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Oosting SF, van der Veldt AAM, Fehrmann RSN, Bhattacharya A, van Binnendijk RS, GeurtsvanKessel CH, Dingemans AMC, Smit EF, Hiltermann TJN, den Hartog G, Jalving M, Westphal TT, de Wilt F, Ernst SM, Boerma A, van Zijl L, Rimmelzwaan GF, Kvistborg P, van Els CACM, Rots NY, van Baarle D, Haanen JBAG, de Vries EGE. Factors associated with long-term antibody response after COVID-19 vaccination in patients treated with systemic treatment for solid tumors. ESMO Open 2023; 8:101599. [PMID: 37450950 PMCID: PMC10284446 DOI: 10.1016/j.esmoop.2023.101599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- S F Oosting
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - A A M van der Veldt
- Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - R S N Fehrmann
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - A Bhattacharya
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - R S van Binnendijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - C H GeurtsvanKessel
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A-M C Dingemans
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - E F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - T J N Hiltermann
- Department of Pulmonary Diseases, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - G den Hartog
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - M Jalving
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - T T Westphal
- The Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - F de Wilt
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - S M Ernst
- Department of Respiratory Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A Boerma
- Department of Medical Microbiology and Infection Prevention University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - L van Zijl
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - G F Rimmelzwaan
- Research Centre for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - P Kvistborg
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C A C M van Els
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - N Y Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - D van Baarle
- Department of Medical Microbiology and Infection Prevention University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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2
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Remon J, Besse B, Aix SP, Callejo A, Al-Rabi K, Bernabe R, Greillier L, Majem M, Reguart N, Monnet I, Cousin S, Garrido P, Robinet G, Campelo RG, Madroszyk A, Mazières J, Curcio H, Wasąg B, Pretzenbacher Y, Fournier B, Dingemans AMC, Dziadziuszko R. Osimertinib treatment based on plasma T790M monitoring in patients with EGFR-mutant non-small cell lung cancer (NSCLC): EORTC Lung Cancer Group 1613 APPLE phase II randomized clinical trial. Ann Oncol 2023; 34:468-476. [PMID: 36863484 DOI: 10.1016/j.annonc.2023.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The APPLE trial aimed to evaluate the feasibility of longitudinal plasma EGFR T790M monitoring for the best sequencing strategy of gefitinib and osimertinib. METHODS APPLE is a randomized, non-comparative, phase II study in patients with common EGFR-mutant, treatment-naïve NSCLC including 3-arms: Arm A (osimertinib upfront until RECIST progression, PD), Arm B (gefitinib until emergence of circulating tumor DNA EGFR T790M mutation by cobas EGFR Test v2 or RECIST PD) and Arm C (gefitinib until RECIST PD), and then switch to osimertinib in both arms. The primary endpoint is the progression-free survival rate "on osimertinib" at 18 months (PFSR-OSI-18) after randomization in Arm B (H0: PFSR-OSI-18 of ≤40%). Secondary endpoints include response rate, overall survival (OS) and brain PFS (BPFS). We report the results of Arms B and C. RESULTS From November 2017 to February 2020, 52 and 51 patients were randomized into Arms B and C. Most patients were females (70%) and had EGFR Del19 (65%); one-third had baseline brain metastases. In Arm B, 17% of patients (8/47) switched to osimertinib based on the emergence of ct-DNA T790M mutation before RECIST PD, with a median time to molecular PD of 266 days. The study met its primary endpoint of PFSR-OSI-18 by 67.2% (84% CI: 56.4-75.9%) in Arm B vs. 53.5% (84% CI 42.3-63.5%) in Arm C, with a median PFS of 22.0 months vs. 20.2 months, respectively. The median OS was not reached in Arm B vs. 42.8 months in Arm C. Median BPFS in Arms B and C were 24.4 months and 21.4 months, respectively. CONCLUSIONS The serial monitoring of ct-DNA T790M-status in advanced EGFR-mutant NSCLC during treatment with first-generation EGFR inhibitors was feasible, and a molecular progression before RECIST PD led to an earlier switch to osimertinib in 17% of patients with satisfactory PFS and OS outcomes.
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Affiliation(s)
- J Remon
- Paris-Saclay University, Institut Gustave Roussy, Villejuif, France
| | - B Besse
- Paris-Saclay University, Institut Gustave Roussy, Villejuif, France
| | - S Ponce Aix
- Hospital Universitario 12 De Octubre, Madrid, Spain
| | - A Callejo
- Hospital Universitari Vall d'Hebron- Vall d'Hebron Institut Oncologia, Barcelona, Spain
| | - K Al-Rabi
- King Hussein Cancer Center, Amman, Jordan
| | - R Bernabe
- University Hospital Virgen del Rocio, Sevilla, Spain
| | - L Greillier
- Aix Marseille University, Assitance Publique-Hôpitaux de Marseille (APHM), Marseille, France
| | - M Majem
- Hospital De La Santa Creu I Sant Pau, Barcelona, Spain
| | - N Reguart
- Hospital Clinic Universitari de Barcelona, IDIBAPS, Barcelona, Spain
| | - I Monnet
- Centre Hospitalier Intercommunal De Creteil, Creteil, France
| | - S Cousin
- Institut Bergonie, Bordeaux, France
| | - P Garrido
- Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | - R Garcia Campelo
- University Hospital A Coruna-Hospital Teresa Herrera, A Coruna, Spain
| | | | - J Mazières
- CHU de Toulouse - Hopital Larrey, Toulouse, France
| | - H Curcio
- Centre François Baclesse, CHU Côte de Nacre, Caen, France
| | - B Wasąg
- Medical University of Gdansk, Gdansk, Poland
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3
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van der Veldt AAM, Oosting SF, Fehrmann RSN, GeurtsvanKessel CH, van Binnendijk RS, Dingemans AMC, Smit EF, Hiltermann TJN, Hartog GD, Jalving M, Westphal TT, Bhattacharya A, de Wilt F, Ernst SM, Boerma A, van Zijl L, Rimmelzwaan GF, Kvistborg P, van Els CACM, Rots NY, van Baarle D, Haanen JBAG, de Vries EGE. One-year data on immunogenicity and breakthrough infections in patients with solid tumors vaccinated against COVID-19 during systemic cancer treatment. ESMO Open 2023; 8:100785. [PMID: 36764094 PMCID: PMC9829609 DOI: 10.1016/j.esmoop.2023.100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Affiliation(s)
- A A M van der Veldt
- Department of Medical Oncology, Erasmus Medical Centre, Rotterdam, Netherlands; Radiology & Nuclear Medicine, Erasmus Medical Centre, Rotterdam, Netherlands.
