cure. However, after complete surgical resection, approximately 50% of patients with stage I-IIIA NSCLC experience recurrence and death. Once postoperative recurrence of NSCLC occurs, the prognosis is significantly poor, and the course of treatment after recurrence may influence overall survival (OS). Consequently, we investigated the relationship between relapse-free survival (RFS), post-progression survival (PPS), and OS in patients with postoperative recurrence of NSCLC with driver gene mutation/translocation negative or unknown status. METHODS Between January 2007 and September 2019, 101 patients with driver gene mutation/translocation negative or unknown status of NSCLC who underwent complete resection and in whom recurrence occurred were analyzed. The associations between RFS, PPS, and OS were analyzed at the individual patient level. RESULTS Linear regression and Spearman rank correlation analyses revealed that PPS was strongly associated with OS (r = 0.83, p < 0.0001, R2 = 0.71), whereas RFS was moderately correlated with OS (r = 0.65, p < 0.0001, R2 = 0.48). In the multivariate analysis, performance status at relapse, administration of immune checkpoint inhibitors, and radiotherapy for oligo-recurrences were significantly associated with PPS (p < 0.001). CONCLUSION Current analysis of individual-level data of patients who underwent complete resection implied that PPS had a higher impact on OS than RFS in patients with postoperative recurrence of driver gene mutation/translocation negative or unknown status of NSCLC. Additionally, current perceptions indicate that treatment beyond progression after complete surgical resection might strongly affect OS.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Ryoichi Onozato
- Division of Thoracic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Sayaka Kawashima
- Division of Pharmacy, Gunma Prefectural Cancer Center, Ota, Japan
| | - Ken Masubuchi
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kohei Tajima
- Division of Thoracic Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
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Luo W, Li Y, Ye F, Li Q, Zhang G, Li J, Li X. Anti-EGFR monoclonal antibody plus chemotherapy for treating advanced non-small cell lung cancer: A meta-analysis. Medicine (Baltimore) 2021; 100:e27954. [PMID: 34964780 PMCID: PMC8615333 DOI: 10.1097/md.0000000000027954] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The use of standard cytotoxic chemotherapy seems to have reached a "treatment plateau". The application of anti-epidermal growth factor receptor (EGFR) monoclonal antibodies (mAbs) is a new strategy for non-small-cell lung cancer (NSCLC) therapy. We aimed to comprehensively assess the efficacy and safety of anti-EGFR-mAbs plus chemotherapy as first-line therapy for advanced NSCLC. METHODS According to inclusion and exclusion criteria, we conducted a comprehensive literature search of electronic databases. From the included trials, information on overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs) was extracted. RESULTS The research showed that compared with chemotherapy alone, anti-EGFR-mAb plus chemotherapy combinations significantly improved OS (HR = 0.88, 95%CI: 0.83-0.94, P < .0001), PFS (HR = 0.89, 95%CI: 0.83-0.95, P = 0.0004) and ORR (OR = 1.39, 95%CI: 1.13-1.69, P = .001). Meta subgroup analyses manifested that the OS of patients with squamous NSCLC treated with anti-EGFR-mAb plus chemotherapy combinations was notably better than that of patients with non-squamous NSCLC treated with the same combinations (HR = 0.82, 95%CI: 0.73-0.92, P = .0005). Compared with the chemotherapy group, combination of chemotherapy and anti-EGFR mAb showed increase in incidences of severe AEs (> = grade 3) that mainly include, leukopenia (OR = 1.53, 95%CI: 1.28-1.82, P < .00001), febrile neutropenia (OR = 1.35, 95%CI: 1.06-1.71, P = .02), hypomagnesemia (OR = 5.68, 95%CI: 3.54-9.10, P < .00001), acneiform rash (OR = 35.88, 95%CI: 17.37-74.10, P < .00001), fatigue (OR = 1.24, 95%CI: 1.02-1.49, P = .03), diarrhea (OR = 1.69, 95%CI: 1.16-2.47, P = .006), and infusion-related reactions (OR = 3.78, 95%CI: 1.93-7.41, P = .0001). CONCLUSION Adding an anti-EGFR-mAb to the standard platinum-based chemotherapy regimens used for the first-line treatment of advanced NSCLC resulted in statistically notable improvements in OS, PFS, and ORR. In particular, anti-EGFR-mAb and chemotherapy combinations achieved greater survival benefits in patients with squamous NSCLC than in those with non-squamous NSCLC. In addition, the safety profile of chemotherapy plus anti-EGFR-mAb combinations was acceptable compared to that of chemotherapy alone.
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Affiliation(s)
- Wenqing Luo
- Department of thoracic surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuanqi Li
- XiangYa School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Fei Ye
- Department of thoracic surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qiangming Li
- Department of thoracic surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Guoqing Zhang
- Department of thoracic surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jindong Li
- Department of thoracic surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiangnan Li
- Department of thoracic surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Kumar S, Pandey M, Mir IA, Mukhopadhyay A, Sharawat SK, Jain D, Saikia J, Malik PS, Kumar S, Mohan A. Evaluation of the programmed death-ligand 1 mRNA expression and immunopositivity and their correlation with survival outcomes in Indian lung cancer patients. Hum Cell 2021; 35:286-298. [PMID: 34786661 DOI: 10.1007/s13577-021-00647-4] [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: 09/23/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Abstract
The presence of membranous immunopositivity of programmed death-ligand 1 (PD-L1) in tumors serves as a key determinant of response to immune checkpoint inhibitors. However, there are very limited studies on the evaluation of the PD-L1 mRNA expression and immunopositivity and their correlation with therapeutic response and survival outcomes, especially in Indian lung cancer patients. In this prospective study, conducted between 2017 and 2020, we collected biopsies and surgically resected tumors from 173 lung cancer patients. PD-L1 immunopositivity and mRNA expression were determined by immunohistochemistry using SP263 assay and qRT-PCR, respectively. PD-L1 expression was correlated with various clinicopathological variables, response to therapy, and survival outcomes using appropriate statistical methods. The median age was 60 years (range 33-81 years) with the majority of patients being male (86.5%) and smokers (83%). Histologically, the majority of patients were non-small cell lung cancer (89.4%) and of squamous cell carcinoma histology (64.3%). PD-L1 immunopositivity in tumor cells (tumor proportion score (TPS) ≥ 1%) was detected in 37.6%, while high immunopositivity (TPS ≥ 50%) was detected in 16.8% of lung cancer patients. Almost 76% of lung cancer patients with PD-L1 TPS ≥ 50% belonged to PD-L1 mRNA high-expression group. PD-L1 mRNA expression and immunopositivity did not correlate with response to therapy and survival outcomes. We conclude that PD-L1 immunopositivity and mRNA expression do not seem to serve as a prognostic biomarker for lung cancer patients treated with chemotherapy. More prospective studies should be planned to evaluate the predictive and prognostic relevance of PD-L1 expression in Indian lung cancer patients being treated with immune checkpoint inhibitors.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- B7-H1 Antigen/genetics
- B7-H1 Antigen/metabolism
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/metabolism
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/mortality
- Female
- Gene Expression
- Humans
- Immune Checkpoint Inhibitors/therapeutic use
- Immunohistochemistry
- India/epidemiology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Lung Neoplasms/mortality
- Male
- Middle Aged
- Prospective Studies
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Survival Rate
- Time Factors
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Affiliation(s)
- Sachin Kumar
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Monu Pandey
