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Sebastian M, Eberhardt WEE, von der Heyde E, Dörfel S, Wiegand J, Schiefer C, Losem C, Jänicke M, Fleitz A, Zacharias S, Kaiser-Osterhues A, Hipper A, Dietel C, Bleckmann A, Benkelmann R, Boesche M, Grah C, Müller A, Griesinger F, Thomas M. Patient-reported outcomes in advanced NSCLC before and during the COVID-19 pandemic: Real-world data from the German prospective CRISP Registry (AIO-TRK-0315). Int J Cancer 2024; 154:1967-1978. [PMID: 38329180 DOI: 10.1002/ijc.34868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024]
Abstract
Patients with lung cancer under treatment have been associated with a high risk of COVID-19 infection and potentially worse outcome, but real-world data on patient-reported outcomes (PROs) are rare. We assess patients' characteristics and PROs before and during the COVID-19 pandemic in an advanced non-small cell lung cancer (NSCLC) cohort in Germany. Patients with locally advanced or metastatic NSCLC from the prospective, multicentre, observational CRISP Registry (NCT02622581) were categorised as pre-pandemic (March 2019 to Feb 2020, n = 1621) and pandemic (March 2020 to Feb 2021, n = 1317). From baseline to month 15, patients' health-related quality of life (HRQoL) was assessed by FACT-L, anxiety and depression by PHQ-4. Association of pandemic status with time to deterioration (TTD) in QoL scales adjusted for potential covariates was estimated using Cox modelling. PROs were documented for 1166 patients (72%) in the pre-pandemic, 979 (74%) in the pandemic group. Almost 60% of patients were male, median age was 66 years, comorbidities occurred in 85%. Regarding HRQoL, mean-change-from-baseline plots hardly differed between both samples. Approximately 15%-21% of patients reported anxiety, about 19%-27% signs of depression. For the pandemic group, TTD was slightly, but statistically significantly, worse for the physical well-being-FACT-G subscale (HR 1.15 [95%CI 1.02-1.30]) and the anxiety-GAD-2 subscale (HR 1.14 [95%CI 1.01-1.29]). These prospectively collected real-world data provide valuable insights into PROs before and during the COVID-19 pandemic in advanced NSCLC. For the patients, the pandemic seemed to be less of a burden than the disease itself, as there was a considerable proportion of patients with anxiety and depression in both groups.
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Grants
- The CRISP project is supported by grants from Amgen Ltd, AstraZeneca GmbH, Boehringer Ingelheim Pharma GmbH & Co. KG, Bristol-Myers Squibb GmbH & Co. KGaA, Celgene GmbH, Janssen-Cilag GmbH, Lilly Deutschland GmbH, MSD Sharp & Dohme GmbH, Novartis Pharma GmbH, Pfizer Pharma GmbH, Roche Pharma AG, and Takeda Pharma Vertriebs GmbH & Co. KG. None of the funders had any role in study design, data collection and analysis, interpretation of results, decision to publish, or preparation of the manuscript
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Affiliation(s)
- Martin Sebastian
- Department of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
- Frankfurt Cancer Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Wilfried E E Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | | | | | - Jörg Wiegand
- Gemeinschaftspraxis für Hämatologie & Onkologie, Moers, Germany
| | | | | | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg i. Br, Germany
| | - Annette Fleitz
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg i. Br, Germany
| | | | | | | | | | - Annalen Bleckmann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Münster, Germany
| | - Robin Benkelmann
- Innere Medizin/Hämatoonkologie/Gastroenterologie/Palliativmedizin, I. Med. Klinik, Konstanz, Germany
| | - Michael Boesche
- Pneumologie, Klinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Christian Grah
- Pneumologie-Lungenkrebszentrum, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Annette Müller
- Marienhof Koblenz, Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational, Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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Bischoff P, Reck M, Overbeck T, Christopoulos P, Rittmeyer A, Lüders H, Kollmeier J, Kulhavy J, Kemper M, Reinmuth N, Röper J, Janning M, Sommer L, Aguinarte L, Koch M, Wiesweg M, Wesseler C, Waller CF, Kauffmann-Guerrero D, Stenzinger A, Stephan-Falkenau S, Trautmann M, Lassmann S, Tiemann M, Klauschen F, Sebastian M, Griesinger F, Wolf J, Loges S, Frost N. Outcome of First-Line Treatment With Pembrolizumab According to KRAS/TP53 Mutational Status for Nonsquamous Programmed Death-Ligand 1-High (≥50%) NSCLC in the German National Network Genomic Medicine Lung Cancer. J Thorac Oncol 2024; 19:803-817. [PMID: 38096950 DOI: 10.1016/j.jtho.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Programmed death-ligand 1 expression currently represents the only validated predictive biomarker for immune checkpoint inhibition in metastatic NSCLC in the clinical routine, but it has limited value in distinguishing responses. Assessment of KRAS and TP53 mutations (mut) as surrogate for an immunosupportive tumor microenvironment (TME) might help to close this gap. METHODS A total of 696 consecutive patients with programmed death-ligand 1-high (≥50%), nonsquamous NSCLC, having received molecular testing within the German National Network Genomic Medicine Lung Cancer between 2017 and 2020, with Eastern Cooperative Oncology Group performance status less than or equal to 1 and pembrolizumab as first-line palliative treatment, were included into this retrospective cohort analysis. Treatment efficacy and outcome according to KRAS/TP53 status were correlated with TME composition and gene expression analysis of The Cancer Genome Atlas lung adenocarcinoma cohort. RESULTS Proportion of KRASmut and TP53mut was 53% (G12C 25%, non-G12C 28%) and 51%, respectively. In KRASmut patients, TP53 comutations increased response rates (G12C: 69.7% versus 46.5% [TP53mut versus wild-type (wt)], p = 0.004; non-G12C: 55.4% versus 39.5%, p = 0.03), progression-free survival (G12C: hazard ratio [HR] = 0.59, p = 0.009, non-G12C: HR = 0.7, p = 0.047), and overall survival (G12C: HR = 0.72, p = 0.16, non-G12C: HR = 0.56, p = 0.002), whereas no differences were observed in KRASwt patients. After a median follow-up of 41 months, G12C/TP53mut patients experienced the longest progression-free survival and overall survival (33.7 and 65.3 mo), which correlated with high tumor-infiltrating lymphocyte densities in the TME and up-regulation of interferon gamma target genes. Proinflammatory pathways according to TP53 status (mut versus wt) were less enhanced and not different in non-G12C and KRASwt, respectively. CONCLUSIONS G12C/TP53 comutations identify a subset of patients with a very favorable long-term survival with immune checkpoint inhibitor monotherapy, mediated by highly active interferon gamma signaling in a proinflammatory TME.
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Affiliation(s)
- Philip Bischoff
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany; BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| | - Tobias Overbeck
- Department of Haematology and Medical Oncology, University Medical Center Göttingen and Lungentumorzentrum Universität Göttingen, Göttingen, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Achim Rittmeyer
- Department of Thoracic Oncology, LKI Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - Heike Lüders
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany; Berlin Lung Institute, Berlin, Germany
| | - Jonas Kulhavy
- Translational Oncology/Early Clinical Trial Unit (ECTU), Comprehensive Cancer Center Mainfranken and Bavarian Cancer Research Center (BZKF), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marcel Kemper
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Niels Reinmuth
- Asklepios Lung Clinic, member of the German Center for Lung Research (DZL), Munich-Gauting, Germany
| | - Julia Röper
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine-Oncology, Oldenburg, Germany
| | - Melanie Janning
- DKFZ-Hector Cancer Institute and Department of Personalized Oncology at the University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Division of Personalized Medical Oncology (A420), German Cancer Research Center (DKFZ), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Linna Sommer
- Department of Thoracic Oncology, Carl-Gustav-Carus Dresden University Hospital, Dresden, Germany
| | - Lukas Aguinarte
- Hematology/Oncology, Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Myriam Koch
- University Hospital Regensburg, Department of Internal Medicine 2, Regensburg, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Claas Wesseler
- Department of Thoracic Oncology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Cornelius F Waller
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg and Faculty of Medicine, Freiburg, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL-CPCM), Munich, Germany
| | | | | | - Marcel Trautmann
- University of Münster, Division of Translational Pathology, Gerhard-Domagk-Institute of Pathology, Münster University Hospital, Münster, Germany
| | - Silke Lassmann
- Institute for Surgical Pathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany; Berlin Institute for the Foundation of Learning and Data (BIFOLD) and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Sebastian
- Hematology/Oncology, Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine-Oncology, Oldenburg, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Sonja Loges
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany.
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Kemper M, Soltani Germy P, Acker F, Luan J, Griesinger F, Tufman A, Kropf-Sanchen C, Overbeck TR, Bleckmann A, Blasi M. Thoracic Oncology Highlights from the European Society for Medical Oncology Annual Meeting 2023 with focus on perioperative therapy, radiotherapy and BiTEs. Oncol Res Treat 2024:000538662. [PMID: 38574467 DOI: 10.1159/000538662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
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Illini O, Saalfeld FC, Christopoulos P, Duruisseaux M, Vikström A, Peled N, Demedts I, Dudnik E, Eisert A, Hashemi SMS, Janzic U, Kian W, Mohorcic K, Mohammed S, Silvoniemi M, Rothschild SI, Schulz C, Wesseler C, Addeo A, Armster K, Itchins M, Ivanović M, Kauffmann-Guerrero D, Koivunen J, Kuon J, Pavlakis N, Piet B, Sebastian M, Velthaus-Rusik JL, Wannesson L, Wiesweg M, Wurm R, Albers-Leischner C, Aust DE, Janning M, Fabikan H, Herold S, Klimova A, Loges S, Sharapova Y, Schütz M, Weinlinger C, Valipour A, Overbeck TR, Griesinger F, Jakopovic M, Hochmair MJ, Wermke M. Mobocertinib in Patients with EGFR Exon 20 Insertion-Positive Non-Small Cell Lung Cancer (MOON): An International Real-World Safety and Efficacy Analysis. Int J Mol Sci 2024; 25:3992. [PMID: 38612799 PMCID: PMC11012872 DOI: 10.3390/ijms25073992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
EGFR exon 20 (EGFR Ex20) insertion mutations in non-small cell lung cancer (NSCLC) are insensitive to traditional EGFR tyrosine kinase inhibitors (TKIs). Mobocertinib is the only approved TKI specifically designed to target EGFR Ex20. We performed an international, real-world safety and efficacy analysis on patients with EGFR Ex20-positive NSCLC enrolled in a mobocertinib early access program. We explored the mechanisms of resistance by analyzing postprogression biopsies, as well as cross-resistance to amivantamab. Data from 86 patients with a median age of 67 years and a median of two prior lines of treatment were analyzed. Treatment-related adverse events (TRAEs) occurred in 95% of patients. Grade ≥3 TRAEs were reported in 38% of patients and included diarrhea (22%) and rash (8%). In 17% of patients, therapy was permanently discontinued, and two patients died due to TRAEs. Women were seven times more likely to discontinue treatment than men. In the overall cohort, the objective response rate to mobocertinib was 34% (95% CI, 24-45). The response rate in treatment-naïve patients was 27% (95% CI, 8-58). The median progression-free and overall survival was 5 months (95% CI, 3.5-6.5) and 12 months (95% CI, 6.8-17.2), respectively. The intracranial response rate was limited (13%), and one-third of disease progression cases involved the brain. Mobocertinib also showed antitumor activity following EGFR Ex20-specific therapy and vice versa. Potential mechanisms of resistance to mobocertinib included amplifications in MET, PIK3CA, and NRAS. Mobocertinib demonstrated meaningful efficacy in a real-world setting but was associated with considerable gastrointestinal and cutaneous toxicity.