| | - S F Oosting
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - R S N Fehrmann
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - R S van Binnendijk
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - A-M C Dingemans
- Department of Respiratory Medicine Erasmus Medical Centre, Rotterdam, Netherlands
| | - E F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - T J N Hiltermann
- Department of Pulmonary Diseases, University Medical Centre Groningen, Amsterdam, Netherlands
| | - G den Hartog
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - M Jalving
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - T T Westphal
- Comprehensive Cancer Organization the Netherlands, Utrecht, Netherlands
| | - A Bhattacharya
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - F de Wilt
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, Netherlands
| | - S M Ernst
- Department of Respiratory Medicine Erasmus Medical Centre, Rotterdam, Netherlands
| | - A Boerma
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - L van Zijl
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - G F Rimmelzwaan
- Research Centre for Emerging Infections and Zoonoses, University of Veterinary Medicine Hannover, Hannover, Germany
| | - P Kvistborg
- Department of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - C A C M van Els
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - N Y Rots
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - D van Baarle
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - J B A G Haanen
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - E G E de Vries
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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4
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Willemsen ACH, Degens JHRJ, Baijens LWJ, Dingemans AMC, Hoeben A, Hoebers FJP, De Ruysscher DKM, Schols AMWJ. Early Loss of Fat Mass During Chemoradiotherapy Predicts Overall Survival in Locally Advanced Squamous Cell Carcinoma of the Lung, but Not in Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Front Nutr 2020; 7:600612. [PMID: 33324671 PMCID: PMC7726186 DOI: 10.3389/fnut.2020.600612] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Cancer cachexia is highly prevalent in advanced non-small cell lung cancer (NSCLC) and locally advanced head and neck squamous cell carcinoma (LAHNSCC), and compromises treatment tolerance and overall survival (OS). NSCLC and LAHNSCC patients share similar risk factors, and receive comparable anti-cancer treatment regimens. The aim of this study was to determine the predictive value of body composition assessed by bioelectrical impedance analysis (BIA) and handgrip strength (HGS) (baseline and early changes during therapy) on OS in NSCLC and LAHNSCC patients treated with platinum-based chemoradiotherapy (CRT) or cetuximab-based bioradiotherapy (BRT). To elucidate potential underlying determinants of early changes in body composition and HGS, specific (fat and fat free) mass loss patterns of squamous NSCLC (sNSCLC) were compared to human papilloma virus negative (HPV–) LAHNSCC patients treated with CRT. Methods: Between 2013 and 2016, BIA and HGS were performed at baseline and after 3 weeks of CRT/BRT in LAHNSCC and NSCLC patients treated with curative intent. Results: Two hundred thirty-three patients were included for baseline measurements. Fat free mass index (FFMI) and HGS<10th percentile of reference values at baseline were both prognostic for poor OS in NSCLC and LAHNSCC [HR 1.64 [95%CI 1.13–2.39], p = 0.01 and HR 2.30 [95%CI 1.33–3.97], p = 0.003, respectively], independent of Charlson Comorbidity Index, cancer site, and gross tumor volume. Early fat mass (FM) loss during CRT was predictive for poor OS in sNSCLC (n = 64) [HR 3.80 [95%CI 1.79–8.06] p ≤ 0.001] but not in HPV– LAHNSCC (n = 61). In patients with significant weight loss (>2%) in the first 3 weeks of CRT (sNSCLC n = 24, HPV– LAHNSCC n = 23), the FM change was −1.4 ± 14.5% and −8.7 ± 9.0% in sNSCLC and HPV– LAHNSCC patients, respectively (p < 0.05). Fat fee mass change was −5.6 ± 6.3% and −4.0 ± 4.3% for sNSCLC and HPV– LAHNSCC, respectively (p = 0.31). Conclusion: FFMI and HGS<10th percentile at baseline are independent prognostic factors for poor OS in NSCLC and LAHNSCC patients treated with CRT/BRT. The specific composition of mass loss during first 3 weeks of CRT significantly differs between sNSCLC and HPV– LAHNSCC patients. Early FM loss was prognostic in sNSCLC only.
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Affiliation(s)
- A C H Willemsen
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - J H R J Degens
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
| | - L W J Baijens
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.,Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - A-M C Dingemans
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, Netherlands
| | - A Hoeben
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - F J P Hoebers
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.,Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center+, Maastricht, Netherlands
| | - D K M De Ruysscher
- GROW School of Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands.,Department of Radiation Oncology (MAASTRO), Maastricht University Medical Center+, Maastricht, Netherlands
| | - A M W J Schols
- Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands
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5
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Degens JHRJ, Dingemans AMC, Schols AMWJ, Willemsen ACH. Letter to the Editor. Lung Cancer 2020; 153:184. [PMID: 33309334 DOI: 10.1016/j.lungcan.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- J H R J Degens
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - A-M C Dingemans
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - A M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - A C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands; Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, The Netherlands.
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6
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Hermans BCM, Derks JL, Moonen L, Habraken CHJ, der Thüsen JV, Hillen LM, Speel EJM, Dingemans AMC. Pulmonary neuroendocrine neoplasms with well differentiated morphology and high proliferative activity: illustrated by a case series and review of the literature. Lung Cancer 2020; 150:152-158. [PMID: 33171403 DOI: 10.1016/j.lungcan.2020.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 09/07/2020] [Accepted: 10/16/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Pulmonary neuroendocrine neoplasms (NENs) are subdivided in carcinoids and neuroendocrine carcinomas (small cell lung carcinoma and large cell neuroendocrine carcinoma (LCNEC)), based on the presence of necrosis and mitotic index (MI). However, it is unclear if tumors with well differentiated morphology but high proliferation rate should be regarded as LCNEC or as high grade carcinoids. In previous case series, a longer overall survival then expected in LCNEC has been suggested. We describe 7 of those cases analyzed for pRb expression and overall survival. MATERIAL AND METHODS Cases with well differentiated morphology, but MI > 10/2mm2 and/or Ki-67 proliferation index >20% were selected based on pathology reports of consecutive NENs in our university medical center (Maastricht UMC+, 2007-2018) and confirmed by pathological review. Immunohistochemistry was performed to assess pRb expression. RESULTS Seven stage IV cases were included in this study. Median overall survival was 8 months (95% confidence interval 5-11 months). Cases with well differentiated morphology and preserved pRb expression (4/7) had a median overall survival of 45 months. CONCLUSION A subgroup of pulmonary NENs with well differentiated morphology but high proliferation rate likely exists. pRb staining might be helpful to predict prognosis, but clinical relevance remains to be studied.
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Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - L Moonen
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - C H J Habraken
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - J von der Thüsen
- Department of Pathology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - L M Hillen
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - E J M Speel
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; Department of Pulmonary Diseases, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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7
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Lefebvre C, Martin E, Hendriks LEL, Veillon R, Puisset F, Mezquita L, Ferrara R, Sabatier M, Filleron T, Dingemans AMC, Besse B, Raherisson C, Mazières J. Immune checkpoint inhibitors versus second line chemotherapy for patients with lung cancer refractory to first line chemotherapy. Respir Med Res 2020; 78:100788. [PMID: 32980653 DOI: 10.1016/j.resmer.2020.100788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/17/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Anti Programmed Death-ligand (PD1/PD-L1) directed immune-checkpoint-inhibitors (ICI) are widely used to treat patients with advanced non-small cell lung cancer (NSCLC) who progress after first line chemotherapy. The best strategy after early progression under first line has not been specifically studied. PATIENTS AND METHODS We conducted a multicenter, retrospective study including all consecutive NSCLC patients progressing within the first 3 months following introduction of first-line chemotherapy and being treated with second line ICI monotherapy or chemotherapy between March 2010 and November 2017. We analysed the clinicopathological data and outcome under second line chemotherapy vs. second line ICI: objective response rate (ORR), progression-free survival (PFS), overall survival (OS. RESULTS We identified 176 patients with refractory disease, 99 who received subsequent immunotherapy and 77 undergoing chemotherapy. The 2 populations were comparable regarding the main prognostic criteria, median age was 60, main histology was adenocarcimoma (68.2%). PFS was not significantly different between both treatments 1.9 [1.8-2.1] versus 1.6 month [1.4-2.0] (P=0.125). Compared to chemotherapy, ICI treated patients had a superior OS (P=0.03) (Median [95% CI] OS 4.6 [2.8-6.7] versus 4.2 months [3.4-5.9] and a non-significant improvement in ORR (17.2% versus 7.9%, respectively, P=0.072). Poor performance status (ECOG PS≥2) and a higher number of metastatic sites (≥3) were associated with poorer prognosis. KRAS-mutated patients did not seem to benefit more from ICI than chemotherapy. CONCLUSIONS ICI appears to be the preferred second-line treatment for patients who are refractory to first line chemotherapy.
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Affiliation(s)
- C Lefebvre
- Department of Pneumology, University Hospital of Bordeaux, 33604 Pessac, France
| | - E Martin
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - L E L Hendriks
- Department of Pulmonology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - R Veillon
- Department of Pneumology, University Hospital of Bordeaux, 33604 Pessac, France
| | - F Puisset
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius-Regaud, Toulouse, France
| | - L Mezquita
- Institut d'Oncologie Thoracique, Institut Gustave Roussy, Villejuif, France
| | - R Ferrara
- Institut d'Oncologie Thoracique, Institut Gustave Roussy, Villejuif, France
| | - M Sabatier
- Pharmacy department IUCT (Institut Universitaire du Cancer) Oncopole, Institut Claudius-Regaud, Toulouse, France
| | - T Filleron
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - A-M C Dingemans
- Department of Pulmonology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - B Besse
- Institut d'Oncologie Thoracique, Institut Gustave Roussy, Villejuif, France
| | - C Raherisson
- Department of Pneumology, University Hospital of Bordeaux, 33604 Pessac, France
| | - J Mazières
- Pulmonology Department, Toulouse University Hospital, Université Paul Sabatier, Toulouse, France.