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Ishfaq A Mir
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Abhirup Mukhopadhyay
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Surender K Sharawat
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Jyoutishman Saikia
- Department of Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Prabhat S Malik
- Department of Medical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Anant Mohan
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Nishino M, Lu J, Hino T, Vokes NI, Jänne PA, Hatabu H, Johnson BE. Tumor Growth Rate After Nadir Is Associated With Survival in Patients With EGFR-Mutant Non-Small-Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor. JCO Precis Oncol 2021; 5:1603-1610. [PMID: 34994646 PMCID: PMC9848598 DOI: 10.1200/po.21.00172] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/24/2021] [Accepted: 09/09/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the association between tumor volume growth rate after the nadir and survival in patients with EGFR-mutant advanced non-small-cell lung cancer (NSCLC) treated with erlotinib. MATERIALS AND METHODS Seventy-one patients with EGFR-mutant advanced NSCLC treated with erlotinib were studied for computed tomography tumor volume kinetics during therapy. The tumor growth rate after nadir was obtained using a previously published analytic module for longitudinal volume tracking to study its relationship with overall survival (OS). RESULTS The median tumor volume for the cohort was 19,842 mm3 at baseline and 4,083 mm3 at nadir. The median time to nadir was 6.2 months. The tumor growth rate after nadir for logeV (the natural logarithm of tumor volume measured in mm3) was 0.11/mo on average for the cohort (SE: 0.014), which was very similar to the previously validated reference value of 0.12/mo to define slow and fast tumor growth. The OS of 48 patients with slow tumor growth (≤ 0.12/mo) was significantly longer compared with 23 patients with fast tumor growth (> 0.12/mo; median OS: 37.8 v 25.0 months; P = .0012). In Cox models, tumor growth rate was also associated with survival (regression coefficient: 3.9903; P = .0024; faster rate leads to increased hazards), after adjusting for time to nadir (regression coefficient: -0.0863; P = .0008; longer time to nadir leads to decreased hazards) and smoking history. CONCLUSION In patients with EGFR-mutant advanced NSCLC treated with erlotinib, slower tumor growth rates after nadir were associated with longer OS, providing a rationale for using tumor growth rates to guide precision therapy for lung cancer.
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Affiliation(s)
- Mizuki Nishino
- Department of Imaging, Dana Farber Cancer
Institute, Boston, MA
- Department of Radiology, Brigham and
Women's Hospital, Boston, MA
| | - Junwei Lu
- Department of Biostatistics, Harvard Chan
School of Public Health, Boston, MA
| | - Takuya Hino
- Department of Radiology, Brigham and
Women's Hospital, Boston, MA
| | - Natalie I. Vokes
- Department of Medical Oncology, Dana
Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and
Women's Hospital, Boston, MA
| | - Pasi A. Jänne
- Department of Medical Oncology, Dana
Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and
Women's Hospital, Boston, MA
| | - Hiroto Hatabu
- Department of Imaging, Dana Farber Cancer
Institute, Boston, MA
- Department of Radiology, Brigham and
Women's Hospital, Boston, MA
| | - Bruce E. Johnson
- Department of Medical Oncology, Dana
Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and
Women's Hospital, Boston, MA
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Nishino M, Lu J, Hino T, Vokes NI, Jänne PA, Hatabu H, Johnson BE. Tumor Growth Rate After Nadir Is Associated With Survival in Patients With EGFR-Mutant Non-Small-Cell Lung Cancer Treated With Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor. JCO Precis Oncol 2021. [PMID: 34994646 DOI: 10.1200/po.20.00478:501-509] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
PURPOSE To investigate the association between tumor volume growth rate after the nadir and survival in patients with EGFR-mutant advanced non-small-cell lung cancer (NSCLC) treated with erlotinib. MATERIALS AND METHODS Seventy-one patients with EGFR-mutant advanced NSCLC treated with erlotinib were studied for computed tomography tumor volume kinetics during therapy. The tumor growth rate after nadir was obtained using a previously published analytic module for longitudinal volume tracking to study its relationship with overall survival (OS). RESULTS The median tumor volume for the cohort was 19,842 mm3 at baseline and 4,083 mm3 at nadir. The median time to nadir was 6.2 months. The tumor growth rate after nadir for logeV (the natural logarithm of tumor volume measured in mm3) was 0.11/mo on average for the cohort (SE: 0.014), which was very similar to the previously validated reference value of 0.12/mo to define slow and fast tumor growth. The OS of 48 patients with slow tumor growth (≤ 0.12/mo) was significantly longer compared with 23 patients with fast tumor growth (> 0.12/mo; median OS: 37.8 v 25.0 months; P = .0012). In Cox models, tumor growth rate was also associated with survival (regression coefficient: 3.9903; P = .0024; faster rate leads to increased hazards), after adjusting for time to nadir (regression coefficient: -0.0863; P = .0008; longer time to nadir leads to decreased hazards) and smoking history. CONCLUSION In patients with EGFR-mutant advanced NSCLC treated with erlotinib, slower tumor growth rates after nadir were associated with longer OS, providing a rationale for using tumor growth rates to guide precision therapy for lung cancer.
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Affiliation(s)
- Mizuki Nishino
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Junwei Lu
- Department of Biostatistics, Harvard Chan School of Public Health, Boston, MA
| | - Takuya Hino
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Natalie I Vokes
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Pasi A Jänne
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Hiroto Hatabu
- Department of Imaging, Dana Farber Cancer Institute, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Bruce E Johnson
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Li Y, Zhang Y, Jia X, Jiang P, Mao Z, Liang T, Du Y, Zhang J, Zhang G, Niu G, Guo H. Effect of Immune-Related Adverse Events and Pneumonitis on Prognosis in Advanced Non-Small Cell Lung Cancer: A Comprehensive Systematic Review and Meta-analysis. Clin Lung Cancer 2021; 22:e889-e900. [PMID: 34183265 DOI: 10.1016/j.cllc.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/09/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The correlation between immune-related adverse events (irAEs) and prognosis remains controversial in advanced non-small cell lung cancer (NSCLC). The aim of this study was to systematically evaluate the effect of irAEs, especially checkpoint inhibitor pneumonitis (CIP), on the survival and treatment response in advanced NSCLC. METHODS The primary outcomes were overall survival (OS) and objective response rate (ORR). Databases were searched for relevant studies, and meta-analysis was conducted with RevMan. RESULTS A total of 51 studies involving 12,600 participants were included. The development of irAEs had an advantageous effect on OS and ORR in advanced NSCLC (OS: hazard ratio [HR], 0.56 [95% confidence interval [CI] 0.46 to 0.67]; ORR: odds ratio [OR], 3.13 [2.41 to 4.06]). The occurrence of endocrine and skin irAEs had advantageous effects on both OS and ORR (endocrine OS, HR, 0.47 [-0.37 to 0.59]; endocrine ORR: OR, 1.90 [1.27 to 2.84]; skin OS: HR, 0.48 [0.38 to 0.61]; skin ORR: OR, 4.30 [2.68 to 6.91]). Severe-grade irAEs resulted in shorter OS than low-grade irAEs (HR, 1.49 [1.06, 2.09]), and multiple irAEs resulted in better ORR compared with 1 irAE (OR, 2.04 [1.41 to 2.94]). The occurrence of CIP had no significant effect on OS (HR, 1.14 [0.70 to 1.86]), but it was associated with better ORR (OR, 2.12 [1.06 to 4.25]). Severe-grade CIP had no effect on OS or ORR, but CIP leading to treatment discontinuation resulted in shorter OS (HR, 2.35 [1.17 to 4.72]). CONCLUSION The development of irAEs had advantageous effects on survival and response in advanced NSCLC. CIP had no effect on survival, but it predicted better response.