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Affiliation(s)
- Oliver Illini
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Bruenner Straße 68, A-1210 Vienna, Austria (M.J.H.)
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Felix Carl Saalfeld
- Clinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany; (F.C.S.); (M.W.)
- National Center for Tumor Diseases, 01307 Dresden, Germany
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
| | - Petros Christopoulos
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Thoraxklinik and Translational Lung Research Center (TLRC), member of the German Center for Lung Research (DZL), Heidelberg University Hospital, 69126 Heidelberg, Germany
| | - Michaël Duruisseaux
- Respiratory Department and Early Phase, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, 69002 Lyon, France
- Oncopharmacology Laboratory, Cancer Research Center of Lyon, Unité Mixte de Recherche (UMR), Institut National de la Santé et de la Recherche Médicale (INSERM), 1052 Centre National de la Recherche Scientifique (CNRS), 5286 Lyon, France
- Université Claude Bernard, Université de Lyon, 69622 Villeurbanne cedex, France
| | - Anders Vikström
- Department of Pulmonary Medicine, University Hospital Linköping, 58185 Linköping, Sweden
| | - Nir Peled
- The Hemsely Cancer Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Ingel Demedts
- Department of Pulmonary Diseases, AZ Delta, Deltalaan 1, 8800 Roeselare, Belgium;
| | - Elizabeth Dudnik
- Head, Thoracic Oncology Service, Assuta Medical Centers, Tel-Aviv 6329302, Israel
- Faculty of Health Sciences, Ben-Gurion Unversity of the Negev, Be’er Sheva 84105, Israel
| | - Anna Eisert
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Sayed M. S. Hashemi
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, 1081 Amsterdam, The Netherlands
| | - Urska Janzic
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (U.J.)
- Medical Oncology Unit, University Clinic Golnik, 4204 Golnik, Slovenia
| | - Waleed Kian
- The Hemsely Cancer Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Institute of Oncology, Assuta Ashdod University Hospital, Ashdod 7747629, Israel
| | - Katja Mohorcic
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (U.J.)
| | - Saara Mohammed
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent TN24QJ, UK
| | - Maria Silvoniemi
- Department of Pulmonary Diseases, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Sacha I. Rothschild
- Center for Oncology & Hematology and Comprehensive Cancer Center, Cantonal Hospital Baden, 5404 Baden, Switzerland
| | - Christian Schulz
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Internal Medicine II, University Hospital, 93053 Regensburg, Germany
| | - Claas Wesseler
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Pneumology, Asklepios Tumorzentrum Hamburg, Klinikum Harburg, 21075 Hamburg, Germany
| | - Alfredo Addeo
- Oncology Department, University Hospital Geneva, 1205 Geneva, Switzerland
| | - Karin Armster
- Department of Pneumology, Universitätsklinikum Krems, 3500 Krems an der Donau, Austria
| | - Malinda Itchins
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW 2065, Australia
| | - Marija Ivanović
- Department of Oncology, University Medical Centre Maribor, 2000 Maribor, Slovenia
| | - Diego Kauffmann-Guerrero
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Thoracic Oncology Center Munich, University Hospital, University of Munich (LMU), 81377 Munich, Germany
| | - Jussi Koivunen
- Department of Oncology and Radiotherapy, Oulu University Hospital, 90014 Oulu, Finland
- Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
- Medical Research Center Oulu, 90014 Oulu, Finland
| | - Jonas Kuon
- Department Thoracic Oncology, SLK Fachklinik Löwenstein, 74245 Löwenstein, Germany
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW 2065, Australia
| | - Berber Piet
- Department of Respiratory Medicine, Radboudumc, 6225 GA Nijmegen, The Netherlands
| | - Martin Sebastian
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Medicine, Hematology/Oncology, University Hospital, University of Frankfurt, 60596 Frankfurt am Main, Germany
| | - Janna-Lisa Velthaus-Rusik
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Luciano Wannesson
- Istituto Oncologico della Svizzera Italiana, 6500 Bellinzona, Switzerland
| | - Marcel Wiesweg
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- West German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, 45147 Essen, Germany
| | - Robert Wurm
- Division of Pulmonology, Department of Internal Medicine, LKH-Universitätsklinikum, Medical University of Graz, 8036 Graz, Austria
| | - Corinna Albers-Leischner
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Comprehensive Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Daniela E. Aust
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department for Pathology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Melanie Janning
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, 68167 Mannheim, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Hannah Fabikan
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Sylvia Herold
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department for Pathology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Anna Klimova
- Core Unit for Data Management and Analytics, National Center for Tumor Diseases, 01307 Dresden, Germany
| | - Sonja Loges
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, 68167 Mannheim, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Yana Sharapova
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, 68167 Mannheim, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, 68167 Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Maret Schütz
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department for Pathology, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
| | - Christoph Weinlinger
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Bruenner Straße 68, A-1210 Vienna, Austria (M.J.H.)
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Tobias Raphael Overbeck
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen University, 37075 Göttingen, Germany
| | - Frank Griesinger
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
- Department of Hematology and Oncology, Pius University Hospital, University Medicine Oldenburg, 26121 Oldenburg, Germany
| | - Marko Jakopovic
- Department for Respiratory Diseases Jordanovac, University Hospital Center Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Maximilian J. Hochmair
- Department of Respiratory and Critical Care Medicine, Klinik Floridsdorf, Vienna Healthcare Group, Bruenner Straße 68, A-1210 Vienna, Austria (M.J.H.)
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, A-1210 Vienna, Austria
| | - Martin Wermke
- Clinic for Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany; (F.C.S.); (M.W.)
- National Center for Tumor Diseases, 01307 Dresden, Germany
- National Network Genomic Medicine Lung Cancer (nNGM), 50937 Cologne, Germany
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Stratmann JA, Althoff FC, Doebel P, Rauh J, Trummer A, Hünerlitürkoglu AN, Frost N, Yildirim H, Christopoulos P, Burkhard O, Büschenfelde CMZ, Becker von Rose A, Alt J, Aries SP, Webendörfer M, Kaldune S, Uhlenbruch M, Tritchkova G, Waller CF, Rittmeyer A, Hoffknecht P, Braess J, Kopp HG, Grohé C, Schäfer M, Schumann C, Griesinger F, Kuon J, Sebastian M, Reinmuth N. Sotorasib in KRAS G12C-mutated non-small cell lung cancer: A multicenter real-world experience from the compassionate use program in Germany. Eur J Cancer 2024; 201:113911. [PMID: 38377774 DOI: 10.1016/j.ejca.2024.113911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Sotorasib is a first-in-class KRAS p.G12C-inhibitor that has entered clinical trials in pretreated patients with non-small cell lung cancer (NSCLC) in 2018. First response rates were promising in the CodeBreaK trials. It remains unclear whether response to sotorasib and outcomes differ in a real-world setting when including patients underrepresented in clinical trials. METHODS Patients with KRAS p.G12C-mutated advanced or metastatic NSCLC received sotorasib within the German multicenter sotorasib compassionate use program between 2020 to 2022. Data on efficacy, tolerability, and survival were analyzed in the full cohort and in subgroups of special interest such as co-occurring mutations and across PD-L1 expression levels. RESULTS We analyzed 163 patients who received sotorasib after a median of two treatment lines (range, 0 to 7). Every fourth patient had a poor performance status and 38% had brain metastases (BM). The objective response rate was 38.7%. The median overall survival was 9.8 months (95% CI, 6.5 to not reached). Median real-world (rw) progression-free survival was 4.8 months (9% CI, 3.9 to 5.9). Dose reductions and permanent discontinuation were necessary in 35 (21.5%) and 7 (4.3%) patients, respectively. Efficacy seems to be influenced by PD-L1 expression and a co-occurring KEAP1 mutation. KEAP1 was associated with an inferior survival. Other factors such as BM, STK11, and TP53 mutations had no impact on response and survival. CONCLUSION First results from a real-world population confirm promising efficacy of sotorasib for the treatment of advanced KRAS p.G12C-mutated NSCLC. Patients with co-occurring KEAP1 mutations seem to derive less benefit.