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Hermans BCM, Sanduleanu S, Derks JL, Woodruff H, Hillen LM, Casale R, Hoesein FM, de Jong E, Berge DMHJT, Speel EJM, Lambin P, Gietema HA, Dingemans AMC. Exploring imaging features of molecular subtypes of large cell neuroendocrine carcinoma (LCNEC). Lung Cancer 2020; 148:94-99. [PMID: 32858338 DOI: 10.1016/j.lungcan.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Radiological characteristics and radiomics signatures can aid in differentiation between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC). We investigated whether molecular subtypes of large cell neuroendocrine carcinoma (LCNEC), i.e. SCLC-like (with pRb loss) vs. NSCLC-like (with pRb expression), can be distinguished by imaging based on (1) imaging interpretation, (2) semantic features, and/or (3) a radiomics signature, designed to differentiate between SCLC and NSCLC. MATERIALS AND METHODS Pulmonary oncologists and chest radiologists assessed chest CT-scans of 44 LCNEC patients for 'small cell-like' or 'non-small cell-like' appearance. The radiologists also scored semantic features of 50 LCNEC scans. Finally, a radiomics signature was trained on a dataset containing 48 SCLC and 76 NSCLC scans and validated on an external set of 58 SCLC and 40 NSCLC scans. This signature was applied on scans of 28 SCLC-like and 8 NSCLC-like LCNEC patients. RESULTS Pulmonary oncologists and radiologists were unable to differentiate between molecular subtypes of LCNEC and no significant differences in semantic features were found. The area under the receiver operating characteristics curve of the radiomics signature in the validation set (SCLC vs. NSCLC) was 0.84 (95% confidence interval (CI) 0.77-0.92) and 0.58 (95% CI 0.29-0.86) in the LCNEC dataset (SCLC-like vs. NSCLC-like). CONCLUSION LCNEC appears to have radiological characteristics of both SCLC and NSCLC, irrespective of pRb loss, compatible with the SCLC-like subtype. Imaging interpretation, semantic features and our radiomics signature designed to differentiate between SCLC and NSCLC were unable to separate molecular LCNEC subtypes, which underscores that LCNEC is a unique disease.
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Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - S Sanduleanu
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - H Woodruff
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - L M Hillen
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - R Casale
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - F Mohamed Hoesein
- Department of Radiology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
| | - E de Jong
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - D M H J Ten Berge
- Department of Radiology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Pulmonology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - E J M Speel
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - P Lambin
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands; The D-Lab, Department of Precision Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - H A Gietema
- GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; GROW - School for Oncology & Developmental Biology, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Pulmonology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
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9
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Hermans BCM, Derks JL, Groen HJM, Stigt JA, van Suylen RJ, Hillen LM, van den Broek EC, Speel EJM, Dingemans AMC. Large cell neuroendocrine carcinoma with a solitary brain metastasis and low Ki-67: a unique subtype. Endocr Connect 2019; 8:1600-1606. [PMID: 31751303 PMCID: PMC6933830 DOI: 10.1530/ec-19-0372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/14/2019] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Stage IV large cell neuroendocrine carcinoma (LCNEC) of the lung generally presents as disseminated and aggressive disease with a Ki-67 proliferation index (PI) 40-80%. LCNEC can be subdivided in two main subtypes: the first harboring TP53/RB1 mutations (small-cell lung carcinoma (SCLC)-like), the second with mutations in TP53 and STK11/KEAP1 (non-small-cell lung carcinoma (NSCLC)-like). Here we evaluated 11 LCNEC patients with only a solitary brain metastasis and evaluate phenotype, genotype and follow-up. METHODS Eleven LCNEC patients with solitary brain metastases were analyzed. Clinical characteristics and survival data were retrieved from medical records. Pathological analysis included histomorphological analysis, immunohistochemistry (pRB and Ki-67 PI) and next-generation sequencing (TP53, RB1, STK11, KEAP1 and MEN1). RESULTS All patients had N0 or N1 disease. Median overall survival (OS) was 12 months (95% confidence interval (CI) 5.5-18.5 months). Mean Ki-67 PI was 59% (range 15-100%). In 6/11 LCNEC Ki-67 PI was ≤40%. OS was longer for Ki-67 ≤40% compared to >40% (17 months (95% CI 11-23 months) vs 5 months (95% CI 0.7-9 months), P = 0.007). Two patients were still alive at follow-up after 86 and 103 months, both had Ki-67 ≤40%. 8/11 patients could be subclassified, and both SCLC-like (n = 6) and NSCLC-like (n = 2) subtypes were present. No MEN1 mutation was found. CONCLUSION Stage IV LCNEC with a solitary brain metastasis and N0/N1 disease show in the majority of cases Ki-67 PI ≤40% and prolonged survival, distinguishing them from general LCNEC. This unique subgroup can be both of the SCLC-like and NSCLC-like subtype.
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Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - J A Stigt
- Department of Pulmonary Diseases, Isala Hospital, Zwolle, The Netherlands
| | - R J van Suylen
- Pathology-DNA, Jeroen Bosch Hospital, ‘s Hertogenbosch, The Netherlands
| | - L M Hillen
- Department of Pathology, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - E J M Speel
- Department of Pathology, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, GROW School for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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10
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Pruis MA, Geurts-Giele WRR, von der TJH, Meijssen IC, Dinjens WNM, Aerts JGJV, Dingemans AMC, Lolkema MP, Paats MS, Dubbink HJ. Highly accurate DNA-based detection and treatment results of MET exon 14 skipping mutations in lung cancer. Lung Cancer 2019; 140:46-54. [PMID: 31862577 DOI: 10.1016/j.lungcan.2019.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/01/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The oncogenic MET exon 14 skipping mutation (METex14del) is described to drive 1.3 %-5.7 % of non-small-cell lung cancer (NSCLC) and multiple studies with cMET inhibitors show promising clinical responses. RNA-based analysis seems most optimal for METex14del detection, however, acquiring sufficient RNA material is often problematic. An alternative is DNA-based analysis, but commercially available DNA-based panels only detect up to 63 % of known METex14del alterations. The goal of this study is to describe an optimized DNA-based diagnostic test for METex14del in NSCLC, including clinical features and follow-up of patients treated with cMET-targeted therapy and consequent resistance mechanisms. MATERIAL AND METHODS Routinely processed diagnostic pathology non-squamous NSCLC specimens were investigated by a custom-made DNA-based targeted amplicon-based next generation sequencing (NGS) panel, which includes 4 amplicons for METex14del detection. Retrospectively, histopathological characteristics and clinical follow up were investigated for advanced non-squamous NSCLC with METex14del. RESULTS In silico analysis showed that our NGS panel is able to detect 96 % of reported METex14 alterations. METex14del was found in 2 % of patients with non-squamous NSCLC tested for therapeutic purposes. In total, from May 2015 - Sep 2018, METex14del was found in 46 patients. Thirty-six of these patients had advanced non-squamous NSCLC, they were predominantly elderly (76.5 years [53-90]), male (25/36) and (ex)-smokers (23/36). Five patients received treatment with crizotinib (Pfizer Oncology), in a named patient based program, disease control was achieved for 4/5 patients (3 partial responses, 1 stable disease) and one patient had a mixed response. Two patients developed a MET D1228N mutation during crizotinib treatment, inducing a resistance mechanism to crizotinib. CONCLUSIONS This study shows that METex14del can be reliably detected by routine DNA NGS analysis. Although a small cohort, patients responded well to targeted treatment, underlining the need for routine testing of METex14del in advanced non-squamous NSCLC to guarantee optimal personalized treatment.