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Affiliation(s)
- Yanlin Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yajuan Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaohui Jia
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Panpan Jiang
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ziyang Mao
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yonghao Du
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jia Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guangjian Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Gang Niu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hui Guo
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, Shaanxi, China; Bioinspired Engineering and Biomechanics Center, Xi'an Jiaotong University, Ministry of Education of China, Xi'an, Shaanxi, China
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Ramagopalan S, Gupta A, Arora P, Thorlund K, Ray J, Subbiah V. Comparative Effectiveness of Atezolizumab, Nivolumab, and Docetaxel in Patients With Previously Treated Non-Small Cell Lung Cancer. JAMA Netw Open 2021; 4:e2134299. [PMID: 34767024 PMCID: PMC8590169 DOI: 10.1001/jamanetworkopen.2021.34299] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Evidence regarding real-world effectiveness of therapies for patients with advanced non-small cell lung cancer (NSCLC) whose tumors are resistant to platinum-based chemotherapy is lacking. OBJECTIVE To compare the effectiveness of the immune checkpoint inhibitors atezolizumab (programmed cell death ligand 1 inhibitor) and nivolumab (programmed cell death 1 inhibitor) and the chemotherapy drug docetaxel in patients with advanced NSCLC resistant to platinum-based chemotherapy. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study compared patients aged 18 years or older with advanced NSCLC who initiated atezolizumab, docetaxel, or nivolumab and who had previously been exposed to platinum-based chemotherapy using nationally representative real-world data from more than 280 US cancer clinics. Patients were followed-up from May 2011 to March 2020. Data analysis was performed between April and June 2021. Comparisons of interest were between atezolizumab vs docetaxel and atezolizumab vs nivolumab. EXPOSURES Initiation of atezolizumab, nivolumab, or docetaxel monotherapy. MAIN OUTCOME AND MEASURES The main outcome was overall survival (OS). RESULTS A total of 3336 patients (mean [SD] age, 67.1 [9.49] years; 1820 [54.6%] men and 1516 [45.4%] women) were assessed in the main analysis, including 206 patients receiving atezolizumab, 500 receiving docetaxel, and 2630 receiving nivolumab. Patients receiving atezolizumab were older than those treated with docetaxel (mean age [SD], 68.3 [9.4] years vs 65.6 [9.5] years), and were more likely to have been treated in an academic setting (39 patients [18.9%]) than those receiving docetaxel (49 patients [9.8%]) and nivolumab (128 patients [4.9%]). After adjustment for baseline characteristics, atezolizumab was associated with a significantly longer OS compared with docetaxel (adjusted hazard ratio [aHR], 0.79; 95% CI, 0.64-0.97). No significant difference in OS was observed between atezolizumab and nivolumab (aHR, 1.07; 95% CI, 0.89-1.28). These findings were consistent across all patient subgroups tested, and robust to plausible deviations from random missingness for Eastern Cooperative Oncology Group performance status in real-world data (eg, the tipping point for loss of a significantly beneficial effect for atezolizumab vs docetaxel was achieved if patients in the docetaxel group missing baseline Eastern Cooperative Oncology Group performance status had a mean performance status of 1.43 higher than expected). CONCLUSIONS AND RELEVANCE In this comparative effectiveness study, atezolizumab was superior to docetaxel and matched nivolumab in prolonging OS in a real-world cohort of patients with advanced NSCLC who previously received platinum-based chemotherapy.
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Affiliation(s)
| | | | | | | | - Joshua Ray
- Global Access, F. Hoffmann-La Roche, Basel, Switzerland
| | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston
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Ma W, Liang J, Mo J, Zhang S, Hu N, Tian D, Chen Z. Butyrophilin-like 9 expression is associated with outcome in lung adenocarcinoma. BMC Cancer 2021; 21:1096. [PMID: 34635082 PMCID: PMC8507344 DOI: 10.1186/s12885-021-08790-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/28/2020] [Accepted: 09/17/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Lung adenocarcinoma (LUAD) is the most prevalent non-small cell lung cancer (NSCLC). Patients with LUAD have a poor 5-year survival rate. The use of immune checkpoint inhibitors (ICIs) for the treatment of LUAD has been on the rise in the past decade. This study explored the prognostic role of butyrophilin-like 9 (BTNL9) in LUAD. METHODS Gene expression profile of buytrophilins (BTNs) was determined using the GEPIA database. The effect of BTNL9 on the survival of LUAD patients was assessed using Kaplan-Meier plotter and OncoLnc. Correlation between BTNL9 expression and tumor-infiltrating immune cells (TILs) was explored using TIMER and GEPIA databases. Further, the relationship between BTNL9 expression and drug response was evaluated using CARE. Besides, construction and evaluation of nomogram based on BTNL9 expression and TNM stage. RESULTS BTNL9 expression was downregulated in LUAD and was associated with a poor probability of 1, 3, 5-years overall survival (OS). In addition, BTNL9 expression was regulated at epigenetic and post-transcriptional modification levels. Moreover, BTNL9 expression was significantly positively correlated with ImmuneScore and ESTIMATEScore. Furthermore, BTNL9 expression was positively associated with infiltration levels of B cells, CD4+ T cells, and macrophages. Kaplan-Meier analysis showed that BTNL9 expression in B cells and dendritic cells (DCs) was significantly associated with OS. BTNL9 expression was significantly positively correlated with CARE scores. CONCLUSIONS These findings show that BTNL9 is a potential prognostic biomarker for LUAD. Low BTNL9 expression levels associated with low infiltration levels of naïve B cells, and DCs in the tumor microenvironment are unfavorable for OS in LUAD patients.
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Affiliation(s)
- Weishuang Ma
- Department of Respiratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University Qingyuan People's Hospital, Qingyuan, China
- Zhouxin Community Health Service, Qingcheng District, Qingyuan, China
| | - Jiaming Liang
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Junjian Mo
- Department of Respiratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University Qingyuan People's Hospital, Qingyuan, China
| | - Siyuan Zhang
- Department of Respiratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University Qingyuan People's Hospital, Qingyuan, China
| | - Ningdong Hu
- Department of Thoracic Surgery, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Dongbo Tian
- Department of Respiratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University Qingyuan People's Hospital, Qingyuan, China.
| | - Zisheng Chen
- Department of Respiratory Medicine, The Sixth Affiliated Hospital of Guangzhou Medical University Qingyuan People's Hospital, Qingyuan, China.