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Affiliation(s)
- Jan A Stratmann
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany
| | - Friederike C Althoff
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany.
| | - Paula Doebel
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany
| | - Jacqueline Rauh
- Hospital Witten, Medical Specialist Center of Internal Medicine, Witten, Germany
| | - Arne Trummer
- Municipal Clinic Braunschweig, Medical Specialist Center of Hematology/Oncology, Braunschweig, Germany
| | | | - Nikolaj Frost
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | | | - Petros Christopoulos
- University Hospital Heidelberg, Thoraxklinik Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg, member of the German Center for Lung Research (DZL), Germany
| | - Oswald Burkhard
- Medical Specialist Center of Internal Medicine, Hematology Oncology, Palliative Medicine in Worms, Worms, Germany
| | | | - Aaron Becker von Rose
- Technical University Munich, Klinikum rechts der Isar, Medical Department for Haematology and Oncology, Munich, Germany
| | - Jürgen Alt
- University Medical Center Mainz, Department of Internal Medicine III, Mainz, Germany
| | | | - Maximilian Webendörfer
- University Hospital Essen, West German Cancer Center, Department of Medical Oncology, Essen, Germany
| | - Stefan Kaldune
- RoMed Clinic Rosenheim, Department of Hematology/Oncology, Rosenheim, Germany
| | - Mark Uhlenbruch
- Kaiserswerther Diakonie Florence-Nightingale-Hospital Düsseldorf, Department of Hematology/Oncology, Düsseldorf, Germany
| | - Guergana Tritchkova
- University Hospital Dresden, TU Dresden, Clinic for Internal Medicine I, Dresden, Germany
| | - Cornelius F Waller
- University of Freiburg, University Medical Centre Freiburg, Department of Haematology, Oncology and Stem Cell Transplantation, Freiburg, Germany
| | | | - Petra Hoffknecht
- Niels-Stensen-Kliniken Franziskus Hospital Harderberg, Department of Hematology/Oncology, Hardenberg, Germany
| | - Jan Braess
- Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Hans-Georg Kopp
- Robert Bosch Center for Tumor Diseases, Robert-Bosch-Hospital, Stuttgart, Germany
| | | | - Monica Schäfer
- Helios Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - Christian Schumann
- Klinikverbund Allgäu gGmbH, Clinic for Pneumology, Thoracic Oncology, Sleep and Respiratory Medicine, Kempten and Immenstadt, Germany
| | - Frank Griesinger
- Pius-Hospital, University Medicine Oldenburg, Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Oldenburg, Germany
| | - Jonas Kuon
- Lungenklinik Löwenstein, Department of Oncology, Löwenstein, Germany
| | - Martin Sebastian
- Goethe University Frankfurt, University Hospital, Department of Internal Medicine II, Hematology/Oncology, Frankfurt am Main, Germany
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Griesinger F, Sebastian M, Brueckl WM, Hummel HD, Jaeschke B, Kern J, Wesseler C, Jänicke M, Fleitz A, Zacharias S, Hipper A, Groth A, Weichert W, Dörfel S, Petersen V, Schröder J, Wilke J, Eberhardt WE, Thomas M. Checkpoint Inhibitor Monotherapy in Potentially Trial-Eligible or Trial-Ineligible Patients With Metastatic NSCLC in the German Prospective CRISP Registry Real-World Cohort (AIO-TRK-0315). JTO Clin Res Rep 2024; 5:100626. [PMID: 38586301 PMCID: PMC10995980 DOI: 10.1016/j.jtocrr.2023.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 04/09/2024] Open
Abstract
Introduction Patients with metastatic NSCLC (mNSCLC) treated with immune checkpoint inhibitors in clinical practice may often not meet the strict inclusion criteria of clinical trials. Our aim was to assess the trial eligibility of patients with mNSCLC treated with pembrolizumab monotherapy in real-world and to compare the outcome of "trial-ineligible" and "potentially trial-eligible" patients. Methods Data from the prospective, clinical research platform CRISP were used to compare patient characteristics, treatment, and outcome of patients with programmed cell death-ligand 1 tumor proportion score greater than or equal to 50% tumors treated with pembrolizumab monotherapy who are deemed either "potentially trial-eligible" or "trial-ineligible" according to inclusion and exclusion criteria of the registrational studies (KEYNOTE-024 and -042). Results Of 746 patients included, 343 patients (46.0%) were classified as "trial-ineligible" and had significantly worse outcomes compared with "potentially trial-eligible" patients (n = 403, 54.0%): median progression-free survival: 6.2 (95% confidence interval [CI]: 5.2-8.4) versus 10.3 (95% CI: 8.4-13.8) months, hazard ratio (trial-ineligible versus potentially trial-eligible) of 1.43 (95% CI: 1.19-1.72), p less than 0.001; median overall survival: 15.9 (95% CI: 11.4-20.3) versus 25.3 (95% CI: 19.8-30.4) months, hazard ratio of 1.36 (95% CI: 1.10-1.67), p equals 0.004. Conclusions Our data reveal that a considerable proportion of patients with mNSCLC are not eligible to participate in a clinical trial and were found to have worse outcomes than potentially trial-eligible patients, whose outcomes were comparable with those obtained from pivotal clinical trials. This is of substantial clinical relevance for physicians discussing outcomes to be expected with their patients and stresses the need for real-world effectiveness analyses.
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Affiliation(s)
- Frank Griesinger
- Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Martin Sebastian
- Department of Medicine II, Hematology/Oncology, University Hospital Frankfurt, Frankfurt, Germany; German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Germany; Frankfurt Cancer Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Wolfgang M. Brueckl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Horst-Dieter Hummel
- Translational Oncology/Early Clinical Trial Unit (ECTU), Comprehensive Cancer Center Mainfranken and Bavarian Cancer Research Center (BZKF), University Hospital Würzburg, Würzburg, Germany
| | - Bastian Jaeschke
- HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, IM III: Hämatologie, Onkologie, Palliativmedizin, Interdisziplinäre Onkologische Ambulanz, Wiesbaden, Germany
| | - Jens Kern
- Klinikum Würzburg Mitte, Missioklinik, Medizinische Klinik – Schwerpunkt Pneumologie und Beatmungsmedizin, Würzburg, Germany
| | - Claas Wesseler
- Asklepios Tumorzentrum Hamburg, Klinikum Harburg, Lungenabteilung, Hamburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Annette Fleitz
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | | | - Wilko Weichert
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Volker Petersen
- Onkologische Schwerpunktpraxis Dr. med. Volker Petersen, Heidenheim a.d.B, Germany
| | - Jan Schröder
- Gemeinschaftspraxis für Hämatologie und internistische Onkologie, Mülheim a.d.R., Germany
| | - Jochen Wilke
- Schwerpunktpraxis Hämatologie & Internistische Onkologie, Fürth, Germany
| | - Wilfried E.E. Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen - Ruhrlandklinik, Essen, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational, Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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7
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Acker F, Luan J, Soltani Germy P, Kemper M, Blasi M, Griesinger F, Tufman A, Bleckmann A, Kropf-Sanchen C, Overbeck TR. Thoracic Oncology Highlights from the European Society for Medical Oncology Annual Meeting 2023 with focus on targeted therapies. Oncol Res Treat 2024:000538436. [PMID: 38527447 DOI: 10.1159/000538436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 03/27/2024]
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8
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George J, Maas L, Abedpour N, Cartolano M, Kaiser L, Fischer RN, Scheel AH, Weber JP, Hellmich M, Bosco G, Volz C, Mueller C, Dahmen I, John F, Alves CP, Werr L, Panse JP, Kirschner M, Engel-Riedel W, Jürgens J, Stoelben E, Brockmann M, Grau S, Sebastian M, Stratmann JA, Kern J, Hummel HD, Hegedüs B, Schuler M, Plönes T, Aigner C, Elter T, Toepelt K, Ko YD, Kurz S, Grohé C, Serke M, Höpker K, Hagmeyer L, Doerr F, Hekmath K, Strapatsas J, Kambartel KO, Chakupurakal G, Busch A, Bauernfeind FG, Griesinger F, Luers A, Dirks W, Wiewrodt R, Luecke A, Rodermann E, Diel A, Hagen V, Severin K, Ullrich RT, Reinhardt HC, Quaas A, Bogus M, Courts C, Nürnberg P, Becker K, Achter V, Büttner R, Wolf J, Peifer M, Thomas RK. Evolutionary trajectories of small cell lung cancer under therapy. Nature 2024; 627:880-889. [PMID: 38480884 PMCID: PMC10972747 DOI: 10.1038/s41586-024-07177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
The evolutionary processes that underlie the marked sensitivity of small cell lung cancer (SCLC) to chemotherapy and rapid relapse are unknown1-3. Here we determined tumour phylogenies at diagnosis and throughout chemotherapy and immunotherapy by multiregion sequencing of 160 tumours from 65 patients. Treatment-naive SCLC exhibited clonal homogeneity at distinct tumour sites, whereas first-line platinum-based chemotherapy led to a burst in genomic intratumour heterogeneity and spatial clonal diversity. We observed branched evolution and a shift to ancestral clones underlying tumour relapse. Effective radio- or immunotherapy induced a re-expansion of founder clones with acquired genomic damage from first-line chemotherapy. Whereas TP53 and RB1 alterations were exclusively part of the common ancestor, MYC family amplifications were frequently not constituents of the founder clone. At relapse, emerging subclonal mutations affected key genes associated with SCLC biology, and tumours harbouring clonal CREBBP/EP300 alterations underwent genome duplications. Gene-damaging TP53 alterations and co-alterations of TP53 missense mutations with TP73, CREBBP/EP300 or FMN2 were significantly associated with shorter disease relapse following chemotherapy. In summary, we uncover key processes of the genomic evolution of SCLC under therapy, identify the common ancestor as the source of clonal diversity at relapse and show central genomic patterns associated with sensitivity and resistance to chemotherapy.