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Affiliation(s)
- M A Pruis
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - W R R Geurts-Giele
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Thüsen J H von der
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - I C Meijssen
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - W N M Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J G J V Aerts
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - A M C Dingemans
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Department of Pulmonary Diseases, Maastricht UMC +, Maastricht, the Netherlands
| | - M P Lolkema
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M S Paats
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - H J Dubbink
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
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11
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Hermans BCM, Derks JL, Thunnissen E, van Suylen RJ, den Bakker MA, Groen HJM, Smit EF, Damhuis RA, van den Broek EC, Ruland A, Speel EJM, Dingemans AMC. DLL3 expression in large cell neuroendocrine carcinoma (LCNEC) and association with molecular subtypes and neuroendocrine profile. Lung Cancer 2019; 138:102-108. [PMID: 31678831 DOI: 10.1016/j.lungcan.2019.10.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES For stage IV pulmonary large cell neuroendocrine carcinoma (LCNEC), the only therapeutic option is palliative chemotherapy. DLL3 is a new therapeutic target, which seems to be often expressed in SCLC and LCNEC. It has recently been reported that DLL3 mRNA expression is particularly upregulated in the LCNEC subgroup with STK11/KEAP1 and TP53 co-mutations, in contrast to lower expression levels in RB1 and TP53 co-mutated LCNEC. Our aim was to investigate DLL3 protein expression in stage IV LCNEC and correlate data with mutational profiles (i.e.STK11/KEAP1/RB1), immunostaining results (pRb, NE markers) and clinical characteristics. MATERIALS AND METHODS Immunohistochemical analysis for DLL3 (SC16.65) and ASCL1 (SC72.201) was performed on 94 and 51 FFPE tissue sections, respectively, of pathologically reviewed stage IV LCNEC. DLL3 and ASCL1 were scored positive if ≥1% of the tumor cells showed cytoplasmic/membranous or dotlike (DLL3) or nuclear (ASCL1) immunostaining. Data were correlated with available sequencing (TP53, RB1, STK11, KEAP1), immunostaining (pRb, NE markers) and clinical data. RESULTS DLL3 was expressed in 70/94 (74%) LCNEC, 56 (80%) of which showed cytoplasmic/membranous staining. Median H-score was 55 (interquartile range 0-160). DLL3 staining was not different in pRb immunohistochemistry negative and positive patients (DLL3+ in 53/70 (76%) vs. 14/21 (67%), p = 0.409) or RB1 mutated and wildtype patients (DLL3+ in 27/34 (79%) vs. 23/33 (70%), p = 0.361). Nevertheless, 6/6 (100%) STK11 mutated, 10/11 (91%) KEAP1 mutated and 9/9 (100%) TP53 wildtype tumors were DLL3+ . Furthermore, DLL3 expression was associated with expression of ASCL1 and at least 2 out of 3 neuroendocrine markers. CONCLUSION The high percentage (74%) of DLL3 expression in stage IV LCNEC denotes the potential of DLL3 targeted therapy in this patient group.
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Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Thunnissen
- Department of Pathology, VU University Medical Centre, Amsterdam, The Netherlands
| | - R J van Suylen
- Pathology-DNA, location Jeroen Bosch Hospital, s' Hertogenbosch, The Netherlands
| | - M A den Bakker
- Department of Pathology, Maasstad hospital, Rotterdam, The Netherlands; Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - E F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - R A Damhuis
- Department Research, Comprehensive Cancer Association, Utrecht, The Netherlands
| | | | - A Ruland
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E J M Speel
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A M C Dingemans
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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12
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Alcala N, Leblay N, Gabriel AAG, Mangiante L, Hervas D, Giffon T, Sertier AS, Ferrari A, Derks J, Ghantous A, Delhomme TM, Chabrier A, Cuenin C, Abedi-Ardekani B, Boland A, Olaso R, Meyer V, Altmuller J, Le Calvez-Kelm F, Durand G, Voegele C, Boyault S, Moonen L, Lemaitre N, Lorimier P, Toffart AC, Soltermann A, Clement JH, Saenger J, Field JK, Brevet M, Blanc-Fournier C, Galateau-Salle F, Le Stang N, Russell PA, Wright G, Sozzi G, Pastorino U, Lacomme S, Vignaud JM, Hofman V, Hofman P, Brustugun OT, Lund-Iversen M, Thomas de Montpreville V, Muscarella LA, Graziano P, Popper H, Stojsic J, Deleuze JF, Herceg Z, Viari A, Nuernberg P, Pelosi G, Dingemans AMC, Milione M, Roz L, Brcic L, Volante M, Papotti MG, Caux C, Sandoval J, Hernandez-Vargas H, Brambilla E, Speel EJM, Girard N, Lantuejoul S, McKay JD, Foll M, Fernandez-Cuesta L. Integrative and comparative genomic analyses identify clinically relevant pulmonary carcinoid groups and unveil the supra-carcinoids. Nat Commun 2019; 10:3407. [PMID: 31431620 PMCID: PMC6702229 DOI: 10.1038/s41467-019-11276-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [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: 11/07/2018] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
The worldwide incidence of pulmonary carcinoids is increasing, but little is known about their molecular characteristics. Through machine learning and multi-omics factor analysis, we compare and contrast the genomic profiles of 116 pulmonary carcinoids (including 35 atypical), 75 large-cell neuroendocrine carcinomas (LCNEC), and 66 small-cell lung cancers. Here we report that the integrative analyses on 257 lung neuroendocrine neoplasms stratify atypical carcinoids into two prognostic groups with a 10-year overall survival of 88% and 27%, respectively. We identify therapeutically relevant molecular groups of pulmonary carcinoids, suggesting DLL3 and the immune system as candidate therapeutic targets; we confirm the value of OTP expression levels for the prognosis and diagnosis of these diseases, and we unveil the group of supra-carcinoids. This group comprises samples with carcinoid-like morphology yet the molecular and clinical features of the deadly LCNEC, further supporting the previously proposed molecular link between the low- and high-grade lung neuroendocrine neoplasms.
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Affiliation(s)
- N Alcala
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - N Leblay
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - A A G Gabriel
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - L Mangiante
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - D Hervas
- Health Research Institute La Fe, Avenida Fernando Abril Martorell, Torre 106 A 7planta, 46026, Valencia, Spain
| | - T Giffon
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - A S Sertier
- Synergie Lyon Cancer, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - A Ferrari
- Synergie Lyon Cancer, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - J Derks
- Maastricht University Medical Centre (MUMC), GROW School for Oncology and Developmental Biology, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - A Ghantous
- International Agency for Research on Cancer (IARC/WHO), Section of Mechanisms of Carcinogenesis, 150 Cours Albert Thomas, 69008, Lyon, France
| | - T M Delhomme
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - A Chabrier
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - C Cuenin
- International Agency for Research on Cancer (IARC/WHO), Section of Mechanisms of Carcinogenesis, 150 Cours Albert Thomas, 69008, Lyon, France
| | - B Abedi-Ardekani
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - A Boland
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de Biologie François Jacob, CEA, Université Paris-Saclay, 2 rue Gaston Crémieux, CP 5706, 91057, Evry Cedex, France
| | - R Olaso
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de Biologie François Jacob, CEA, Université Paris-Saclay, 2 rue Gaston Crémieux, CP 5706, 91057, Evry Cedex, France
| | - V Meyer
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de Biologie François Jacob, CEA, Université Paris-Saclay, 2 rue Gaston Crémieux, CP 5706, 91057, Evry Cedex, France
| | - J Altmuller
- Cologne Centre for Genomics (CCG) and Centre for Molecular Medicine Cologne (CMMC), University of Cologne, Weyertal 115, 50931, Cologne, Germany
| | - F Le Calvez-Kelm
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - G Durand
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - C Voegele
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - S Boyault
- Translational Research and Innovation Department, Cancer Genomic Platform, 28 Rue Laennec, 69008, Lyon, France
| | - L Moonen
- Maastricht University Medical Centre (MUMC), GROW School for Oncology and Developmental Biology, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - N Lemaitre
- Institute for Advanced Biosciences, Site Santé, Allée des Alpes, 38700, La Tronche, Grenoble, France
| | - P Lorimier
- Institute for Advanced Biosciences, Site Santé, Allée des Alpes, 38700, La Tronche, Grenoble, France
| | - A C Toffart
- Pulmonology-Physiology Unit, Grenoble Alpes University Hospital, 38700, La Tronche, France
| | - A Soltermann
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland
| | - J H Clement
- Department Hematology and Medical Oncology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - J Saenger
- Bad Berka Institute of Pathology, Robert-Koch-Allee 9, 99438, Bad Berka, Germany
| | - J K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, 6 West Derby Street, L7 8TX, Liverpool, UK
| | - M Brevet
- Pathology Institute, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 59 Boulevard Pinel, 69677, BRON Cedex, France
| | - C Blanc-Fournier
- CLCC François Baclesse, 3 avenue du Général Harris, 14076, Caen Cedex 5, France
| | - F Galateau-Salle
- Department of Pathology, Centre Léon Bérard, 28, rue Laennec, 69373, Lyon Cedex 8, France