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Batra A, Yusuf D, Hurry M, Walton RN, Devost N, Farrer C, Cheung WY. A Population-based Study of Treatment Patterns and Survival of Patients With De Novo Stage IV Non-Small Cell Lung Cancer. Am J Clin Oncol 2021; 44:512-518. [PMID: 34380947 DOI: 10.1097/coc.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treatment strategies for metastatic non-small cell lung cancer (NSCLC) are evolving rapidly and can be highly variable. Real-world evidence of treatment patterns and outcomes can provide an understanding of our current practice and offer insights on ways to incorporate emerging therapies into our treatment paradigm. In this population-based study, we investigated treatments and outcomes of stage IV NSCLC patients from a large Canadian province. METHODS Patients diagnosed with de novo stage IV NSCLC from April 1, 2010 to March 31, 2015 were identified. Data for baseline characteristics, treatments, and outcomes were obtained from provincial data sources, including the cancer registry and electronic medical records. We classified systemic treatments as chemotherapy, targeted therapy (anti-epidermal growth factor receptor, and anti-anaplastic lymphoma kinase) and immunotherapy (checkpoint inhibitors) and characterized clinical outcomes by treatment type. RESULTS A total of 6438 patients were identified with NSCLC, of whom 3606 (56%) had de novo stage IV disease. The median age of diagnosis was 69 (range: 20 to 100) years and 52.4% were men. First-line palliative treatments included: chemotherapy in 19.5% (n=703), targeted agents in 5.7% (n=204), immunotherapy in 1% (n=1), radiotherapy in 6.8% (n=246), and best supportive care in 74.8% (n=2,698). Median overall survival (mOS) from diagnosis for the whole cohort was 3.8 months. Within subgroups, mOS was 18.0 months for targeted therapies, 9.4 months for chemotherapy, and 2.5 months for best supportive care. Only 1.0% of patients (n=34) received immunotherapy at any line. CONCLUSIONS Survival benefit was dependent on type of treatment received, with significantly better mOS observed with the use of small-molecule targeted therapy against epidermal growth factor receptor mutations and anaplastic lymphoma kinase rearrangements, as compared with best supportive care.
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Affiliation(s)
- Atul Batra
- Alberta Health Services (AHS), Edmonton, AB
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Chmielewska I, Dudzińska M, Szczyrek M, Świrska J, Wojas-Krawczyk K, Zwolak A. Do endocrine adverse events predict longer progression-free survival among patients with non-small-cell lung cancer receiving nivolumab? PLoS One 2021; 16:e0257484. [PMID: 34587185 PMCID: PMC8480788 DOI: 10.1371/journal.pone.0257484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/03/2021] [Indexed: 12/26/2022] Open
Abstract
The aim of the study was to assess the occurrence and nature of immune-related endocrine adverse events (irAEs) among patients with non-small-cell lung cancer (NSCLC) treated with nivolumab. METHODS The study group included 35 patients (15 women, 20 men, 65.8 ± 7.1 years) with NSCLC in stage IIIB (n = 16, 45.7%) and IV (n = 19,54.3%) who were treated with nivolumab. RESULTS Of the studied patients, 34.3% (n = 12) developed endocrine irAEs (irAE group): 22.9% (n = 8) hyperthyroidism and 8.6% (n = 3) hypothyroidism, and in one case, hypophysitis was observed. The median irAEs onset time was 2 months. In the group of patients with thyroid disorders, permanent hypothyroidism eventually developed in 58.3%. The severity of the analyzed irAEs ranged from mild to moderate (Grade 1-2); the case of hypophysitis was estimated as Grade 3. The comparison of progression-free survival time (PFS) between the two groups showed longer PFS in patients in the irAE group (p = 0.021). Patients with irAE were treated significantly longer with nivolumab and they received more doses of nivolumab, however in Cox analysis we did not find patients with irAE to experience progression later than patients without them. CONCLUSIONS Nivolumab therapy is associated with an increased risk of endocrine adverse effects, particularly thyroid dysfunction. Endocrine adverse effects can be successfully treated pharmacologically and usually do not require discontinuation of immunotherapy. The relationship between a better cancer prognosis in patients who developed endocrine irAE has not been found.
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Affiliation(s)
- Izabela Chmielewska
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
- * E-mail:
| | - Marta Dudzińska
- Chair of Internal Medicine and Department of Internal Medicine in Nursing, Medical University of Lublin, Lublin, Poland
| | - Michał Szczyrek
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Joanna Świrska
- Chair of Internal Medicine and Department of Internal Medicine in Nursing, Medical University of Lublin, Lublin, Poland
| | - Kamila Wojas-Krawczyk
- Department of Pneumology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Zwolak
- Chair of Internal Medicine and Department of Internal Medicine in Nursing, Medical University of Lublin, Lublin, Poland
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Huang B, Chen Q, Allison D, El Khouli R, Peh KH, Mobley J, Anderson A, Durbin EB, Goodin D, Villano JL, Miller RW, Arnold SM, Kolesar JM. Molecular Tumor Board Review and Improved Overall Survival in Non-Small-Cell Lung Cancer. JCO Precis Oncol 2021; 5:PO.21.00210. [PMID: 34622117 PMCID: PMC8492377 DOI: 10.1200/po.21.00210] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
With the introduction of precision medicine, treatment options for non-small-cell lung cancer have improved dramatically; however, underutilization, especially in disadvantaged patients, like those living in rural Appalachian regions, is associated with poorer survival. Molecular tumor boards (MTBs) represent a strategy to increase precision medicine use. UK HealthCare at the University of Kentucky (UK) implemented a statewide MTB in January 2017. We wanted to test the impact of UK MTB review on overall survival in Appalachian and other regions in Kentucky. METHODS We performed a case-control study of Kentucky patients newly diagnosed with non-small-cell lung cancer between 2017 and 2019. Cases were reviewed by the UK MTB and were compared with controls without UK MTB review. Controls were identified from the Kentucky Cancer Registry and propensity-matched to cases. The primary end point was the association between MTB review and overall patient survival. RESULTS Overall, 956 patients were included, with 343 (39%) residing in an Appalachian region. Seventy-seven (8.1%) were reviewed by the MTB and classified as cases. Cox regression analysis showed that poorer survival outcome was associated with lack of MTB review (hazard ratio [HR] = 8.61; 95% CI, 3.83 to 19.31; P < .0001) and living in an Appalachian region (hazard ratio = 1.43; 95% CI, 1.17 to 1.75; P = .004). Among individuals with MTB review, survival outcomes were similar regardless of whether they lived in Appalachia or other parts of Kentucky. CONCLUSION MTB review is an independent positive predictor of overall survival regardless of residence location. MTBs may help overcome some health disparities for disadvantaged populations.