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Affiliation(s)
- Julie George
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, Cologne, Germany.
| | - Lukas Maas
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nima Abedpour
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Cologne, Cologne, Germany
- Cancer Research Centre Cologne Essen, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maria Cartolano
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Centre for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Laura Kaiser
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rieke N Fischer
- Department I of Internal Medicine, Lung Cancer Group Cologne, University Hospital Cologne, Cologne, Germany
| | - Andreas H Scheel
- Institute of Pathology, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Philipp Weber
- Department I of Internal Medicine, Lung Cancer Group Cologne, University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics, and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Graziella Bosco
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Caroline Volz
- Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Cologne, Cologne, Germany
- Centre for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Christian Mueller
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine and University Hospital Cologne, University Hospital of Cologne, Cologne, Germany
| | - Ilona Dahmen
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix John
- Department I of Internal Medicine, Lung Cancer Group Cologne, University Hospital Cologne, Cologne, Germany
| | - Cleidson Padua Alves
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Werr
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jens Peter Panse
- Department of Haematology, Oncology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Centre for Integrated Oncology, Aachen Bonn Cologne Düsseldorf, Aachen, Germany
| | - Martin Kirschner
- Department of Haematology, Oncology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Centre for Integrated Oncology, Aachen Bonn Cologne Düsseldorf, Aachen, Germany
| | - Walburga Engel-Riedel
- Department of Pneumology, City of Cologne Municipal Hospitals, Lung Hospital Cologne Merheim, Cologne, Germany
| | - Jessica Jürgens
- Department of Pneumology, City of Cologne Municipal Hospitals, Lung Hospital Cologne Merheim, Cologne, Germany
| | - Erich Stoelben
- Thoraxclinic Cologne, Thoracic Surgery, St. Hildegardis-Krankenhaus, Cologne, Germany
| | - Michael Brockmann
- Department of Pathology, City of Cologne Municipal Hospitals, Witten/Herdecke University, Cologne, Germany
| | - Stefan Grau
- Department of General Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
- University Medicine Marburg - Campus Fulda, Department of Neurosurgery, Fulda, Germany
| | - Martin Sebastian
- Department of Medicine II, Haematology/Oncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Frankfurt Cancer Institute, Goethe University Frankfurt, Frankfurt, Germany
- DKFZ, German Cancer Research Centre, German Cancer Consortium, Heidelberg, Germany
| | - Jan A Stratmann
- Department of Medicine II, Haematology/Oncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Frankfurt Cancer Institute, Goethe University Frankfurt, Frankfurt, Germany
| | - Jens Kern
- Klinikum Würzburg Mitte - Missioklinik site, Pneumology and Respiratory Medicine, Würzburg, Germany
| | - Horst-Dieter Hummel
- Translational Oncology/Early Clinical Trial Unit, Comprehensive Cancer Centre Mainfranken, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
| | - Martin Schuler
- DKFZ, German Cancer Research Centre, German Cancer Consortium, Heidelberg, Germany
- Department of Medical Oncology, West German Cancer Centre Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Medical Oncology, West German Cancer Centre Essen, University Duisburg-Essen, Essen, Germany
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- Department of Thoracic Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Thomas Elter
- Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Cologne, Cologne, Germany
| | - Karin Toepelt
- Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Cologne, Cologne, Germany
| | | | - Sylke Kurz
- Department of Respiratory Diseases, Evangelische Lungenklinik, Berlin, Germany
| | - Christian Grohé
- Department of Respiratory Diseases, Evangelische Lungenklinik, Berlin, Germany
| | - Monika Serke
- DGD Lungenklinik Hemer, Internal Medicine, Pneumology and Oncology, Hemer, Germany
| | - Katja Höpker
- Clinic III for Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lars Hagmeyer
- Clinic of Pneumology and Allergology, Centre for Sleep Medicine and Respiratory Care, Bethanien Hospital Solingen, Solingen, Germany
| | - Fabian Doerr
- Department of Thoracic Surgery, University Medicine Essen - Ruhrlandklinik, University Duisburg-Essen, Essen, Germany
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Khosro Hekmath
- Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
| | - Judith Strapatsas
- Department of Haematology, Oncology and Clinical Immunology, University Hospital of Duesseldorf, Düsseldorf, Germany
| | | | | | - Annette Busch
- Medical Clinic III for Oncology, Haematology, Immune-Oncology and Rheumatology, Centre for Integrative Medicine, University Hospital Bonn, Bonn, Germany
| | - Franz-Georg Bauernfeind
- Medical Clinic III for Oncology, Haematology, Immune-Oncology and Rheumatology, Centre for Integrative Medicine, University Hospital Bonn, Bonn, Germany
| | - Frank Griesinger
- Pius-Hospital Oldenburg, Department of Haematology and Oncology, University Department Internal Medicine-Oncology, University Medicine Oldenburg, Oldenburg, Germany
| | - Anne Luers
- Pius-Hospital Oldenburg, Department of Haematology and Oncology, University Department Internal Medicine-Oncology, University Medicine Oldenburg, Oldenburg, Germany
| | - Wiebke Dirks
- Pius-Hospital Oldenburg, Department of Haematology and Oncology, University Department Internal Medicine-Oncology, University Medicine Oldenburg, Oldenburg, Germany
| | - Rainer Wiewrodt
- Pulmonary Division, Department of Medicine A, Münster University Hospital, Münster, Germany
| | - Andrea Luecke
- Pulmonary Division, Department of Medicine A, Münster University Hospital, Münster, Germany
| | - Ernst Rodermann
- Onkologie Rheinsieg, Praxisnetzwerk Hämatologie und Internistische Onkologie, Troisdorf, Germany
| | - Andreas Diel
- Onkologie Rheinsieg, Praxisnetzwerk Hämatologie und Internistische Onkologie, Troisdorf, Germany
| | - Volker Hagen
- Clinic II for Internal Medicine, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Kai Severin
- Haematologie und Onkologie Köln MV-Zentrum, Cologne, Germany
| | - Roland T Ullrich
- Department I of Internal Medicine, Centre for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University Hospital Cologne, Cologne, Germany
- Centre for Molecular Medicine, University of Cologne, Cologne, Germany
| | - Hans Christian Reinhardt
- Department of Haematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
- West German Cancer Centre, University Hospital Essen, Essen, Germany
| | - Alexander Quaas
- Institute of Pathology, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Magdalena Bogus
- Institute of Legal Medicine, University of Cologne, Cologne, Germany
| | - Cornelius Courts
- Institute of Legal Medicine, University of Cologne, Cologne, Germany
| | - Peter Nürnberg
- Cologne Centre for Genomics, West German Genome Centre, University of Cologne, Cologne, Germany
| | - Kerstin Becker
- Cologne Centre for Genomics, West German Genome Centre, University of Cologne, Cologne, Germany
| | - Viktor Achter
- Computing Centre, University of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Institute of Pathology, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Lung Cancer Group Cologne, University Hospital Cologne, Cologne, Germany
| | - Martin Peifer
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Centre for Molecular Medicine, University of Cologne, Cologne, Germany.
| | - Roman K Thomas
- Department of Translational Genomics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Institute of Pathology, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany.
- DKFZ, German Cancer Research Centre, German Cancer Consortium, Heidelberg, Germany.
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9
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Griesinger F, Ramagopalan S, Cheung WY, Wilke T, Mueller S, Gupta A, O'Sullivan DE, Arora P, Brenner DR, Froelich C, Inskip J, Maywald U, Subbiah V. Association between treatment and improvements in overall survival of patients with advanced/metastatic non-small cell lung cancer since 2011: A study in the United States, Canada, and Germany using retrospective real-world databases. Cancer 2024; 130:530-540. [PMID: 37933916 DOI: 10.1002/cncr.35094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND This study aimed to describe treatment patterns and overall survival (OS) in patients with advanced non-small cell lung cancer (aNSCLC) in three countries between 2011 and 2020. METHODS Three databases (US, Canada, Germany) were used to identify incident aNSCLC patients. OS was assessed from the date of incident aNSCLC diagnosis and, for patients who received at least a first line of therapy (1LOT), from the date of 1LOT initiation. In multivariable analyses, we analyzed the influence of index year and type of prescribed treatment on OS. FINDINGS We included 51,318 patients with an incident aNSCLC diagnosis. The percentage of patients treated with a 1LOT differed substantially between countries, whereas the number of patients receiving immunotherapies/targeted treatments increased over time in all three countries. Median OS from the date of incident diagnosis was 9.9 months in the United States vs. 4.1 months in Canada. When measured from the start of 1LOT, patients had a median OS of 10.7 months in the United States, 10.9 months in Canada, and 10.9 months in Germany. OS from the start of 1LOT improved in all three countries from 2011 to 2020 by approximately 3 to 4 months. CONCLUSIONS Observed continuous improvement in OS among patients receiving at least a 1LOT from 2011 to 2020 was likely driven by improved care and changes in the treatment landscape. The difference in the proportion of patients receiving a 1LOT in the observed countries requires further investigation.
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Affiliation(s)
- Frank Griesinger
- Department of Medical Oncology, Pius-Hospital Oldenburg, Oldenburg, Germany
| | | | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, Alberta, Canada
| | - Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik e.V., University of Wismar, Wismar, Germany
| | | | | | - Dylan E O'Sullivan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, Alberta, Canada
| | - Paul Arora
- Cytel, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Darren R Brenner
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Griesinger F, Curigliano G, Subbiah V, Baik CS, Tan DS, Lee DH, Misch D, Garralda E, Kim DW, van der Wekken AJ, Gainor JF, Paz-Ares L, Liu SV, Kalemkerian GP, Bowles DW, Mansfield AS, Lin JJ, Smoljanovic V, Rahman A, Zalutskaya A, Louie-Gao M, Boral AL, Mazières J. Pralsetinib in patients with RET fusion-positive non-small-cell lung cancer: A plain language summary of the ARROW study. Future Oncol 2024; 20:297-306. [PMID: 37916501 DOI: 10.2217/fon-2023-0155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of a research study called ARROW, which tested a medicine called pralsetinib in patients with non-small cell lung cancer (NSCLC), thyroid cancer, and other advanced solid tumours caused by a change in a gene called RET. For the purposes of this summary, only patients with NSCLC with a change in RET called fusion (RET fusion+) are highlighted. WHAT WERE THE RESULTS? In total, 281 patients with RET fusion+ NSCLC had taken part in this study across the USA, Europe, and Asia. Patients were asked to take four pills (adding up to 400 mg) of pralsetinib each day and were checked for any changes in their tumours, as well as for any side effects. After an average of 8 months of treatment with pralsetinib, 72% of previously untreated patients and 59% of patients who had previously received chemotherapy had considerable shrinkage of their tumours. Among 10 patients with tumours which had spread to the brain (all of whom had received previous treatments), 70% had their tumours shrink greatly in the brain after treatment with pralsetinib. On average, patients lived with little to no tumour growth for 16 months. In previously untreated patients, the most common severe side effects that were considered related to pralsetinib treatment were decreased white blood cells (neutrophils and lymphocytes), increased blood pressure, and an increase in a blood protein called creatine phosphokinase. In previously treated patients, the severe side effects were decreased white blood cells (neutrophils, lymphocytes, and leukocytes), increased blood pressure, and low levels of red blood cells. In both untreated and previously treated patients, the most common severe side effects that required hospital attention were lung inflammation/swelling causing shortness of breath (pneumonitis) and lung infection (pneumonia). WHAT DO THE RESULTS MEAN? Overall, the ARROW study showed that pralsetinib was effective in shrinking tumours in patients with RET fusion+ NSCLC regardless of previous treatment history. The recorded side effects were expected in patients receiving this type of medicine. Clinical Trial Registration: NCT03037385 (ARROW) (ClinicalTrials.gov).
