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van Berge Henegouwen JM, Jebbink M, Hoes LR, van der Wijngaart H, Zeverijn LJ, van der Velden DL, Roepman P, de Leng WWJ, Jansen AML, van Werkhoven E, van der Noort V, van der Wekken AJ, de Langen AJ, Voest EE, Verheul HMW, Smit EF, Gelderblom H. Trastuzumab and pertuzumab combination therapy for advanced pre-treated HER2 exon 20-mutated non-small cell lung cancer. Eur J Cancer 2022; 171:114-123. [PMID: 35716537 DOI: 10.1016/j.ejca.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/23/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In 1-3% of non-small cell lung cancer (NSCLC) human epidermal growth factor 2 (HER2) mutations are identified as a genomic driver. Nevertheless, no HER2-targeted treatment is approved for NSCLC. In the Drug Rediscovery Protocol (DRUP), patients are treated with off-label drugs based on their molecular profile. Here, we present the results of the cohort 'trastuzumab/pertuzumab for HER2 exon20 mutation positive (HER2m+) NSCLC'. METHODS Patients with treatment refractory, advanced HER2m+ NSCLC with measurable disease (RECISTv1.1) were eligible. Treatment with intravenous trastuzumab combined with pertuzumab every 3 weeks was administered. The primary end-point was clinical benefit (CB: either objective response or stable disease ≥ 16 weeks). Patients were enrolled using a Simon-like 2-stage design, with 8 patients in stage 1 and up to 24 patients in stage 2 if at least 1 patient had CB in stage 1. At baseline, a biopsy for biomarker analysis, including whole genome sequencing, was obtained. RESULTS Twenty-four evaluable patients were enrolled and treated between May 2017 and August 2020. CB was observed in 9 patients (38%); including an objective response rate of 8.3% (2 patients had a partial response) and 7 patients with stable disease ≥ 16 weeks. The most frequently observed HER2 mutation was p.Y772_A775dup (71%, n = 20). Median follow-up was 13 months, median progression-free survival and overall survival 4 (95% CI 3-6) and 10 months (95% CI 4 - not reached), respectively. Whole genome sequencing data (available for 67% of patients) confirmed the inclusion mutation in all cases. No unexpected toxicity was observed. CONCLUSION Despite the fact that the study did meet its primary end-point, trastuzumab/pertuzumab was only marginally active in a subset of patients with heavily pre-treated HER2m+ NSCLC.
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Affiliation(s)
- J M van Berge Henegouwen
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands; Oncode Institute, the Netherlands
| | - M Jebbink
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - L R Hoes
- Oncode Institute, the Netherlands; Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H van der Wijngaart
- Oncode Institute, the Netherlands; Department of Medical Oncology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - L J Zeverijn
- Oncode Institute, the Netherlands; Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - D L van der Velden
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - P Roepman
- Hartwig Medical Foundation, Amsterdam, the Netherlands
| | - W W J de Leng
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A M L Jansen
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E van Werkhoven
- Biometrics Department, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - V van der Noort
- Biometrics Department, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - A J van der Wekken
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A J de Langen
- Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - E E Voest
- Oncode Institute, the Netherlands; Department of Molecular Oncology & Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E F Smit
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
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van der Velden DL, Hoes LR, van der Wijngaart H, van Berge Henegouwen JM, van Werkhoven E, Roepman P, Schilsky RL, de Leng WWJ, Huitema ADR, Nuijen B, Nederlof PM, van Herpen CML, de Groot DJA, Devriese LA, Hoeben A, de Jonge MJA, Chalabi M, Smit EF, de Langen AJ, Mehra N, Labots M, Kapiteijn E, Sleijfer S, Cuppen E, Verheul HMW, Gelderblom H, Voest EE. The Drug Rediscovery protocol facilitates the expanded use of existing anticancer drugs. Nature 2019; 574:127-131. [DOI: 10.1038/s41586-019-1600-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/14/2019] [Indexed: 12/19/2022]
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van Waalwijk van Doorn-Khosrovani SB, Pisters-van Roy A, van Saase L, van der Graaff M, Gijzen J, Sleijfer S, Hoes LR, van Berge Henegouwen JM, van der Wijngaart H, van der Velden DL, van Werkhoven E, Retel VP, van Harten WH, Huitema ADR, Timmers L, Gelderblom H, Verheul HMW, Voest EE. Personalised reimbursement: a risk-sharing model for biomarker-driven treatment of rare subgroups of cancer patients. Ann Oncol 2019; 30:663-665. [PMID: 31038154 DOI: 10.1093/annonc/mdz119] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - L van Saase