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Affiliation(s)
- Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Division of Cancer Biostatistics, University of Kentucky, Lexington, KY
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Division of Cancer Biostatistics, University of Kentucky, Lexington, KY
| | - Derek Allison
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Radiology, University of Kentucky, Lexington, KY
| | - Riham El Khouli
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY
| | - Keng Hee Peh
- Department of Pharmacy, University of Kentucky, Lexington, KY
| | - James Mobley
- Department of Internal Medicine, University of Kentucky, Lexington, KY
| | | | - Eric B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Internal Medicine, University of Kentucky, Lexington, KY
| | | | - John L Villano
- Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Rachel W Miller
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY
| | - Susanne M Arnold
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Jill M Kolesar
- Markey Cancer Center, University of Kentucky, Lexington, KY
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY
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Huang Y, Soon YY, Aminkeng F, Tay SH, Ang Y, Kee ACL, Goh BC, Wong ASC, Soo RA. Risk factors for immune-related adverse events from anti-PD-1 or anti-PD-L1 treatment in an Asian cohort of nonsmall cell lung cancer patients. Int J Cancer 2021; 150:636-644. [PMID: 34562273 DOI: 10.1002/ijc.33822] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/27/2021] [Accepted: 09/16/2021] [Indexed: 12/17/2022]
Abstract
Immune-related adverse events (IrAEs) of immune checkpoint inhibitors (ICIs) can be serious and unpredictable. We examine the incidence rate and risk factors for IrAEs in an Asian cohort of nonsmall cell lung cancer (NSCLC) patients treated with immunotherapy. Between June 2014 and August 2020, we retrospectively analysed IrAEs in NSCLC patients treated with anti-PD-1 or anti-PD-L1 inhibitors at the National University Cancer Institute, Singapore. A Poisson regression model was used to estimate the effect of risk factors on incidence rate of any grade IrAEs. One hundred and forty-one patients were enrolled. Median age was 63. Majority were male (67%) with Eastern Cooperative Oncology Group (ECOG) PS 0-1 (77%). More than half (56%) received pembrolizumab. Eleven percent harboured epidermal growth factor receptor (EGFR) mutation. Eighteen percent received concomitant chemotherapy. Median number of cycles was 4, and median duration of treatment was 2.1 months. IrAEs were seen in 71 (50.4%) patients, with an incidence rate of 99 events per 1000 person-months. Fatigue (25%), rash (10.5%) and pneumonitis (7.9%) were the most common IrAEs. Twenty out of 152 IrAEs (13.2%) were Grade 3 or higher in severity: most common being pneumonitis (5.3%), fatigue (3.3%) and transaminitis (1.3%). Multivariable analysis demonstrated that concomitant chemotherapy use, higher BMI and presence of EGFR mutation are significant predictors for IrAEs (P < .0001; P = .016; P = .007). Our findings can help guide risk stratification and monitoring of IrAEs among NSCLC patients on immunotherapy.
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Affiliation(s)
- Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore
| | - Folefac Aminkeng
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sen Hee Tay
- Department of Medicine, Rheumatology Division, National University Hospital, Singapore
| | - Yvonne Ang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Adrian C L Kee
- Department of Medicine, Respiratory Division, National University Hospital, Singapore
| | - Boon Cher Goh
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Alvin S C Wong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Ross A Soo
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
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Kawaguchi Y, Hanaoka J, Ohshio Y, Okamoto K, Kaku R, Hayashi K, Shiratori T, Akazawa A. Sarcopenia increases the risk of post-operative recurrence in patients with non-small cell lung cancer. PLoS One 2021; 16:e0257594. [PMID: 34551011 PMCID: PMC8457491 DOI: 10.1371/journal.pone.0257594] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/06/2021] [Indexed: 12/25/2022] Open
Abstract
Background Sarcopenia is among the most prevalent and serious cancer-related symptom, and is strongly correlated with a poor prognosis. Moreover, it reportedly predicts poor prognosis after surgery in patients with lung cancer. However, it is unclear whether sarcopenia directly affects post-operative recurrence. The purpose of this study was to evaluate whether sarcopenia can be a risk indicator for post-operative recurrence, and whether it suppresses anti-tumor immunity, in a cohort of patients with resected non-small cell lung cancer. Methods This study retrospectively reviewed the data of 256 consecutive patients who underwent curative lobectomy and lymph node dissection for non-small cell lung cancer at our institution. The psoas muscle mass index was calculated as the total psoas muscle area at the third lumbar vertebral level/height2 (cm2/m2). Sarcopenia was defined by a psoas muscle mass index of under 5.03 cm2/m2 and 3.17 cm2/m2 in male and female patients, respectively. Post-operative prognosis and cumulative incidence of recurrence rates were calculated. Results The 5-year overall survival and disease-free survival rates post-surgery were 59.5% and 38.6%, respectively, in patients with sarcopenia versus 81.1% and 72.1%, respectively, in patients without sarcopenia (p < 0.001). The 5-year cumulative incidence of recurrence rate in patients with sarcopenia was significantly higher than those without sarcopenia (49.9% versus 22.4%, respectively) in every pathological stage. Pathological stages II and III (hazard ratio, 3.36; p = 0.004), histological type (hazard ratio, 2.31; p = 0.025), and sarcopenia (hazard ratio, 2.52; p = 0.001) were independent risk factors for post-operative recurrence according to multivariate analysis. Conclusion Sarcopenia is a risk indicator for post-operative recurrence in patients with non-small cell lung cancer.
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Affiliation(s)
- Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
- * E-mail:
| | - Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Ryosuke Kaku
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takuya Shiratori
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Akira Akazawa
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Di Federico A, De Giglio A, Parisi C, Gelsomino F. STK11/LKB1 and KEAP1 mutations in non-small cell lung cancer: Prognostic rather than predictive? Eur J Cancer 2021; 157:108-113. [PMID: 34500370 DOI: 10.1016/j.ejca.2021.08.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 05/19/2021] [Revised: 08/03/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022]
Abstract
Immune checkpoint inhibitors (ICIs), either alone or combined with chemotherapy, represent the cornerstone of the treatment of advanced non-small cell lung cancer (NSCLC) without targetable gene alterations. Programmed death ligand-1 expression currently represents the only available biomarker to predict response to ICI, although its reliability is debated. However, most patients still do not derive benefit from immunotherapy, making the identification of further predictive biomarkers extremely needed. Serine/threonine kinase 11 (STK11)/liver kinase B1 (LKB1) and Kelch-like ECH-associated protein 1 (KEAP1) mutations occur in 25-30% and 11-27% of advanced NSCLC, respectively. Several studies associated their presence with poor outcomes in patients treated with ICI. However, more recent evidence showed poor outcomes among NSCLC with STK11/LKB1 and/or KEAP1 mutations regardless of the treatment received. We reviewed the literature to provide a comprehensive, timely and structured overview of the role of STK11/LKB1 and KEAP1 mutations in NSCLC. Although conflicting outcomes have been reported by studies evaluating their impact in KRAS wild-type patients or regardless of KRAS mutation, the correlation between STK11/LKB1 and KEAP1 mutations and poor outcomes with ICI appears to be consistent in presence of concurrent KRAS mutations. The main limitations of most studies are represented by the inclusion of other gene mutations (e.g. TP53) together with STK11 and KEAP1 mutations as a group and by the lack of comparison arms including patients who received other treatments (e.g. chemotherapy). Studies evaluating the impact of STK11 and KEAP1 mutations on the outcomes with ICI and other therapies showed a similar effect regardless of the treatment received, suggesting a prognostic, rather than predictive, value.
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Affiliation(s)
- Alessandro Di Federico
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy.
| | - Andrea De Giglio
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy.
| | - Claudia Parisi
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy.
| | - Francesco Gelsomino
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, 9, 40138 Bologna, Italy.