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Affiliation(s)
| | - Giuseppe Curigliano
- European Institute of Oncology, IRCCS, Milan, Italy
- University of Milano, Milan, Italy
| | | | | | | | - Dae H Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Elena Garralda
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Dong-Wan Kim
- Seoul National University College of Medicine & Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | - Andy L Boral
- Blueprint Medicines Corporation, Cambridge, MA, USA
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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Frost N, Bleckmann A, Griesinger F, Grohé C, Janning M, Kollmeier J, Reinmuth N, Sebastian M, Thomas M, Reck M. Rationale and Design of the Phase II ANTELOPE Study of Atezolizumab, Carboplatin and nab-Paclitaxel vs. Pembrolizumab, Platinum and Pemetrexed in TTF-1 Negative, Metastatic Lung Adenocarcinoma (AIO-TRK-0122). Clin Lung Cancer 2023; 24:568-572. [PMID: 37169628 DOI: 10.1016/j.cllc.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/02/2023] [Accepted: 04/08/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Pemetrexed-based immunochemotherapy represents an established standard of care as first line treatment for non-oncogenic driven metastatic non-small cell lung adenocarcinoma (NSCLC/ADC). However, retrospective analyses revealed better outcomes for pemetrexed-free regimens compared to pemetrexed-containing regimens in patients with thyroid transcription factor 1 (TTF-1) negative NSCLC/ADC. The multicenter, phase II, randomized, open-label ANTELOPE trial evaluates whether atezolizumab, carboplatin and nab-paclitaxel is superior to pembrolizumab, cis-/carboplatin and pemetrexed in TTF-1 negative NSCLC/ADC. METHODS Eligible participants are ≥18 years of age, with histologically or cytologically confirmed, treatment-naïve stage IV TTF-1 negative NSCLC/ADC without actionable genomic alterations or PD-L1-overexpression (TPS ≥50%) and will be randomized in a 1:1 fashion to pemetrexed-free (group A) vs. pemetrexed-based (group B) immunochemotherapy. The primary endpoint of this trial is overall survival (OS). RESULTS Enrollment will start in Q2 2023 at 30 sites in Germany with a planned inclusion of 136 participants. CONCLUSION ANTELOPE will provide efficacy outcomes of the current standard-of-care for the specific subset of TTF-1 negative NSCLC/ADC in a head-to-head comparison of approved immunochemotherapy regimens.
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Affiliation(s)
- Nikolaj Frost
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany.
| | - Annalen Bleckmann
- West German Cancer Center, University Hospital Münster, Münster, Germany; Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Münster, Münster, Germany
| | - Frank Griesinger
- Pius Hospital, Department Internal Medicine-Oncology, Oldenburg, Germany
| | - Christian Grohé
- Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Melanie Janning
- DKFZ-Hector Cancer Institute and Department of Personalized Oncology at the University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim; Division of Personalized Medical Oncology (A420), German Cancer Research Center (DKFZ), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, and Berlin Lung Institute, Berlin, Germany
| | | | - Martin Sebastian
- Department of Internal Medicine II, University Clinic of Frankfurt, Frankfurt, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany, and Translational Research Center Heidelberg, member of the German Center for Lung Research (DZL)
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungenClinic, Grosshansdorf, Germany
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13
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Thurner L, Ziepert M, Berdel C, Schmidt C, Borchmann P, Kaddu-Mulindwa D, Viardot A, Witzens-Harig M, Dierlamm J, Haenel M, Metzner B, Wulf G, Lengfelder E, Keller UB, Frickhofen N, Nickelsen M, Gaska T, Griesinger F, Mahlberg R, Marks R, Shpilberg O, Lindemann HW, Soekler M, Fischer von Weikersthal L, Kiehl M, Roemer E, Bentz M, Krammer-Steiner B, Trappe R, de Nully Brown P, Federico M, Merli F, Engelhard M, Glass B, Schmitz N, Truemper L, Bewarder M, Hartmann F, Murawski N, Stilgenbauer S, Rosenwald A, Altmann B, Schmidberger H, Fleckenstein J, Loeffler M, Poeschel V, Held G. Radiation and Dose-densification of R-CHOP in Aggressive B-cell Lymphoma With Intermediate Prognosis: The UNFOLDER Study. Hemasphere 2023; 7:e904. [PMID: 37427146 PMCID: PMC10325769 DOI: 10.1097/hs9.0000000000000904] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/03/2023] [Indexed: 07/11/2023] Open
Abstract
UNFOLDER (Unfavorable Young Low-Risk Densification of R-Chemo Regimens) is an international phase-3 trial in patients 18-60 years with aggressive B-cell lymphoma and intermediate prognosis defined by age-adjusted International Prognostic Index (aaIPI) of 0 and bulky disease (≥7.5 cm) or aaIPI of 1. In a 2 × 2 factorial design patients were randomized to 6× R-CHOP-14 or 6× R-CHOP-21 (rituximab, cyclophosphamide, doxorubicin, vincristine, and prediso[lo]ne) and to consolidation radiotherapy to extralymphatic and bulky disease or observation. Response was assessed according to the standardized response criteria published in 1999, not including F-18 fluordesoxyglucose positron emission tomography/computed tomography (FDG-PET). Primary endpoint was event-free survival (EFS). A total of 695 of 700 patients were eligible for the intention-to-treat analysis. Totally 467 patients qualified for radiotherapy of whom 305 patients were randomized to receive radiotherapy (R-CHOP-21: 155; R-CHOP-14: 150) and 162 to observation (R-CHOP-21: 81, R-CHOP-14: 81). Two hundred twenty-eight patients not qualifying for radiotherapy were randomized for R-CHOP-14 versus R-CHOP-21. After a median observation of 66 months 3-year EFS was superior in the radiotherapy-arm versus observation-arm (84% versus 68%; P = 0.0012), due to a lower rate of partial responses (PR) (2% versus 11%). PR often triggered additional treatment, mostly radiotherapy. No significant difference was observed in progression-free survival (PFS) (89% versus 81%; P = 0.22) and overall survival (OS) (93% versus 93%; P = 0.51). Comparing R-CHOP-14 and R-CHOP-21 EFS, PFS and OS were not different. Patients randomized to radiotherapy had a superior EFS, largely due to a lower PR rate requiring less additional treatment (NCT00278408, EUDRACT 2005-005218-19).
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Affiliation(s)
- Lorenz Thurner
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
| | - Christian Berdel
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical School, Homburg/Saar, Germany
| | | | - Peter Borchmann
- Department of Hematology and Oncology, University Hospital of Cologne, Germany
| | - Dominic Kaddu-Mulindwa
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Germany
| | | | - Judith Dierlamm
- Department of Internal Medicine II, University Hospital Eppendorf, Hamburg, Germany
| | - Mathias Haenel
- Department of Internal Medicine III, Küchwald Hospital Chemnitz, Germany
| | - Bernd Metzner
- Department of Hematology and Oncology, University Clinic, Klinikum Oldenburg, Germany
| | - Gerald Wulf
- Department of Hematology and Oncology, Georg August University of Goettingen, Germany
| | - Eva Lengfelder
- Department of Internal Medicine III, University Hospital Mannheim, Germany
| | - Ulrich B. Keller
- Department of Internal Medicine III, Klinikum rechts der Isar der TU München, Munich, Germany
| | - Norbert Frickhofen
- Department of Internal Medicine III, Helios Dr. Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | | | - Tobias Gaska
- Department of Hematology and Oncology, Brüderkrankenhaus St. Josef, Paderborn, Germany
| | - Frank Griesinger
- Department of Internal Oncology, Pius-Hospital, Oldenburg, Germany
| | - Rolf Mahlberg
- Department of Internal Medicine I, Klinikum Mutterhaus der Borromaerinnen, Trier, Germany
| | - Reinhard Marks
- Department of Hematology and Oncology, University Medical Center, Freiburg, Germany
| | - Ofer Shpilberg
- Department of Hematology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, Israel
| | | | - Martin Soekler
- Department of Internal Medicine II, University Hospital Tuebingen, Germany
| | | | - Michael Kiehl
- Department of Internal Medicine, Klinikum Frankfurt (Oder), Germany
| | - Eva Roemer
- Department of Gastroenterology, Nephrology, Diabeteology, Hematoloy, Internal Oncology and Internal Intensive Medical Care, Klinikum Idar-Oberstein, Germany
| | - Martin Bentz
- Department of Hematology and Oncology, Städtisches Klinikum, Karlsruhe, Germany
| | | | - Ralf Trappe
- Department of Internal Medicine II, Evang. Diakonie-Krankenhaus gGmbH, Bremen, Germany
| | | | - Massimo Federico
- CHIMOMO Department, University of Modena and Reggio Emilia, Italy
| | | | | | - Bertram Glass
- Department of Hematology and Stem Cell Transplantation, Helios Klinikum Berlin-Buch, Germany
| | - Norbert Schmitz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Germany
| | - Lorenz Truemper
- Department of Hematology and Oncology, Georg August University of Goettingen, Germany
| | - Moritz Bewarder
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Frank Hartmann
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Niels Murawski
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Wuerzburg, and Comprehensive Cancer Center Mainfranken, Germany
| | - Bettina Altmann
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
| | - Heinz Schmidberger
- Department of Radiooncology and Radiotherapy, University Medical Center, Mainz, Germany
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical School, Homburg/Saar, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
| | - Viola Poeschel
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Gerhard Held
- Department of Internal Medicine 1, Westpfalz-Klinikum, Kaiserslautern, Germany
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Held G, Thurner L, Poeschel V, Ott G, Schmidt C, Christofyllakis K, Viardot A, Borchmann P, Engel-Riedel W, Frickhofen N, Nickelsen M, Shpilberg O, Witzens-Harig M, Griesinger F, Krammer-Steiner B, Neubauer A, de Nully Brown P, Federico M, Glass B, Schmitz N, Wulf G, Truemper L, Bewarder M, Murawski N, Stilgenbauer S, Rosenwald A, Altmann B, Engelhard M, Schmidberger H, Fleckenstein J, Berdel C, Loeffler M, Ziepert M. Radiation and Dose-densification of R-CHOP in Primary Mediastinal B-cell Lymphoma: Subgroup Analysis of the UNFOLDER Trial. Hemasphere 2023; 7:e917. [PMID: 37427145 PMCID: PMC10325764 DOI: 10.1097/hs9.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/17/2023] [Indexed: 07/11/2023] Open
Abstract
UNFOLDER (NCT00278408, EUDRACT 2005-005218-19) is a phase-3 trial in patients with aggressive B-cell lymphoma and intermediate prognosis, including primary mediastinal B-cell lymphoma (PMBCL). In a 2 × 2 factorial design, patients were randomized to 6× R-CHOP-14 or R-CHOP-21 (rituximab, cyclophosphamide, doxorubicin, vincristine, and prediso(lo)ne) and to consolidation radiotherapy to extralymphatic/bulky disease or observation. Response was assessed according to the standardized criteria from 1999, which did not include F-18 fluordesoxyglucose positron emission tomography/computed tomography (FDG-PET) scans. Primary end point was event-free survival (EFS). A subgroup of 131 patients with PMBCLs was included (median age, 34 y; 54% female, 79% elevated lactate dehydrogenase (LDH), 20% LDH >2× upper limit of normal [ULN], and 24% extralymphatic involvement). Eighty-two (R-CHOP-21: 43 and R-CHOP-14: 39) patients were assigned to radiotherapy and 49 (R-CHOP-21: 27, R-CHOP-14: 22) to observation. The 3-year EFS was superior in radiotherapy arm (94% [95% confidence interval (CI), 89-99] versus 78% [95% CI, 66-89]; P = 0.0069), due to a lower rate of partial responses (PRs) (2% versus 10%). PR triggered additional treatment, mostly radiotherapy (n = 5; PR: 4; complete response/unconfirmed complete response: 1). No significant differences were observed in progression-free survival (PFS) (95% [95% CI, 90-100] versus 90% [95% CI, 81-98]; P = 0.25) nor in overall survival (OS) (98% [95% CI, 94-100] versus 96% [95% CI, 90-100]; P = 0.64). Comparing R-CHOP-14 and R-CHOP-21, EFS, PFS, and OS were not different. A prognostic marker for adverse outcome was elevated LDH >2× ULN (EFS: P = 0.016; PFS: P = 0.0049; OS: P = 0.0014). With the limitation of a pre-PET-era trial, the results suggest a benefit of radiotherapy only for patients responding to R-CHOP with PR. PMBCL treated with R-CHOP have a favorable prognosis with a 3-year OS of 97%.