- National Health Care Institute (Zorginstituut Nederland), Diemen
| | - M van der Graaff
- National Health Care Institute (Zorginstituut Nederland), Diemen
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam; Center for Personalised Cancer Treatment (CPCT)
| | - L R Hoes
- Division of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam
| | | | - H van der Wijngaart
- Division of Medical Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, Amsterdam
| | - D L van der Velden
- Division of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam
| | - E van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam
| | - V P Retel
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam; Department of Health Technology and Services Research, University of Twente, Enschede
| | - W H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam; Department of Health Technology and Services Research, University of Twente, Enschede; Rijnstate Hospital, Arnhem
| | - A D R Huitema
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam; Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L Timmers
- National Health Care Institute (Zorginstituut Nederland), Diemen
| | - H Gelderblom
- Division of Medical Oncology, Leiden University Medical Center, Leiden
| | - H M W Verheul
- Division of Medical Oncology, Leiden University Medical Center, Leiden
| | - E E Voest
- Center for Personalised Cancer Treatment (CPCT); Division of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam.
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van der Velden DL, van Herpen CML, van Laarhoven HWM, Smit EF, Groen HJM, Willems SM, Nederlof PM, Langenberg MHG, Cuppen E, Sleijfer S, Steeghs N, Voest EE. Molecular Tumor Boards: current practice and future needs. Ann Oncol 2018; 28:3070-3075. [PMID: 29045504 DOI: 10.1093/annonc/mdx528] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Due to rapid technical advances, steeply declining sequencing costs, and the ever-increasing number of targeted therapies, it can be expected that extensive tumor sequencing such as whole-exome and whole-genome sequencing will soon be applied in standard care. Clinicians will thus be confronted with increasingly complex genetic information and multiple test-platforms to choose from. General medical training, meanwhile, can hardly keep up with the pace of innovation. Consequently, there is a rapidly growing gap between clinical knowledge and genetic potential in cancer care. Multidisciplinary Molecular Tumor Boards (MTBs) have been suggested as a means to address this disparity, but shared experiences are scarce in literature and no quality requirements or guidelines have been published to date. Methods Based on literature review, a survey among hospitals in The Netherlands, and our own experience with the establishment of a nationally operating MTB, this article evaluates current knowledge and unmet needs and lays out a strategy for successful MTB implementation. Results Having access to an MTB can improve and increase the application of genetics-guided cancer care. In our survey, however, <50% of hospitals and only 5% of nonacademic hospitals had access to an MTB. In addition, current MTBs vary widely in terms of composition, tasks, tools, and workflow. This may not only lead to variation in quality of care but also hinders data sharing and thus creation of an effective learning community. Conclusions This article acknowledges a leading role for MTBs to govern (extensive) tumor sequencing into daily practice and proposes three basic necessities for successful MTB implementation: (i) global harmonization in cancer sequencing practices and procedures, (ii) minimal member and operational requirements, and (iii) an appropriate unsolicited findings policy. Meeting these prerequisites would not only optimize MTB functioning but also improve general interpretation and application of genomics-guided cancer care.
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Affiliation(s)
| | - C M L van Herpen
- Division of Medical Oncology, Radboud University Medical Center, Nijmegen
| | | | - E F Smit
- Division of Medical Oncology, Netherlands Cancer Institute, Amsterdam
| | - H J M Groen
- Division of Medical Oncology, University Medical Center Groningen, Groningen
| | - S M Willems
- Division of Pathology, University Medical Center Utrecht, Utrecht
| | - P M Nederlof
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam
| | | | - E Cuppen
- Human Genetics, University Medical Center Utrecht, Utrecht
| | - S Sleijfer
- Division of Medical Oncology, Erasmus University Medical Center, Rotterdam
| | - N Steeghs
- Division of Medical Oncology and Clinical Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E E Voest
- Division of Molecular Oncology, Netherlands Cancer Institute, Amsterdam
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