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Kinoshita F, Tagawa T, Yamashita T, Takenaka T, Matsubara T, Toyokawa G, Takada K, Oba T, Osoegawa A, Yamazaki K, Takenoyama M, Shimokawa M, Nakashima N, Mori M. Prognostic value of postoperative decrease in serum albumin on surgically resected early-stage non-small cell lung carcinoma: A multicenter retrospective study. PLoS One 2021; 16:e0256894. [PMID: 34473762 PMCID: PMC8412276 DOI: 10.1371/journal.pone.0256894] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/18/2021] [Indexed: 01/27/2023] Open
Abstract
Background Preoperative nutritional status is an important host-related prognostic factor for non-small cell lung carcinoma (NSCLC); however, the significance of postoperative changes in nutritional status remains unclear. This study aimed to elucidate the significance of postoperative decreases in serum albumin (ΔAlb) on the outcomes of early-stage NSCLC. Methods We analyzed 443 training cohort (TC) and 642 validation cohort (VC) patients with pStage IA NSCLC who underwent surgery and did not recur within 1 year. We measured preoperative serum albumin levels (preAlb) and postoperative levels 1 year after surgery (postAlb), and calculated ΔAlb as (preAlb − postAlb)/preAlb × 100%. A cutoff value of 11% for ΔAlb was defined on the basis of the receiver operating characteristic curve for the TC. Results Patients were divided into ΔAlb-Decreased and ΔAlb-Stable groups, including 100 (22.6%) and 343 (77.4%) in the TC, and 58 (9.0%) and 584 (90.1%) in the VC. ΔAlb-Decreased was associated with male sex (p = 0.0490), smoking (p = 0.0156), and non-adenocarcinoma (p<0.0001) in the TC, and pT1b (p = 0.0169) and non-adenocarcinoma (p = 0.0251) in the VC. Multivariable analysis identified ΔAlb as an independent prognostic factor for disease-free survival (DFS) and overall survival (OS) in both cohorts (VC: DFS, HR = 1.9, 95%CI: 1.10–3.15, p = 0.0197; OS, HR = 2.0, 95%CI: 1.13–3.45, p = 0.0173). Moreover, subgroup analysis demonstrated that the prognostic value of ΔAlb was consistent for age, sex, smoking history, surgical procedure, and histological type. Conclusion We demonstrated a negative impact of postoperative decrease of the serum albumin on the prognosis of patients with early-stage NSCLC. Postoperative changes in nutritional status might be important in NSCLC outcomes.
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Affiliation(s)
- Fumihiko Kinoshita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuzo Tagawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- * E-mail:
| | | | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taichi Matsubara
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Gouji Toyokawa
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Kazuki Takada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taro Oba
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Osoegawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Mitsuhiro Takenoyama
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Yu C, Li B, Wang J, Zhang Z, Li S, Lei S, Wang Q. miR-145-5p Modulates Gefitinib Resistance by Targeting NRAS and MEST in Non-Small Cell Lung Cancer. Ann Clin Lab Sci 2021; 51:625-637. [PMID: 34686504] [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] [Indexed: 06/13/2023]
Abstract
OBJECTIVE microRNAs may play essential roles in the development and drug resistance of non-small cell lung cancer (NSCLC). However, their functions and mechanisms are not fully understood. Our goal was to define the role of miR-145-5p in the gefitinib resistance of NSCLC. MATERIALS AND METHODS An A549 gefitinib-resistant cell line and xenograft nude mice were used in this study. The expression of miR-145-5p and its targets, NRAS and MEST, were detected and measured by qPCR, Western blot, RNA-FISH, or immunofluorescence analysis. RESULTS miR-145-5p was downregulated in gefitinib-resistant A549 cells (A549/Gef R). Overexpression of miR-145-5p enhanced the sensitivity to gefitinib and inhibited cell proliferation and invasion in A549/Gef R. miR-145-5p was also significantly reduced in LUAD and LUSC clinical samples and closely associated with a favorable prognosis, according to the UALCAN and TCGA databases. Moreover, NRAS and MEST were found to be downstream target genes of miR-145-5p and to function as oncogenes in NSCLC samples, and gefitinib resistance could be improved following the interference of these two molecules. CONCLUSION miR-145-5p improves the sensitivity of acquired gefitinib-resistant cells to gefitinib via inhibiting NRAS and MEST expression. The miR 145-5p-NRAS/MEST axis in NSCLC provides insights for the development of a NRAS/MEST targeting therapeutic approach to overcome gefitinib resistance in NSCLC patients.
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MESH Headings
- Adenocarcinoma of Lung/genetics
- Adenocarcinoma of Lung/mortality
- Animals
- Antineoplastic Agents/pharmacology
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/mortality
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Cell Proliferation/genetics
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- GTP Phosphohydrolases/genetics
- Gefitinib/pharmacology
- Gene Expression Regulation, Neoplastic/drug effects
- Humans
- Lung Neoplasms/drug therapy
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Membrane Proteins/genetics
- Mice, Nude
- MicroRNAs/genetics
- Prognosis
- Proteins/genetics
- Xenograft Model Antitumor Assays
- Mice
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Affiliation(s)
- Chuigong Yu
- Department of Urology, The Third Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bingqing Li
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jinghao Wang
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ziyue Zhang
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shengjing Li
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shixiong Lei
- Department of General Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qinhao Wang
- State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, The Fourth Military Medical University, Xi'an, Shaanxi, China
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Morgan E, Arnold M, Rutherford MJ, Bardot A, Ferlay J, De P, Engholm G, Jackson C, Little A, Saint-Jacques N, Walsh P, Woods RR, O'Connell DL, Bray F, Parkin DM, Soerjomataram I. The impact of reclassifying cancers of unspecified histology on international differences in survival for small cell and non-small cell lung cancer (ICBP SurvMark-2 project). Int J Cancer 2021; 149:1013-1020. [PMID: 33932300 DOI: 10.1002/ijc.33620] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/07/2022]
Abstract
Survival from lung cancer remains low, yet is the most common cancer diagnosed worldwide. With survival contrasting between the main histological groupings, small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), it is important to assess the extent that geographical differences could be from varying proportions of cancers with unspecified histology across countries. Lung cancer cases diagnosed 2010-2014, followed until 31 December 2015 were provided by cancer registries from seven countries for the ICBP SURVMARK-2 project. Multiple imputation was used to reassign cases with unspecified histology into SCLC, NSCLC and other. One-year and three-year age-standardised net survival were estimated by histology, sex, age group and country. In all, 404 617 lung cancer cases were included, of which 47 533 (11.7%) and 262 040 (64.8%) were SCLC and NSCLC. The proportion of unspecified cases varied, from 11.2% (Denmark) to 29.0% (The United Kingdom). After imputation with unspecified histology, survival variations remained: 1-year SCLC survival ranged from 28.0% (New Zealand) to 35.6% (Australia) NSCLC survival from 39.4% (The United Kingdom) to 49.5% (Australia). The largest survival change after imputation was for 1-year NSCLC (4.9 percentage point decrease). Similar variations were observed for 3-year survival. The oldest age group had lowest survival and largest decline after imputation. International variations in SCLC and NSCLC survival are only partially attributable to differences in the distribution of unspecified histology. While it is important that registries and clinicians aim to improve completeness in classifying cancers, it is likely that other factors play a larger role, including underlying risk factors, stage, comorbidity and care management which warrants investigation.