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Affiliation(s)
- Gerhard Held
- Department of Internal Medicine 1, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - Lorenz Thurner
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Viola Poeschel
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | | | - Konstantinos Christofyllakis
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital Ulm, Germany
| | - Peter Borchmann
- Department of Hematology and Oncology, University Hospital of Cologne, Germany
| | | | - Norbert Frickhofen
- Department of Internal Medicine III, Helios Dr.Horst-Schmidt-Kliniken, Wiesbaden, Germany
| | | | - Ofer Shpilberg
- Department of Hematology, Rabin Medical Center, Beilinson Hospital, Petah-Tiqwa, Israel
| | | | - Frank Griesinger
- Department of Internal Oncology, Pius-Hospital, Oldenburg, Germany
| | | | - Andreas Neubauer
- Department of Hematology, Oncology and Immunology, University Hospital Marburg, Germany
| | | | - Massimo Federico
- CHIMOMO Department, University of Modena and Reggio Emilia, Italy
| | - Bertram Glass
- Department of Hematology and Stem Cell Transplantation, Helios Klinikum Berlin-Buch, Germany
| | - Norbert Schmitz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Münster, Germany
| | - Gerald Wulf
- Department of Hematology and Oncology, Georg August University of Goettingen, Germany
| | - Lorenz Truemper
- Department of Hematology and Oncology, Georg August University of Goettingen, Germany
| | - Moritz Bewarder
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Niels Murawski
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine 1 (Oncology, Hematology, Clinical Immunology and Rheumatology), Saarland University Medical School, Homburg/Saar, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Wuerzburg, and Comprehensive Cancer Center Mainfranken, Germany
| | - Bettina Altmann
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
| | | | - Heinz Schmidberger
- Department of Radiooncology and Radiotherapy, University Medical Center, Mainz, Germany
| | - Jochen Fleckenstein
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical School, Homburg/Saar, Germany
| | - Christian Berdel
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical School, Homburg/Saar, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
| | - Marita Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Germany
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Geiken-Weinstock R, Reyners AKL, Griesinger F, Otremba BJ, Hoheisel M, Bäsecke J. Early versus delayed tumor specific therapy and survival in patients with lung cancer: a retrospective study. Oncol Res Treat 2023:000530574. [PMID: 37054696 DOI: 10.1159/000530574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION The timing of tumor specific palliative therapy and its influence on the survival of patients with stage IV lung cancer remains unclear. METHODS 375 patients with stage IV lung cancer who experienced an early or delayed therapy (early or delayed therapy group; TG) were investigated using histology and ECOG performance score-related (ECOG-PS) subgroups. Kaplan-Meier and Cox regression analyses were used for survival analyses. RESULTS Patients in the early TG had a significantly shorter median overall survival (OS) than those in the delayed TG (6 vs. 11 months). Patients with an ECOG-PS of ≥1 were significantly more present in the early than in the delayed TG (66.8% vs. 51.9%). But an early therapy was also significantly associated to a shorter median OS in ECOG-matched subgroups (ECOG-PS of 0; 7 vs. 23 months, ECOG >1 ; 6 vs. 8 months). An early therapy was associated to a significantly worse median OS in histological subgroups (NSCLC; 5 vs. 11 months, SCLC; 7 vs. 11 months) and was an independent risk factor in uni- and multivariate analyses. CONCLUSIONS An early initiation of cancer specific therapy was associated with a shorter survival time in palliative lung cancer patients, independent of the ECOG-PS and histological subtype.
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16
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Englmeier F, Bleckmann A, Brückl W, Griesinger F, Fleitz A, Nagels K. Clinical benefit and cost-effectiveness analysis of liquid biopsy application in patients with advanced non-small cell lung cancer (NSCLC): a modelling approach. J Cancer Res Clin Oncol 2023; 149:1495-1511. [PMID: 35532791 PMCID: PMC10020305 DOI: 10.1007/s00432-022-04034-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/19/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Targeted therapies are effective therapeutic approaches in advanced stages of NSCLC and require precise molecular profiling to identify oncogenic drivers. Differential diagnosis on a molecular level contributes to clinical decision making. Liquid biopsy (LB) use has demonstrated its potential to serve as an alternative to tissue biopsy (TB) particularly in cases where tissue sampling is not feasible or insufficient. We aimed at evaluating the cost-effectiveness of ctDNA-based LB use (molecular multigene testing) according to German care guidelines for metastatic NSCLC. METHODS A Markov model was developed to compare the costs and clinical benefits associated with the use of LB as an add-on to TB according to the guidelines for NSCLC patients. Usual care TB served as comparator. A microsimulation model was used to simulate a cohort of non-squamous NSCLC patients stage IV. The parameters used for modelling were obtained from the literature and from the prospective German CRISP registry ("Clinical Research platform Into molecular testing, treatment, and outcome of non-Small cell lung carcinoma Patients"). For each pathway, average direct medical costs, and QALYs gained per patient were used for calculating incremental cost-effectiveness ratios (ICER). RESULTS The use of LB as an add-on was costlier (€144,981 vs. €144,587) but more effective measured in QALYs (1.20 vs. 1.19) for the care pathway of NSCLC patients (ICER €53,909/QALY). Cost-effectiveness was shown for EGFR-mutated patients (ICER €-13,247/QALY). CONCLUSION Including LB as an add-on into the care pathway of advanced NSCLC has positive clinical effects in terms of QALYs accompanied by a moderate cost-effectiveness.
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Affiliation(s)
- Fabienne Englmeier
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstraße 25, 95445, Bayreuth, Germany
| | - Annalen Bleckmann
- Medical Clinic A, Haematology, Haemostaseology, Oncology and Pulmonology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
- Department of Haematology and Medical Oncology, University of Medicine Goettingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Wolfgang Brückl
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg Lung Cancer Center, General Hospital Nuremberg, Paracelsus Medical University, Prof.-Ernst-Nathan-Straße 1, 90419, Nuremberg, Germany
| | - Frank Griesinger
- Pius-Hospital Oldenburg, University Clinic Internal Medicine, Georgstraße 12, 26121, Oldenburg, Germany
| | - Annette Fleitz
- Clinical Epidemiology and Health Economics, iOMEDICO, Ellen-Gottlieb-Straße 19, 79108, Freiburg, Germany
| | - Klaus Nagels
- Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstraße 25, 95445, Bayreuth, Germany.