| | - N Le Stang
- Department of Pathology, Centre Léon Bérard, 28, rue Laennec, 69373, Lyon Cedex 8, France
| | - P A Russell
- St. Vincent's Hospital and University of Melbourne, Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia
| | - G Wright
- St. Vincent's Hospital and University of Melbourne, Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia
| | - G Sozzi
- Pathology Division Fondazione, IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - U Pastorino
- Pathology Division Fondazione, IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - S Lacomme
- Nancy Regional University Hospital, CHRU, CRB BB-0033-00035, INSERM U1256, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France
| | - J M Vignaud
- Nancy Regional University Hospital, CHRU, CRB BB-0033-00035, INSERM U1256, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy Cedex, France
| | - V Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, Nice Hospital, Biobank BB-0033-00025, IRCAN Inserm U1081 CNRS 7284, University Côte d'Azur, 30 avenue de la voie Romaine, CS, 51069-06001, Nice Cedex 1, France
| | - P Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, Nice Hospital, Biobank BB-0033-00025, IRCAN Inserm U1081 CNRS 7284, University Côte d'Azur, 30 avenue de la voie Romaine, CS, 51069-06001, Nice Cedex 1, France
| | - O T Brustugun
- Drammen Hospital, Vestre Viken Health Trust, Vestre Viken HF, Postboks 800, 3004, Drammen, Norway
- Institute of Cancer Research, Oslo University Hospital, Ullernchausseen 70, 0379, Oslo, Norway
| | - M Lund-Iversen
- Institute of Cancer Research, Oslo University Hospital, Ullernchausseen 70, 0379, Oslo, Norway
| | | | - L A Muscarella
- Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo FG, Italy
| | - P Graziano
- Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo FG, Italy
| | - H Popper
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010, Graz, Austria
| | - J Stojsic
- Department of Thoracopulmonary Pathology, Service of Pathology, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - J F Deleuze
- Centre National de Recherche en Génomique Humaine (CNRGH), Institut de Biologie François Jacob, CEA, Université Paris-Saclay, 2 rue Gaston Crémieux, CP 5706, 91057, Evry Cedex, France
| | - Z Herceg
- International Agency for Research on Cancer (IARC/WHO), Section of Mechanisms of Carcinogenesis, 150 Cours Albert Thomas, 69008, Lyon, France
| | - A Viari
- Synergie Lyon Cancer, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - P Nuernberg
- Cologne Centre for Genomics (CCG) and Centre for Molecular Medicine Cologne (CMMC), University of Cologne, Weyertal 115, 50931, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Joseph-Stelzmann-Straße 26, 50931, Cologne, Germany
| | - G Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, and Inter-Hospital Pathology Division, IRCCS Multimedica, Via Gaudenzio Fantoli, 16/15, 20138, Milan, Italy
| | - A M C Dingemans
- Maastricht University Medical Centre (MUMC), GROW School for Oncology and Developmental Biology, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - M Milione
- Pathology Division Fondazione, IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - L Roz
- Pathology Division Fondazione, IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, 20133, Milan, Italy
| | - L Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010, Graz, Austria
| | - M Volante
- Department of Oncology, University of Turin, Pathology Division, Via Santena 7, 10126, Torino, Italy
| | - M G Papotti
- Department of Oncology, University of Turin, Pathology Division, Via Santena 7, 10126, Torino, Italy
| | - C Caux
- Department of Immunity, Virus, and Inflammation, Cancer Research Centre of Lyon (CRCL), 28 Rue Laennec, 69008, Lyon, France
| | - J Sandoval
- Health Research Institute La Fe, Avenida Fernando Abril Martorell, Torre 106 A 7planta, 46026, Valencia, Spain
| | - H Hernandez-Vargas
- Cancer Research Centre of Lyon (CRCL), Inserm U 1052, CNRS UMR 5286, Centre Léon Bérard, Université de Lyon, 28 Rue Laennec, 69008, Lyon, France
| | - E Brambilla
- Institute for Advanced Biosciences, Site Santé, Allée des Alpes, 38700, La Tronche, Grenoble, France
| | - E J M Speel
- Maastricht University Medical Centre (MUMC), GROW School for Oncology and Developmental Biology, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - N Girard
- Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
- European Reference Network (ERN-EURACAN), 28 rue Laennec, 69008, Lyon, France
| | - S Lantuejoul
- Synergie Lyon Cancer, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
- Translational Research and Innovation Department, Cancer Genomic Platform, 28 Rue Laennec, 69008, Lyon, France
- Department of Pathology, Centre Léon Bérard, 28, rue Laennec, 69373, Lyon Cedex 8, France
| | - J D McKay
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - M Foll
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France
| | - L Fernandez-Cuesta
- International Agency for Research on Cancer (IARC/WHO), Section of Genetics, 150 Cours Albert Thomas, 69008, Lyon, France.
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Degens JHRJ, Sanders KJC, de Jong EEC, Groen HJM, Smit EF, Aerts JG, Schols AMWJ, Dingemans AMC. The prognostic value of early onset, CT derived loss of muscle and adipose tissue during chemotherapy in metastatic non-small cell lung cancer. Lung Cancer 2019; 133:130-135. [PMID: 31200819 DOI: 10.1016/j.lungcan.2019.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the relationship between early changes in muscle and adipose tissue during chemotherapy and overall survival (OS) in stage IV non-small cell lung cancer (NSCLC). MATERIALS AND METHODS In this post-hoc analysis of the first line NVALT12 trial (NCT01171170) in stage IV NSCLC, skeletal muscle (SM), radiation attenuation (RA), subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were assessed at the third lumbar level on CT-images obtained before initiation of chemotherapy and shortly after administration of the second cycle. The contribution of changes in different body compartments to overall survival was assessed. RESULTS CT scans of 111 patients were included. Analysis of body composition changes between the baseline and the follow-up scan, revealed that overall SM cross sectional area (CSA), radiation attenuation and SAT CSA decreased respectively by -1.2 ± 2.9 cm2/m2 (p < 0.001), -0.7 ± 3.3 HU (p = 0.026) and -1.9 ± 8.7 cm2/m2 (p = 0.026), while no significant changes in VAT tissue were observed. Longitudinally, median OS was significantly shorter among patients losing SM compared to patients with preserved SM (9.4 versus 14.2 months; HR 1.9, 95% CI: 1.23, 2.79, p = 0.003). Multivariate analyses showed that proportional loss of muscle mass was associated with poor OS (HR 0.949, 95% CI: 0.915, 0.985, p = 0.006) independent from important clinical prognostic factors including WHO-PS, gender, age and Charlson comorbidity index. CONCLUSION Early loss of SM during first line chemotherapy is a poor prognostic factor in stage IV NSCLC patients. Future studies have to reveal whether early supportive intervention guided by initial CT muscle response to chemotherapy can influence the wasting process and related mortality risk.
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Affiliation(s)
- J H R J Degens
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - K J C Sanders
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - E E C de Jong
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - H J M Groen
- Department of Respiratory Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - E F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - J G Aerts
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - A M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A-M C Dingemans
- Department of Respiratory Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.
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14
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Hermans BCM, Derks JL, Thunnissen E, van Suylen RJ, den Bakker MA, Groen HJM, Smit EF, Damhuis RA, van den Broek EC, Stallinga CM, Roemen GM, Speel EJM, Dingemans AMC. Prevalence and prognostic value of PD-L1 expression in molecular subtypes of metastatic large cell neuroendocrine carcinoma (LCNEC). Lung Cancer 2019; 130:179-186. [PMID: 30885341 DOI: 10.1016/j.lungcan.2019.02.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/08/2019] [Accepted: 02/19/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare tumor with high mutational burden. Two subtypes of LCNEC are recognized, the co-mutated TP53 and RB1 group and the TP53 and STK11/KEAP1 group. We investigated PD-L1 and CD8 expression in a well characterized stage IV LCNEC cohort and compared expression in the two subtypes. METHODS Immunohistochemical (IHC) analysis for PD-L1 and CD8 was performed on pathological reviewed pretreatment tumor samples for 148 stage IV LCNEC. Data about targeted next generation sequencing (TNGS) (TP53, RB1, STK11, KEAP1) and IHC for RB1 were available for most tumors. IHC staining for PD-L1 (DAKO 28-8) was performed and scored positive if tumors showed ≥1% membranous staining. CD8 was scored for intra-tumor T-cells and stromal cells. RESULTS PD-L1 IHC expression data could be generated in 98/148 confirmed LCNEC samples along with RB1 IHC (n = 97) of which 77 passed quality control for TNGS. PD-L1 expression was positive in 16/98 cases (16%); 5 (5%) with ≥50%. PD-L1 expression was equal in RB1 mutated and RB1 wildtype tumors. None of STK11 mutated tumors (n = 7) expressed PD-L1. PD-L1 expression was correlated with superior overall survival (OS), hazard ratio 0.55 ((95% Confidence Interval 0.31-0.96), p = 0.038). Intra-tumor CD8 was associated with PD-L1 expression (p = 0.021) and stromal and intra-tumor CD8 were correlated with improved OS (p = 0.037 and p = 0.026 respectively). CONCLUSIONS PD-L1 expression was positive in 16% of stage IV LCNEC tumors. This was independent of molecular subtype but associated with CD8 expression. In LCNEC patients with PD-L1 and/or CD8 expression superior OS was observed.