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Affiliation(s)
- Eileen Morgan
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Melina Arnold
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mark J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Aude Bardot
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Prithwish De
- Analytics and Informatics, Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Alana Little
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Nathalie Saint-Jacques
- Nova Scotia Health Authority Cancer Care Program, Registry & Analytics, Halifax, Nova Scotia, Canada
| | - Paul Walsh
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | | | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - D Max Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Sheikh M, Mukeriya A, Shangina O, Brennan P, Zaridze D. Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality : A Prospective Cohort Study. Ann Intern Med 2021; 174:1232-1239. [PMID: 34310171 DOI: 10.7326/m21-0252] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death worldwide, and about one half of patients with lung cancer are active smokers at diagnosis. OBJECTIVE To determine whether quitting smoking after diagnosis of lung cancer affects the risk for disease progression and mortality. DESIGN Prospective study of patients with non-small cell lung cancer (NSCLC) who were recruited between 2007 and 2016 and followed annually through 2020. SETTING N.N. Blokhin National Medical Research Center of Oncology and City Clinical Oncological Hospital No. 1, Moscow, Russia. PATIENTS 517 current smokers who were diagnosed with early-stage (IA-IIIA) NSCLC. MEASUREMENTS Probabilities of overall survival, progression-free survival, and lung cancer-specific mortality and hazard ratios (HRs) for all-cause and cancer-specific mortality. RESULTS During an average of 7 years of follow-up, 327 (63.2%) deaths, 273 (52.8%) cancer-specific deaths, and 172 (33.7%) cases of tumor progression (local recurrence or metastasis) were recorded. The adjusted median overall survival time was 21.6 months higher among patients who had quit smoking than those who continued smoking (6.6 vs. 4.8 years, respectively; P = 0.001). Higher 5-year overall survival (60.6% vs. 48.6%; P = 0.001) and progression-free survival (54.4% vs. 43.8%; P = 0.004) were observed among patients who quit than those who continued smoking. After adjustments, smoking cessation remained associated with decreased risk for all-cause mortality (HR, 0.67 [95% CI, 0.53 to 0.85]), cancer-specific mortality (HR, 0.75 [CI, 0.58 to 0.98]), and disease progression (HR, 0.70 [CI, 0.56 to 0.89]). Similar effects were observed among mild to moderate and heavy smokers and patients with earlier and later cancer stages. LIMITATION Exposure measurements were based on self-reported questionnaires. CONCLUSION Smoking cessation after diagnosis materially improved overall and progression-free survival among current smokers with early-stage lung cancer. PRIMARY FUNDING SOURCE International Agency for Research on Cancer.
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Affiliation(s)
- Mahdi Sheikh
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France (M.S., P.B.)
| | - Anush Mukeriya
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia (A.M., O.S., D.Z.)
| | - Oxana Shangina
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia (A.M., O.S., D.Z.)
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France (M.S., P.B.)
| | - David Zaridze
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia (A.M., O.S., D.Z.)
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Roosan MR, Mambetsariev I, Pharaon R, Fricke J, Husain H, Reckamp KL, Koczywas M, Massarelli E, Bild AH, Salgia R. Usefulness of Circulating Tumor DNA in Identifying Somatic Mutations and Tracking Tumor Evolution in Patients With Non-small Cell Lung Cancer. Chest 2021; 160:1095-1107. [PMID: 33878340 PMCID: PMC8449001 DOI: 10.1016/j.chest.2021.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/18/2020] [Revised: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The usefulness of circulating tumor DNA (ctDNA) in detecting mutations and monitoring treatment response has not been well studied beyond a few actionable biomarkers in non-small cell lung cancer (NSCLC). RESEARCH QUESTION How does the usefulness of ctDNA analysis compare with that of solid tumor biopsy analysis in patients with NSCLC? METHODS We retrospectively evaluated 370 adult patients with NSCLC treated at the City of Hope between November 2015 and August 2019 to assess the usefulness of ctDNA in mutation identification, survival, concordance with matched tissue samples in 32 genes, and tumor evolution. RESULTS A total of 1,688 somatic mutations were detected in 473 ctDNA samples from 370 patients with NSCLC. Of the 473 samples, 177 showed at least one actionable mutation with currently available Food and Drug Administration-approved NSCLC therapies. MET and CDK6 amplifications co-occurred with BRAF amplifications (false discovery rate [FDR], < 0.01), and gene-level mutations were mutually exclusive in KRAS and EGFR (FDR, 0.0009). Low cumulative percent ctDNA levels were associated with longer progression-free survival (hazard ratio [HR], 0.56; 95% CI, 0.37-0.85; P = .006). Overall survival was shorter in patients harboring BRAF mutations (HR, 2.35; 95% CI, 1.24-4.6; P = .009), PIK3CA mutations (HR, 2.77; 95% CI, 1.56-4.9; P < .001) and KRAS mutations (HR, 2.32; 95% CI, 1.30-4.1; P = .004). Gene-level concordance was 93.8%, whereas the positive concordance rate was 41.6%. More mutations in targetable genes were found in ctDNA than in tissue biopsy samples. Treatment response and tumor evolution over time were detected in repeated ctDNA samples. INTERPRETATION Although ctDNA analysis exhibited similar usefulness to tissue biopsy analysis, more mutations in targetable genes were missed in tissue biopsy analyses. Therefore, the evaluation of ctDNA in conjunction with tissue biopsy samples may help to detect additional targetable mutations to improve clinical outcomes in advanced NSCLC.
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Affiliation(s)
| | | | | | - Jeremy Fricke
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Hatim Husain
- UC San Diego Health Moores Cancer Center, La Jolla, CA
| | - Karen L Reckamp
- City of Hope Comprehensive Cancer Center, Duarte, CA; Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Andrea H Bild
- Division of Molecular Pharmacology, Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Ravi Salgia
- City of Hope Comprehensive Cancer Center, Duarte, CA.