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17
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Griesinger F, Garassino M, Felip E, Sakai H, Le X, Veillon R, Smit E, Raskin J, Thomas M, Ahn MJ, Vlassak S, Bruns R, Johne A, Paik P. 34P Treatment sequencing in the VISION study of tepotinib in patients with MET exon 14 (METex14) skipping NSCLC. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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18
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Chouaid C, Bosquet L, Girard N, Kron A, Scheffler M, Griesinger F, Sebastian M, Trigo J, Viteri S, Knott C, Rodrigues B, Rahhali N, Cabrieto J, Diels J, Perualila NJ, Schioppa CA, Sermon J, Toueg R, Erdmann N, Mielke J, Nematian-Samani M, Martin-Fernandez C, Pfaira I, Li T, Mahadevia P, Wolf J. An Adjusted Treatment Comparison Comparing Amivantamab Versus Real-World Clinical Practice in Europe and the United States for Patients with Advanced Non-Small Cell Lung Cancer with Activating Epidermal Growth Factor Receptor Exon 20 Insertion Mutations. Adv Ther 2023; 40:1187-1203. [PMID: 36652175 PMCID: PMC9988783 DOI: 10.1007/s12325-022-02408-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Patients with advanced, epidermal growth factor receptor (EGFR)-mutated, non-small cell lung cancer (NSCLC) with Exon 20 insertion mutations (Exon20ins) have poor prognoses, exacerbated by a previous lack of specific treatment guidelines and unmet need for targeted therapies. Amivantamab, an EGFR and MET bispecific antibody, demonstrated efficacy and tolerability in patients with advanced EGFR-mutated NSCLC with Exon20ins following platinum-based therapy in CHRYSALIS (NCT02609776; Cohort D+). Since CHRYSALIS was single-arm, individual patient data (IPD)-based adjusted analyses versus similar patients in real-world clinical practice (RWCP) were conducted to generate comparative evidence. METHODS RWCP cohorts were derived from seven European and US real-world sources, comprising patients fulfilling CHRYSALIS Cohort D+ eligibility criteria. Amivantamab was compared with a basket of RWCP treatments. Differences in prognostic characteristics were adjusted for using inverse probability weighting (IPW; average treatment effect among the treated [ATT]). Balance between cohorts was assessed using standardized mean differences (SMDs). Overall response rate (ORR; investigator- [INV] and independent review committee-assessed [IRC]), overall survival (OS), progression-free survival (PFS; INV and IRC) and time-to-next treatment (TTNT) were compared. Binary and time-to-event endpoints were analyzed using weighted logistic regression and proportional hazards regression, respectively. RESULTS Pre-adjustment, baseline characteristics were comparable between cohorts. IPW ATT-adjustment improved comparability, giving closely matched characteristics. ORR (INV) was 36.8% for amivantamab versus 17.0% for the adjusted EU + US cohort (response rate ratio [RR]: 2.16). Median OS, PFS (INV) and TTNT were 22.77 versus 12.52 months (hazard ratio [HR]: 0.47; p < 0.0001), 6.93 versus 4.17 months (HR: 0.55; p < 0.0001) and 12.42 versus 5.36 months (HR: 0.44; p < 0.0001) for amivantamab versus the adjusted EU + US cohort, respectively. Results were consistent versus EU- and US-only cohorts, and when using IRC assessment. CONCLUSION Adjusted comparisons demonstrated significantly improved outcomes for amivantamab versus RWCP, highlighting the value of amivantamab in addressing unmet need in patients with advanced EGFR Exon20ins NSCLC following platinum-based therapy. TRIAL REGISTRATION CHRYSALIS: NCT02609776.
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Affiliation(s)
- Christos Chouaid
- Service de Pneumologie, Pneumology, Intercommunal Hospital, 40 avenue de Verdun, 94010, Créteil, France.
| | - Lise Bosquet
- Health Data and Partnerships Department, Unicancer, Paris, France
| | | | - Anna Kron
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, Cologne, Germany.,Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Martin Sebastian
- Department of Medicine, Hematology and Oncology, University of Frankfurt, Frankfurt, Germany
| | - Jose Trigo
- Hospital Universitario Virgen de la Victoria y Regional, IBIMA, Malaga, Spain
| | - Santiago Viteri
- UOMI Cancer Center, Clínica Mi Tres Torres, Barcelona, Spain.,Instituto Oncológico Dr Rosell, Hospital Universitari Dexeus, Grupo QuironSalud, Barcelona, Spain
| | - Craig Knott
- Health Data Insight CIC, Cambridge, UK.,National Disease Registration Service, NHS Digital, Leeds, UK
| | | | | | | | | | | | | | - Jan Sermon
- Janssen Pharmaceutica NV, Beerse, Belgium
| | | | | | | | | | | | | | | | | | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I for Internal Medicine and Center for Integrated Oncology Cologne/Bonn, University Hospital Cologne, Cologne, Germany.,Network Genomic Medicine, Cologne, Germany
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19
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Metzenmacher M, Griesinger F, Hummel HD, Elender C, Schäfer H, de Wit M, Kaiser U, Kern J, Jänicke M, Spring L, Zacharias S, Kaiser-Osterhues A, Groth A, Hipper A, Zaun G, Dörfel S, Güldenzoph B, Müller L, Uhlig J, Thomas M, Sebastian M, Eberhardt WE. Prognostic factors in nonsmall cell lung cancer: insights from the German CRISP registry. Eur Respir J 2023; 61:13993003.01336-2022. [PMID: 36180086 PMCID: PMC9892864 DOI: 10.1183/13993003.01336-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Understanding prognosis, especially long-term outcome, in advanced nonsmall cell lung cancer (NSCLC) is crucial to inform patients, guide treatment and plan supportive and palliative care. METHODS Prognostic factors influencing overall survival (OS) and progression-free survival (PFS) in 2082 patients with wild-type (WT)-NSCLC (629 M1a, 249 M1b, 1204 M1c) are reported. Patients were included in the prospective German CRISP registry recruiting in >150 centres. Analysis for pre-therapeutic factors was based on results from Cox proportional hazard models. RESULTS Current M-descriptors of the Union for International Cancer Control-8 staging system were validated: M1a and M1b patients had significantly longer median time to events compared to M1c (OS/PFS 16.4/7.2 months, 17.8/6.7 months and 10.9/5.4 months, respectively). OS and PFS were influenced by number and location of metastatic organ systems. M1c and four or more metastatic organs involved had shorter OS and PFS than M1c with one to three organs (OS hazard ratio (HR) 1.69, p<0.001; PFS HR 1.81, p<0.001). M1b-liver metastases had shorter OS/PFS than M1b involving other organs (OS HR 2.70, p=0.006; PFS HR 2.48, p=0.007). Based on number of involved organs (orgsys) and liver metastases, two risk groups (low-risk: M1a, M1b-non-liver, M1c-1-3-orgsys-non-liver; high-risk: M1c-liver, M1b-liver, M1c-4+-orgsys) with significantly different prognoses could be amalgamated (median OS/PFS 14.3/6.5 months and 7.7/4.1 months, respectively). Other favourable factors were female gender and Eastern Cooperative Oncology Group stage 0, with age showing no impact. Those with T1- or N0-status were associated with longer OS than T2-4 or N2-3. CONCLUSION In this large observational dataset, we further defined factors for outcome in WT-NSCLC, including increased number of involved metastatic organ systems and liver metastases, as those with overall poorer prognosis and reduced survival chance.
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Affiliation(s)
- Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen – Ruhrlandklinik, Essen, Germany
| | - Frank Griesinger
- Department of Haematology and Oncology, University Dept Internal Medicine-Oncology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Horst-Dieter Hummel
- Interdisziplinäres Studienzentrum mit ECTU/Translationale Onkologie, Comprehensive Cancer Center, Mainfranken, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Corinna Elender
- Pneumologie, Infektiologie, Internistische Intensivmedizin, Klinik Nord im Klinikum Dortmund, Dortmund, Germany
| | - Harald Schäfer
- Pneumologie, Thorakale Onkologie, Palliativmedizin, Infektiologie, SHG Kliniken Völklingen, Völklingen, Germany
| | - Maike de Wit
- Klinik für Innere Medizin – Hämatologie, Onkologie und Palliativmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Ulrich Kaiser
- Medizinische Klinik II, Hämatologie & Internistische Onkologie, St. Bernward Krankenhaus, Hildesheim, Germany
| | - Jens Kern
- Klinikum Würzburg Mitte – Standort Missioklinik, Med. Klinik mit Schwerpunkt Pneumologie, Würzburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Lisa Spring
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | | | | | | | - Gregor Zaun
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | | | - Björn Güldenzoph
- Hämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany
| | | | - Jens Uhlig
- Praxis Dr. med. Jens Uhlig, Naunhof, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, University Hospital Heidelberg and Translational, Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Martin Sebastian
- Department of Hematology and Medical Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Wilfried E.E. Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen – Ruhrlandklinik, Essen, Germany
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20
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Althoff FC, Bolt TA, Rost M, Atmaca A, Bleckmann A, Griesinger F, Tufman A, Overbeck TR. Thoracic Oncology Highlights from the European Society for Medical Oncology Annual Meeting 2022. Oncol Res Treat 2022; 46:45-49. [PMID: 36529117 DOI: 10.1159/000528728] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Friederike C Althoff
- Department of Medicine II, Hematology, Oncology, University Hospital Frankfurt, Frankfurt am Main, Frankfurt, Germany
| | - Toki A Bolt
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Rost
- Department of Medicine II, Hematology, Oncology, University Hospital Frankfurt, Frankfurt am Main, Frankfurt, Germany
| | - Akin Atmaca
- Department of Oncology and Hematology, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany
| | - Annalen Bleckmann
- Department of Medicine A, Hematology, Oncology, and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, University Medicine Oldenburg, Pius-Hospital, Oldenburg, Germany
| | - Amanda Tufman
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
| | - Tobias R Overbeck
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
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21
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Gessner C, Griesinger F, Shah R, Talbot T, Venkateshan S, Vadanahalli Shankar A, Seluzhytsky A, Marsden D. 119TiP An observational study to assess the effectiveness and safety of cemiplimab in patients with advanced non-small cell lung cancer (NSCLC) in routine clinical practice within Europe (CEMI-LUNG). Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Ahn MJ, Kim HR, Yang JCH, Han JY, Li JYC, Hochmair MJ, Chang GC, Delmonte A, Lee KH, Campelo RG, Gridelli C, Spira AI, Califano R, Griesinger F, Ghosh S, Felip E, Kim DW, Liu Y, Zhang P, Popat S, Camidge DR. Efficacy and Safety of Brigatinib Compared With Crizotinib in Asian vs. Non-Asian Patients With Locally Advanced or Metastatic ALK-Inhibitor-Naive ALK+ Non-Small Cell Lung Cancer: Final Results From the Phase III ALTA-1L Study. Clin Lung Cancer 2022; 23:720-730. [PMID: 36038416 DOI: 10.1016/j.cllc.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/08/2022] [Accepted: 07/16/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Brigatinib is a next-generation anaplastic lymphoma kinase (ALK) inhibitor with demonstrated efficacy in locally advanced and metastatic non-small cell lung cancer (NSCLC) in crizotinib-refractory and ALK inhibitor-naive settings. This analysis assessed brigatinib in Asian vs. non-Asian patients from the first-line ALTA-1L trial. PATIENTS AND METHODS This was a subgroup analysis from the phase III ALTA-1L trial of brigatinib vs. crizotinib in ALK inhibitor-naive ALK+ NSCLC. The primary endpoint was progression-free survival (PFS) as assessed by blinded independent review committee (BIRC). Secondary endpoints included confirmed objective response rate (ORR) and overall survival (OS) in the overall population and BIRC-assessed intracranial ORR and PFS in patients with brain metastases. RESULTS Of the 275 randomized patients, 108 were Asian. Brigatinib showed consistent superiority in BIRC-assessed PFS vs. crizotinib in Asian (hazard ratio [HR]: 0.35 [95% CI: 0.20-0.59]; log-rank P = .0001; median 24.0 vs. 11.1 months) and non-Asian (HR: 0.56 [95% CI: 0.38-0.84]; log-rank P = .0041; median 24.7 vs. 9.4 months) patients. Results were consistent with investigator-assessed PFS and BIRC-assessed intracranial PFS. Brigatinib was well tolerated. Toxicity profiles and dose modification rates were similar between Asian and non-Asian patients. CONCLUSION Efficacy with brigatinib was consistently better than with crizotinib in Asian and non-Asian patients with locally advanced or metastatic ALK inhibitor-naive ALK-+ NSCLC. There were no clinically notable differences in overall safety in Asian vs. non-Asian patients.