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Affiliation(s)
- B C M Hermans
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - J L Derks
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| | - E Thunnissen
- Department of Pathology, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - R J van Suylen
- Pathology-DNA, location Jeroen Bosch Hospital, P.O. Box 90153, 5200 ME s', Hertogenbosch, the Netherlands
| | - M A den Bakker
- Department of Pathology, Maasstad hospital, P.O. Box 9100, 3007 AC, Rotterdam, the Netherlands; Department of Pathology, Erasmus MC, P.O.Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - H J M Groen
- Department of Pulmonary Diseases, University of Groningen and University Medical Centre, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - E F Smit
- Department of Thoracic Oncology, Netherlands Cancer Institute, P.O. Box 90203, 1006 BE, Amsterdam, the Netherlands
| | - R A Damhuis
- Department Research, Comprehensive Cancer Association, P.O. Box 19079, 3501 DB, Utrecht, the Netherlands
| | | | - C M Stallinga
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - G M Roemen
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - E J M Speel
- Department of Pathology, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, GROW school for Oncology & Developmental Biology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
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15
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Kuijpers CCHJ, Hendriks LEL, Derks JL, Dingemans AMC, van Lindert ASR, van den Heuvel MM, Damhuis RA, Willems SM. Association of molecular status and metastatic organs at diagnosis in patients with stage IV non-squamous non-small cell lung cancer. Lung Cancer 2018; 121:76-81. [PMID: 29858031 DOI: 10.1016/j.lungcan.2018.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Biological predisposition for specific metastatic organs might differ between molecular subgroups of lung cancer. We aimed to assess the association between molecular status and metastatic organs at diagnosis in a nationwide stage IV non-squamous non-small cell lung cancer ((ns)-NSCLC) cohort. METHODS All ns-NSCLC from 2013 that were stage IV at diagnosis were identified from the Netherlands Cancer Registry, which records information on metastatic organs at diagnosis. Tumors were matched to the Dutch Pathology Registry (PALGA) from which data on molecular status established in routine practice was extracted. Four molecular subgroups (EGFR+, KRAS+, ALK+, triple-negative) were identified. For each metastatic organ, proportions of tumors metastasized to this organ were, per molecular subgroup, compared to triple-negative tumors by multivariable logistic regression analyses (adjusted odds ratios (OR) with 95% confidence intervals (CI)), taking clinicopathological variables into account. RESULTS 160 EGFR+ (exon 19 del, exon 21 L858R), 784 KRAS+, 42 ALK+, and 1008 triple-negative tumors were identified. Most frequent metastatic organs were the bone (34%), pleura (24%), lung (23%), and brain (22%). Compared to triple-negatives, EGFR+ tumors had more often metastases to the bone (31.5 vs 53.8%; OR 2.55 (95% CI 1.80-3.62)) and pleura (24.1 vs 37.5%; OR 2.06 (1.42-2.98)), and less often to the brain (22.0 vs 12.5%; OR 0.53 (0.32-0.88)) and adrenal glands (19.1 vs 7.5%; OR 0.46 (0.28-0.75)). Compared to triple-negatives, KRAS+ and ALK+ tumors had at diagnosis metastasized more often to the lung (20.3 vs 26.7%; OR 1.40 (1.12-1.76)) and the liver (13.1 vs 23.8%; OR 2.07 (1.00-4.32)), respectively. CONCLUSION NSCLC molecular status was associated with metastatic pattern at diagnosis. 54% of stage IV EGFR+ ns-NSCLC patients had bone metastases at diagnosis. These observational results are hypothesis generating, and call for a prospective study where EGFR+ patients are screened for bone metastases, and treated to prevent skeletal related events.
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Affiliation(s)
- C C H J Kuijpers
- Dept. of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Foundation PALGA, Randhoeve 225, 3995 GA, Houten, The Netherlands.
| | - L E L Hendriks
- Dept. of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - J L Derks
- Dept. of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - A-M C Dingemans
- Dept. of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
| | - A S R van Lindert
- Dept. of Respiratory Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - M M van den Heuvel
- Dept. of Lung Disease, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - R A Damhuis
- Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
| | - S M Willems
- Dept. of Pathology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Foundation PALGA, Randhoeve 225, 3995 GA, Houten, The Netherlands; Dept. of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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16
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van Kruijsdijk RCM, Visseren FLJ, Boni L, Groen HJM, Dingemans AMC, Aerts JGJV, van der Graaf Y, Ardizzoni A, Smit EF. Pemetrexed plus carboplatin versus pemetrexed in pretreated patients with advanced non-squamous non-small-cell lung cancer: treating the right patients based on individualized treatment effect prediction. Ann Oncol 2016; 27:1280-6. [PMID: 27052652 DOI: 10.1093/annonc/mdw154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/28/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Translating results from randomized clinical trials (RCTs) to individual patients in clinical practice is challenging, as treatment effects can vary substantially among individuals. Data from RCTs can be used for individualized treatment effect prediction, to identify patients who benefit from specific treatments. In this study, we developed and validated a prediction model for estimating absolute treatment effect of pemetrexed plus carboplatin versus single-agent pemetrexed in the second-line treatment of non-squamous non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Using data of relapsed patients with advanced non-squamous NSCLC from the NVALT-7 trial, a Weibull model for prediction of gain in median progression-free survival (PFS) by pemetrexed-carboplatin was derived based on patient and tumor characteristics. The model was externally validated in the GOIRC 02-2006 trial. The applicability of the model for guiding clinical decision-making was evaluated using decision curve analysis. RESULTS A wide distribution of predicted gain in median PFS by pemetrexed-carboplatin over pemetrexed was found, with a median of 0.7 months (interquartile range: -0.1 to 1.5 months). Patients who benefited most included women, those with stage IV, high body mass index and/or adenocarcinoma. External validation showed satisfactory calibration and moderate discrimination (C-index: 0.61, 95% confidence interval 0.56-0.67). Decision curve analysis confirmed that the model adequately identified patients who benefit from pemetrexed-carboplatin, as prediction-based treatment led to improvement in net benefit with regard to PFS and overall survival when assuming a treatment threshold of 0-5 months gain in PFS, compared with other treatment strategies. CONCLUSIONS The effects of pemetrexed-carboplatin can be predicted for individual patients based on routinely available patient and tumor characteristics. There is important heterogeneity in the effects on PFS of pemetrexed-carboplatin versus pemetrexed in pretreated patients with advanced non-squamous NSCLC. Individualized prediction of treatment effect could be used to guide shared decision-making by discriminating patients who benefit most, to improve clinical outcome. CLINICAL TRIAL NUMBERS NVALT-7: ISRCTN38269072 (ISRCTN registry), GOIRC 02-2006: NCT00786331 (clinicaltrials.gov).
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Affiliation(s)
- R C M van Kruijsdijk
- Department of Vascular Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F L J Visseren
- Department of Vascular Disease, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Boni
- Clinical Trials Coordinating Center, Instituto Toscano Tumori, University Hospital Careggi, Florence, Italy
| | - H J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen
| | - A M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center, Maastricht
| | - J G J V Aerts
- Department of Pulmonary Diseases, Amphia Hospital, Breda
| | - Y van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Ardizzoni
- Department of Medical Oncology, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - E F Smit
- Department of Pulmonary Diseases, Vrije Universiteit VU Medical Center, Amsterdam, The Netherlands
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17
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Dingemans AMC, Groen HJM, Herder GJM, Stigt JA, Smit EF, Bahce I, Burgers JA, van den Borne BEEM, Biesma B, Vincent A, van der Noort V, Aerts JG. A randomized phase II study comparing paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches in patients with stage IV nonsquamous nonsmall-cell lung cancer: NVALT12 (NCT01171170)†. Ann Oncol 2015; 26:2286-93. [PMID: 26347109 DOI: 10.1093/annonc/mdv370] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/18/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nitroglycerin (NTG) increases tumor blood flow and oxygenation by inhibiting hypoxia-inducible-factor (HIF)-1. A randomized phase II study has shown improved outcome when NTG patches were added to vinorelbine/cisplatin in patients with advanced nonsmall-cell lung cancer (NSCLC). In addition, there is evidence that the combination of bevacizumab and HIF-1 inhibitors increases antitumor activity. PATIENTS AND METHODS In this randomized phase II trial, chemo-naive patients with stage IV nonsquamous NSCLC were randomized to four cycles of carboplatin (area under the curve 6)-paclitaxel (200 mg/m(2))-bevacizumab 15 mg/kg on day 1 every 3 weeks with or without NTG patches 15 mg (day -2 to +2) followed by bevacizumab with or without NTG until progression. Response was assessed every two cycles. Primary end point was progression-free survival (PFS). The study was powered (80%) to detect a decrease in the hazard of tumor progression of 33% at α = 0.05 with a two-sided log-rank test when 222 patients were enrolled and followed until 195 events were observed. RESULTS Between 1 January 2011 and 1 January 2013, a total of 223 patients were randomized; 112 control arm and 111 experimental arm; response rate was 54% in control arm and 38% in experimental arm. Median [95% confidence interval (CI)] PFS in control arm was 6.8 months (5.6-7.3) and 5.1 months (4.2-5.8) in experimental arm, hazard ratio (HR) 1.27 (95% CI 0.96-1.67). Overall survival (OS) was 11.6 months (8.8-13.6) in control arm and 9.4 months (7.8-11.3) in experimental arm, HR 1.02 (95% CI 0.71-1.46). In the experimental arm, no additional toxicity was observed except headache (6% versus 52% in patients treated with NTG). CONCLUSION Adding NTG to first-line carboplatin-paclitaxel-bevacizumab did not improve PFS and OS in patients with stage IV nonsquamous NSCLC.