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He J, Su C, Liang W, Xu S, Wu L, Fu X, Zhang X, Ge D, Chen Q, Mao W, Xu L, Chen C, Hu B, Shao G, Hu J, Zhao J, Liu X, Liu Z, Wang Z, Xiao Z, Gong T, Lin W, Li X, Ye F, Liu Y, Ma H, Huang Y, Zhou J, Wang Z, Fu J, Ding L, Mao L, Zhou C. Icotinib versus chemotherapy as adjuvant treatment for stage II-IIIA EGFR-mutant non-small-cell lung cancer (EVIDENCE): a randomised, open-label, phase 3 trial. Lancet Respir Med 2021; 9:1021-1029. [PMID: 34280355 DOI: 10.1016/s2213-2600(21)00134-x] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Icotinib has provided survival benefits for patients with advanced, epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC). We aimed to compare icotinib with chemotherapy in patients with EGFR-mutant stage II-IIIA NSCLC after complete tumour resection. Here, we report the results from the preplanned interim analysis of the study. METHODS In this multicentre, randomised, open-label, phase 3 trial done at 29 hospitals in China, eligible patients were aged 18-70 years, had histopathogically confirmed stage II-IIIA NSCLC, had complete resection up to 8 weeks before random assignment, were treatment-naive, and had confirmed activation mutation in exon 19 or exon 21 of the EGFR gene. Participants were randomly assigned (1:1) with an interactive web-based response system to receive either oral icotinib 125 mg thrice daily for 2 years or four 21-day cycles of intravenous chemotherapy (vinorelbine 25 mg/m2 on days 1 and 8 of each cycle plus cisplatin 75 mg/m2 on day 1 of each cycle for adenocarcinoma or squamous carcinoma; or pemetrexed 500 mg/m2 plus cisplatin 75 mg/m2 on day 1 every 3 weeks for non-squamous carcinoma). The primary endpoint was disease-free survival assessed in the full analysis set. Secondary endpoints were overall survival assessed in the full analysis set and safety assessed in all participants who received study drug. This trial is registered with ClinicalTrials.gov, NCT02448797. FINDINGS Between June 8, 2015, and August 2, 2019, 322 patients were randomly assigned to icotinib (n=161) or chemotherapy (n=161); the full analysis set included 151 patients in the icotinib group and 132 in the chemotherapy group. Median follow-up in the full analysis set was 24·9 months (IQR 16·6-36·4). 40 (26%) of 151 patients in the icotinib group and 58 (44%) of 132 patients in the chemotherapy group had disease relapse or death. Median disease-free survival was 47·0 months (95% CI 36·4-not reached) in the icotinib group and 22·1 months (16·8-30·4) in the chemotherapy group (stratified hazard ratio [HR] 0·36 [95% CI 0·24-0·55]; p<0·0001). 3-year disease-free survival was 63·9% (95% CI 51·8-73·7) in the icotinib group and 32·5% (21·3-44·2) in the chemotherapy group. Overall survival data are immature with 14 (9%) deaths in the icotinib group and 14 (11%) deaths in the chemotherapy. The HR for overall survival was 0·91 (95% CI 0·42-1·94) in the full analysis set. Treatment-related serious adverse events occurred in two (1%) of 156 patients in the icotinib group and 19 (14%) of 139 patients in the chemotherapy group. No interstitial pneumonia or treatment-related death was observed in either group. INTERPRETATION Our results suggest that compared with chemotherapy, icotinib significantly improves disease-free survival and has a better tolerability profile in patients with EGFR-mutant stage II-IIIA NSCLC after complete tumour resection. FUNDING Betta Pharmaceuticals TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shidong Xu
- Department of Thoracic Surgery and Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Xiangning Fu
- Thoracic Surgery Department, Tongji Hospital, Tongji Medical College of HUST, Wuhan, China
| | - Xiaodong Zhang
- Medical Oncology, Nantong Tumor Hospital, Nantong, China
| | - Di Ge
- Thoracic Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Chen
- Oncology Department, Fuzhou Pulmonary Hospital of Fujian, Fuzhou, China
| | - Weimin Mao
- Thoracic Surgery Department, Zhejiang Cancer Hospital, Hangzhou, China
| | - Lin Xu
- Thoracic Surgery Department, Jiangsu Cancer Hospital, Nanjing, China
| | - Chun Chen
- Thoracic Surgery Department, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bing Hu
- Tumor- chemotherapy Department, Anhui Provincial Hospital, Hefei, China
| | - Guoguang Shao
- Thoracic Surgery Department, The First Hospital of Jilin University, Changchun, China
| | - Jian Hu
- Thoracic Surgery Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Zhao
- Thoracic Surgery Department, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Pulmonary Oncology, The 5th Medical Center of PLA General Hospital, Beijing, China
| | - Zhidong Liu
- Thoracic Surgery Department II, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Zheng Wang
- Thoracic Surgery Department, Shenzhen People's Hospital, Shenzhen, China
| | - Zemin Xiao
- Oncology Department, The First People's Hospital of Changde City, Changde, China
| | - Taiqian Gong
- Thoracic Surgery Department, The 6th Medical Center of PLA General Hospital, Beijing, China
| | - Wen Lin
- Medical Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Xingya Li
- Oncology Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Ye
- Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yang Liu
- Thoracic Surgery Department, Chinese PLA General Hospital, Beijing, China
| | - Haitao Ma
- Thoracic Surgery Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yunchao Huang
- Thoracic Surgery Department I, Yunnan Cancer Hospital, Kunming, China
| | - Jianying Zhou
- Respiratory Medicine Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhonglin Wang
- Cardio-Thoracic Surgery, The First People's Hospital of Changzhou, Changzhou, China
| | - Junke Fu
- Thoracic Surgery Department, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | | | - Li Mao
- Betta Pharmaceuticals, Hangzhou, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital and Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China.
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Li Z, Zhuo Y, Li J, Zhang M, Wang R, Lin L. Long Non-Coding RNA SNHG4 Is a Potential Diagnostic and Prognostic Indicator in Non-Small Cell Lung Cancer. Ann Clin Lab Sci 2021; 51:654-662. [PMID: 34686507] [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] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The mortality rate of non-small cell lung cancer ranks first worldwide. The lack of effective and accurate diagnosis contributes to the unfavorable prognosis of non-small cell lung cancer patients since most of them are diagnosed at an advanced stage. In the present study, we aimed to investigate whether LncRNA SNHG4 was implicated in predicting non-small cell lung cancer diagnosis and outcomes. METHODS We collected 68 unpaired serums and tissues from patients with non-small cell lung cancer and from healthy volunteers. Quantitative real-time polymerase chain reaction (qRT-PCR) assays were conducted accordingly. Furthermore, we uncovered the correlation of their expressions with clinicopathological features and the diagnostic values. The five-year survival rate and disease-free rate were analyzed using Kaplan-Meier methods. Finally, in vitro experiments were performed to explore the role and mechanisms of LncRNA SNHG4 in non-small cell lung cancer. RESULTS LncRNA SNHG4 level was significantly more elevated in non-small cell lung cancer serum samples and tissues than in healthy controls (P<0.01). A receiver operating characteristic (ROC) assay demonstrated that the areas under the curve (AUC) were 0.9087 (95% CI, 0.8529 to 0.9646; specificity=98.53%, sensitivity=80.88%, cutoff=1.7941) and 0.9457 (95% CI, 0.8994 to 0.9920; specificity=100.00%, sensitivity=82.80%, cutoff=1.828), separately. Notably, a higher expression of LncRNA SNHG4 was positively correlated with the clinical stage, lymph node metastasis, and smoking. Meanwhile, patients with higher expressions of LncRNA SNHG4 had significantly lower overall survival rates and disease-free rates. In the in vitro experiments, we found that LncRNA SNHG4 was strongly elevated in the non-small cell lines compared with the human normal lung epithelial cell line BEAS-2B. After transfection with the SNHG4 silencing plasmid, A549 cell viability was significantly inhibited, while apoptosis was promoted. CONCLUSION LncRNA SNHG4 might have diagnostic and prognostic significance in non-small cell lung cancer. However, it is imperative to conduct further experiments on the aspect of the biological mechanisms of LncRNA SNHG4 in the occurrence and development of non-small cell lung cancer.
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Affiliation(s)
- Zhong Li
- Department of Thoracic Surgery, Mindong Hospital Affiliated with Fujian Medical University, Fuan, China
| | - Yimeng Zhuo
- Department of Thoracic Surgery, Mindong Hospital Affiliated with Fujian Medical University, Fuan, China
| | - Jieshi Li
- Department of Thoracic Surgery, Mindong Hospital Affiliated with Fujian Medical University, Fuan, China
| | - Minhui Zhang
- Department of Thoracic Surgery, Mindong Hospital Affiliated with Fujian Medical University, Fuan, China
| | - Ruihua Wang
- Department of Thoracic Surgery, Mindong Hospital Affiliated with Fujian Medical University, Fuan, China
| | - Lijing Lin
- Department of Pain Management, Mindong Hospital Affiliated with Fujian Medical University, Fuan, China
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