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Affiliation(s)
- A-M C Dingemans
- Department of Respiratory Disease, Maastricht University Medical Center, Maastricht
| | - H J M Groen
- Department of Respiratory Disease, University Medical Center Groningen, Groningen
| | - G J M Herder
- Department of Respiratory Disease, Sint Antonius Hospital, Nieuwegein
| | - J A Stigt
- Department of Respiratory Disease, Isala Hospital, Zwolle
| | - E F Smit
- Department of Respiratory Disease, VU Medical Center, Amsterdam Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam
| | - I Bahce
- Department of Respiratory Disease, VU Medical Center, Amsterdam
| | - J A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam
| | | | - B Biesma
- Department of Respiratory Disease, Jeroen Bosch Hospital's, Hertogenbosch
| | - A Vincent
- Department of Biostatistics, Netherlands Cancer Institute, Amsterdam
| | - V van der Noort
- Department of Biostatistics, Netherlands Cancer Institute, Amsterdam
| | - J G Aerts
- Department of Respiratory Disease, Amphia Hospital, Breda Department of Respiratory Disease, University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Gommans EPAT, Even P, Linssen CFM, van Dessel H, van Haren E, de Vries GJ, Dingemans AMC, Kotz D, Rohde GGU. Risk factors for mortality in patients with pulmonary infections with non-tuberculous mycobacteria: a retrospective cohort study. Respir Med 2014; 109:137-45. [PMID: 25464905 DOI: 10.1016/j.rmed.2014.10.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/01/2014] [Accepted: 10/24/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infections with non-tuberculous mycobacteria (NTM) represent an increasing problem. Their clinical relevance is still largely unknown as well as predictors for mortality in affected patients. The objective was to describe prevalence and clinical relevance of different NTM and to identify risk factors for mortality. METHODS Retrospective cohort study of 124 patients with NTM detection between January 2001 and December 2011. Clinical characteristics like symptoms and radiological appearance were assessed at presentation. The primary outcome was all cause mortality during the follow-up period. Univariate and multivariate survival analyses using Cox proportional hazard models were employed for statistical analysis. RESULTS Over the study period, the frequency of NTM isolation varied from 4 to 12 patients per year. Twenty-nine out of 124 patients (23%) had a clinically relevant infection, according to the criteria of the American Thoracic Society (ATS). Mycobacterium avium was isolated most frequently, but Mycobacterium kansasii, Mycobacterium malmoense and Mycobacterium xenopi had the highest clinical relevance. Symptoms were mostly diverse and non-specific. On radiology, cavities were observed more frequently than a nodular-bronchiectatic variant or consolidation. In 75% of all patients, follow up time was more than two years. Median survival was 6.5 years (95%CI = 2.7-10.3). Factors significantly influencing survival time were haemoptysis (HR = 0.2, 95%CI = 0.1-0.6) and a consolidation on imaging (HR = 5.1, 95%CI 1.4-18.2). CONCLUSIONS The presentation of an infection with NTM can be diverse and depends mainly on the causative NTM pathogen. The most important predictor for increased mortality is the radiological appearance of a consolidation.
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Affiliation(s)
- E P A T Gommans
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
| | - P Even
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
| | - C F M Linssen
- Department of Medical Microbiology, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
| | - H van Dessel
- Department of Medical Microbiology, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
| | - E van Haren
- Department of Respiratory Medicine, Atrium Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
| | - G J de Vries
- Department of Respiratory Medicine, Orbis Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands.
| | - A M C Dingemans
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
| | - D Kotz
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands.
| | - G G U Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
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19
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Hendriks LEL, Smit EF, Vosse BAH, Mellema WW, Heideman DAM, Bootsma GP, Westenend M, Pitz C, de Vries GJ, Houben R, Grünberg K, Bendek M, Speel EJM, Dingemans AMC. EGFR mutated non-small cell lung cancer patients: more prone to development of bone and brain metastases? Lung Cancer 2014; 84:86-91. [PMID: 24529684 DOI: 10.1016/j.lungcan.2014.01.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Both bone and brain are frequent sites of metastasis in non-small cell lung cancer (NSCLC). Conflicting data exist whether EGFR mutant (+) patients are more prone to develop brain metastases or have a better outcome with brain metastases compared to EGFR/KRAS wildtype (WT) or KRAS+ patients. For bone metastases this has not been studied. METHODS In this retrospective case-control study all EGFR+ (exons 19 and 21) patients diagnosed at two pathology departments were selected (2004/2008 to 2012). For every EGFR+ patient a consecutive KRAS+ and WT patient with metastatic NSCLC (mNSCLC) was identified. Patients with another malignancy within 2 years of mNSCLC diagnosis were excluded. Data regarding age, gender, performance score, histology, treatment, bone/brain metastases diagnosis, skeletal related events (SRE) and subsequent survival were collected. RESULTS 189 patients were included: 62 EGFR+, 65 KRAS+, 62 WT. 32%, 35% and 40%, respectively, had brain metastases (p=0.645). Mean time to brain metastases was 20.8 [± 12.0], 10.8 [± 9.8], 16.4 [± 10.2] months (EGFR+-KRAS+, p = 0.020, EGFR+-WT, p = 0.321). Median post brain metastases survival was 12.1 [5.0-19.1], 7.6 [1.2-14.0], 10.7 [1.5-19.8] months (p = 0.674). 60%, 52% and 50% had metastatic bone disease (p=0.528). Mean time to development of metastatic bone disease was 13.4 [± 10.6], 23.3 [± 19.4], 16.4 [± 9.6] months (p = 0.201). Median post metastatic bone disease survival was 15.0 [10.6-20.3], 9.0 [5.2-12.9], 3.2 [0.0-6.9] months (p = 0.010). Time to 1st SRE was not significantly different. CONCLUSIONS Incidence of brain and bone metastases was not different between EGFR+, KRAS+ and WT patients. Post brain metastases survival, time from mNSCLC diagnosis to metastatic bone disease and 1st SRE did not differ either. Post metastatic bone disease survival was significantly longer in EGFR+ patients. Although prevention of SRE's is important for all patients, the latter finding calls for a separate study for SRE preventing agents in EGFR+ patients.
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Affiliation(s)
- L E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - E F Smit
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - B A H Vosse
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - W W Mellema
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - G P Bootsma
- Department of Pulmonary Diseases, Atrium Medical Center, H. Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - M Westenend
- Department of Pulmonary Diseases, VieCuri, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - C Pitz
- Department of Pulmonary Diseases, Laurentius Hospital, Mgr. Driessenstraat 6, 6043 CV Roermond, The Netherlands
| | - G J de Vries
- Department of Pulmonary Diseases, Orbis Medical Center, PO Box 5500, 6130 MB Sittard, The Netherlands
| | - R Houben
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 3035, 6202 NA Maastricht, The Netherlands
| | - K Grünberg
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M Bendek
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - E-J M Speel
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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20
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Aerts JG, Codrington H, Lankheet NAG, Burgers S, Biesma B, Dingemans AMC, Vincent AD, Dalesio O, Groen HJM, Smit EF. A randomized phase II study comparing erlotinib versus erlotinib with alternating chemotherapy in relapsed non-small-cell lung cancer patients: the NVALT-10 study. Ann Oncol 2013; 24:2860-5. [PMID: 23986090 DOI: 10.1093/annonc/mdt341] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Epidermal growth factor receptor tyrosine kinase inhibitors (TKIs) administered concurrently with chemotherapy did not improve outcome in non-small-cell lung cancer (NSCLC). However, in preclinical models and early phase noncomparative studies, pharmacodynamic separation of chemotherapy and TKIs did show a synergistic effect. PATIENTS AND METHODS A randomized phase II study was carried out in patients with advanced NSCLC who had progressed on or following first-line chemotherapy. Erlotinib 150 mg daily (monotherapy) or erlotinib 150 mg during 15 days intercalated with four 21-day cycles docetaxel for squamous (SQ) or pemetrexed for nonsquamous (NSQ) patients was administered (combination therapy). After completion of chemotherapy, erlotinib was continued daily. Primary end point was progression-free survival (PFS). RESULTS Two hundred and thirty-one patients were randomized, 115 in the monotherapy arm and 116 in the combination arm. The adjusted hazard ratio for PFS was 0.76 [95% confidence interval (CI) 0.58-1.02; P = 0.06], for overall survival (OS) 0.67 (95% CI 0.49-0.91; P = 0.01) favoring the combination arm. This improvement was primarily observed in NSQ subgroup. Common Toxicity Criteria grade 3+ toxic effect occurred in 20% versus 56%, rash in 7% versus 15% and febrile neutropenia in 0% versus 6% in monotherapy and combination therapy, respectively. CONCLUSIONS PFS was not significantly different between the arms. OS was significantly improved in the combination arm, an effect restricted to NSQ histology. STUDY REGISTRATION NUMBER NCT00835471.
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Affiliation(s)
- J G Aerts
- Department of Pulmonary Diseases, Amphia Hospital, Breda
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21
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Kuiper JL, Lind JSW, Groen HJM, Roder J, Grigorieva J, Roder H, Dingemans AMC, Smit EF. VeriStrat(®) has prognostic value in advanced stage NSCLC patients treated with erlotinib and sorafenib. Br J Cancer 2012; 107:1820-5. [PMID: 23079575 PMCID: PMC3505013 DOI: 10.1038/bjc.2012.470] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The serum proteomic test VeriStrat has been shown to be able to classify advanced
non-small cell lung cancer (NSCLC) patients for overall survival (OS) after treatment
with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). In this
study, VeriStrat was evaluated as a pre-treatment stratification tool in patients with
advanced stage NSCLC for treatment with the combination of erlotinib and sorafenib,
considering both OS and progression-free survival (PFS) as end points. Methods: Serum samples from 50 patients treated within the context of a phase II trial of
first-line erlotinib and sorafenib were analysed with VeriStrat, a fully locked mass
spectrometry-based test that identifies patients likely to have good or poor outcome on
EGFR therapy based on eight distinct features in mass spectra. Analysis was performed
fully blinded to all clinical data, and then the outcome data were analysed with respect
to the obtained serum classifications. Results: VeriStrat classified pre-treatment samples into two groups, VeriStrat Good and
VeriStrat Poor, which were significantly different in OS (hazard ratio (HR) 0.30,
log-rank P=0.009) and in PFS (HR 0.40, log-rank
P=0.035). Conclusion: VeriStrat has shown its potential for stratification of unselected, advanced stage
NSCLC patients treated in first line with a combination of erlotinib and sorafenib.
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Affiliation(s)
- J L Kuiper
- Department of Pulmonary Diseases, VU University Medical Center, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands
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22
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De Ruysscher D, Van Meerbeeck J, Vandecasteele K, Oberije C, Pijls M, Dingemans AMC, Reymen B, van Baardwijk A, Wanders R, Lammering G, Lambin P, De Neve W. Radiation-induced oesophagitis in lung cancer patients. Is susceptibility for neutropenia a risk factor? Strahlenther Onkol 2012; 188:564-7. [PMID: 22543884 DOI: 10.1007/s00066-012-0098-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 02/21/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Radiation-induced oesophagitis is a major side effect of concurrent chemotherapy and radiotherapy. A strong association between neutropenia and oesophagitis was previously shown, but external validation and further elucidation of the possible mechanisms are lacking. METHODS AND PATIENTS A total of 119 patients were included at two institutions. The concurrent group comprised 34 SCLC patients treated with concurrent carboplatin and etoposide, and concurrent chest irradiation, and 36 NSCLC patients with concurrent cisplatin and etoposide, and concurrent radiotherapy, while the sequential group comprised 49 NSCLC patients received sequential cisplatin and gemcitabine, and radiotherapy. RESULTS Severe neutropenia was very frequent during concurrent chemoradiation (grade: 4 41.4%) and during induction chemotherapy in sequentially treated patients (grade 4: 30.6%), but not during radiotherapy (only 4% grade 1). In the concurrent group, the odds ratios of grade 3 oesophagitis vs. neutropenia were the following: grade 2 vs. grade 0/1: 5.60 (95% CI 1.55-20.26), p = 0.009; grade 3 vs. grade 0/1: 10.40 (95% CI 3.19-33.95); p = 0.0001; grade 4 vs. grade 0/1: 12.60 (95% CI 4.36-36.43); p < 0.00001. There was no correlation between the occurrence of neutropenia during induction chemotherapy and acute oesophagitis during or after radiotherapy alone. In the univariate analysis, total radiation dose (p < 0.001), overall treatment time of radiotherapy (p < 0.001), mean oesophageal dose (p = 0.038) and neutropenia (p < 0.001) were significantly associated with the development of oesophagitis. In a multivariate analysis, only neutropenia remained significant (p = 0.023). CONCLUSION We confirm that neutropenia is independently correlated with oesophagitis in concurrent chemoradiation, but that the susceptibility for chemotherapy-induced neutropenia is not associated with radiation-induced oesophagitis. Further studies focusing on the underlying mechanisms are thus warranted.
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Affiliation(s)
- D De Ruysscher
- Department of Radiation Oncology (MAASTRO clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center Maastricht, Maastricht, The Netherlands.
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23
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Dingemans AMC, de Langen AJ, van den Boogaart V, Marcus JT, Backes WH, Scholtens HTGM, van Tinteren H, Hoekstra OS, Pruim J, Brans B, Thunnissen FB, Smit EF, Groen HJM. First-line erlotinib and bevacizumab in patients with locally advanced and/or metastatic non-small-cell lung cancer: a phase II study including molecular imaging. Ann Oncol 2010; 22:559-566. [PMID: 20702788 DOI: 10.1093/annonc/mdq391] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Both bevacizumab and erlotinib have clinical activity in non-small-cell lung cancer (NSCLC). Preclinical data suggest synergistic activity. PATIENTS AND METHODS Chemonaive patients with stage IIIb or IV non-squamous NSCLC were treated with bevacizumab 15 mg/kg every 3 weeks and erlotinib 150 mg daily until progression. Primary end point was non-progression rate (NPR) at 6 weeks. Tumor response was measured with computed tomography, 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG-PET) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). KRAS and EGFR mutations were assessed in tumor samples. RESULTS Forty-seven patients were included. Median follow-up was 15.2 months. NPR at 6 weeks was 75%. Median progression-free survival (PFS) was 3.8 [95% confidence interval (CI) 2.3-5.4] months and median overall survival (OS) was 6.9 (95% CI 5.5-8.4) months. Toxicity was mainly mild. The presence of KRAS (n = 10) or EGFR mutations (n = 5) did not influence outcome. After 3 weeks of treatment, >20% decrease in standard uptake value as measured with positron emission tomography predicted for longer PFS (9.7 versus 2.8 months; P = 0.01) and >40% decrease in K(trans) as assessed by DCE-MRI did not predict for longer PFS. CONCLUSIONS First-line treatment with bevacizumab and erlotinib in stage IIIb/IV NSCLC resulted in an NPR of 75%. OS was however disappointing. Early response evaluation with FDG-PET is the best predictive test for PFS.
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Affiliation(s)
- A-M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center, Maastricht; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht;.
| | | | - V van den Boogaart
- Department of Pulmonary Diseases, Maastricht University Medical Center, Maastricht; GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - J T Marcus
- Physics and Medical Technology, VU University Medical Center, Amsterdam
| | - W H Backes
- Department of Radiology, Maastricht University Medical Center, Maastricht
| | - H T G M Scholtens
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen
| | - H van Tinteren
- Department of Medical Statistics, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam
| | - O S Hoekstra
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam
| | - J Pruim
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen
| | - B Brans
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht;; Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht
| | - F B Thunnissen
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - E F Smit
- Departments of Pulmonary Diseases
| | - H J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen
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