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Affiliation(s)
- Myung J Ahn
- Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Hye R Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - James C H Yang
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, and Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ji-Yu Han
- Center for Lung Cancer, National Cancer Center, Goyang, South Korea
| | - Jacky Yu-Chung Li
- Department of Clinical Oncology, Hong Kong United Oncology Centre, Kowloon, Hong Kong
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | - Gee-Chen Chang
- School of Medicine, and Institute of Medicine, Chung Shan Medical University, Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, and Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Angelo Delmonte
- Medical Oncology, Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST), IRCCS, Meldola, Italy
| | - Ki H Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Rosario G Campelo
- Medical Oncology Department, Thoracic Tumors Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Cesare Gridelli
- Division of Medical Oncology, A.O.S.G. Moscati, Avellino, Italy
| | - Alexander I Spira
- Medical Oncology, Virginia Cancer Specialists and US Oncology Research, Fairfax, VA
| | - Raffaele Califano
- Department of Medical Oncology, The Christie NHS Foundation Trust, and Division of Cancer Sciences, The University of Manchester, Manchester, England, UK
| | - Frank Griesinger
- University Department of Internal Medicine-Oncology, Pius-Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Sharmistha Ghosh
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK
| | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Yuyin Liu
- Oncology Statistics, Takeda Development Center Americas, Inc., Lexington, MA
| | - Pingkuan Zhang
- Clinical Science, Takeda Development Center Americas, Inc., Lexington, MA
| | - Sanjay Popat
- Lung Unit, The Royal Marsden Hospital and The Institute of Cancer Research, London, England, UK
| | - D Ross Camidge
- Department of Medicine, Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO
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Griesinger F, Popat S, Okhuoya P, Servidio L, Fonseca M, Tolani E, Lu S, Zacharias S. 372P Global real-world (rw) study of patients (pts) with epidermal growth factor receptor (EGFR) mutated advanced non-small cell lung cancer (NSCLC) treated with first-line (1L) osimertinib: Interim analysis of an rw pt registry in Germany. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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24
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Ramagopalan SV, Popat S, Gupta A, Boyne DJ, Lockhart A, Hsu G, O’Sullivan DE, Inskip J, Ray J, Cheung WY, Griesinger F, Subbiah V. Transportability of Overall Survival Estimates From US to Canadian Patients With Advanced Non-Small Cell Lung Cancer With Implications for Regulatory and Health Technology Assessment. JAMA Netw Open 2022; 5:e2239874. [PMID: 36326765 PMCID: PMC9634498 DOI: 10.1001/jamanetworkopen.2022.39874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE The external validity of survival outcomes derived from clinical practice data from US patients with advanced non-small cell lung cancer (NSCLC) is not known and is of potential importance because it may be used to support regulatory decision-making and health technology assessment outside of the US. OBJECTIVE To evaluate whether overall survival (OS) estimates for a selected group of patients with advanced NSCLC from a large US clinical practice database are transportable to Canadian patients receiving the same systemic therapies. DESIGN, SETTING, AND PARTICIPANTS This retrospective multicenter cohort study used transportability analysis to assess whether adjustment for pretreatment characteristics of eligible patient cohorts could reliably approximate OS estimated from US-based samples to Canadian populations. A total of 17 432 eligible adult patients who were diagnosed de novo with advanced NSCLC on or after January 1, 2011, were included in the analysis and followed up until September 30, 2020. Because data on race and ethnicity were available in the US database but not the Canadian database and because racial and ethnic distribution was likely to be similar between US and Canadian patients, these characteristics were not analyzed. EXPOSURES Initiation of platinum-doublet chemotherapy or pembrolizumab monotherapy as first-line systemic treatment for advanced NSCLC. MAIN OUTCOMES AND MEASURES OS measured from the time of initiation of the respective treatment regimen. RESULTS Among 17 432 eligible patients, 15 669 patients from the US and 1763 patients from Canada were included in the analysis. Of those, 11 863 patients (sample size-weighted estimates of mean [SD] age, 68.0 [9.3] years; 6606 [55.7%] male; 10 100 from the US and 1763 from Canada) were included in the subset of patients with complete data for baseline covariates. A total of 13 532 US patients received first-line chemotherapy, and 2137 received first-line pembrolizumab monotherapy. Of those, 8447 patients (62.4%) in the first-line chemotherapy group and 1653 patients (77.3%) in the first-line pembrolizumab group had complete data on baseline covariates for outcome model estimation. A total of 1476 Canadian patients who received first-line chemotherapy and 287 patients who received first-line pembrolizumab monotherapy were identified from the target population. After standardization to baseline patient covariates in the Canadian cohorts, transported OS estimates revealed a less than 5% mean absolute difference from the observed OS in the target population (0.56% over 60 months of follow-up in the first-line chemotherapy group and 4.54% over 30 months of follow-up in the first-line pembrolizumab group). Negative control analysis using a mismatched outcome model revealed a 6.64% discrepancy and an incompatible survival curve shape. The results were robust to assumptions of random missingness for baseline covariates, to unadjusted differences in baseline metastases and comorbidities, and to differences in the standard of care between the US and Canada related to administration of second-line anti-programmed cell death 1 ligand 1 immunotherapy for patients who initiated first-line chemotherapy. CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that, under specific circumstances, OS estimates from US clinical practice data can be adjusted using baseline clinical characteristics to closely approximate OS in selected groups of Canadian patients with advanced NSCLC. These results may have implications for regulatory decision-making and health technology assessment in target populations outside of the US.
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Affiliation(s)
| | - Sanjay Popat
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Alind Gupta
- Real-World and Advanced Analytics, Cytel Inc, Cambridge, Massachusetts
| | - Devon J. Boyne
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, University of Calgary, Alberta, Canada
| | | | - Grace Hsu
- Real-World and Advanced Analytics, Cytel Inc, Cambridge, Massachusetts
| | - Dylan E. O’Sullivan
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, University of Calgary, Alberta, Canada
| | | | - Joshua Ray
- Global Access, F. Hoffmann-La Roche Ltd, Grenzacherstrasse, Basel, Switzerland
| | - Winson Y. Cheung
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, University of Calgary, Alberta, Canada
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, Oldenburg, Germany
- Department of Hematology and Oncology, University of Göttingen, Göttingen, Germany
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Haier J, Beller J, Adorjan K, Bleich S, de Greck M, Griesinger F, Heppt M, Hurlemann R, Mees ST, Philipsen A, Rohde G, Schilling G, Trautmann K, Combs SE, Geyer S, Schaefers J. Decision Conflicts in Clinical Care during COVID-19: A Multi-Perspective Inquiry. Healthcare (Basel) 2022; 10:healthcare10101914. [PMID: 36292361 PMCID: PMC9602416 DOI: 10.3390/healthcare10101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The early COVID-19-pandemic was characterized by changes in decision making, decision-relevant value systems and the related perception of decisional uncertainties and conflicts resulting in decisional burden and stress. The vulnerability of clinical care professionals to these decisional dilemmas has not been characterized yet. Methods: A cross-sectional questionnaire study (540 patients, 322 physicians and 369 nurses in 11 institutions throughout Germany) was carried out. The inclusion criterion was active involvement in clinical treatment or decision making in oncology or psychiatry during the first year of COVID-19. The questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, and the perception of consequences for patients). Data analysis was performed using ANOVA, Pearson rank correlations, and the Chi²-test, and for inferential analysis, nominal logistic regression and tree classification were conducted. Results: Professionals reported changes in clinical management (27.5%) and a higher workload (29.2%), resulting in decisional uncertainty (19.2%) and decisional conflicts (22.7%), with significant differences between professional groups (p < 0.005), including anxiety, depression, loneliness and stress in professional subgroups (p < 0.001). Nominal regression analysis targeting “Decisional Uncertainty” provided a highly significant prediction model (LQ p < 0.001) containing eight variables, and the analysis for “Decisional Conflicts” included six items. The classification rates were 64.4% and 92.7%, respectively. Tree analysis confirmed three levels of determinants. Conclusions: Decisional uncertainty and conflicts during the COVID-19 pandemic were independent of the actual pandemic load. Vulnerable professional groups for the perception of a high number of decisional dilemmas were characterized by individual perception and the psychological framework. Coping and management strategies should target vulnerability, enable the handling of the individual perception of decisional dilemmas and ensure information availability and specific support for younger professionals.
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Affiliation(s)
- Joerg Haier
- Hannover Medical School, Comprehensive Cancer Center Hannover, 30625 Hannover, Germany
- Correspondence:
| | - Johannes Beller
- Hannover Medical School, Comprehensive Cancer Center Hannover, 30625 Hannover, Germany
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Hospital, 80539 Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Moritz de Greck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, 60590 Frankfurt am Main, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany
| | - Markus Heppt
- Department of Dermatology, Erlangen University Hospital, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - René Hurlemann
- Department of Psychiatry, Carl von Ossietzky University, 26121 Oldenburg, Germany
| | - Soeren Torge Mees
- Department of General, Visceral and Thoracic Surgery, Friedrichstadt General Hospital, 01067 Dresden, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital, 53127 Bonn, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine and Allergology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Georgia Schilling
- Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Tumorzentrum, 22763 Hamburg, Germany
| | - Karolin Trautmann
- Department of Hematology and Oncology, University Hospital, 01307 Dresden, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 Munich, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Juergen Schaefers
- Hannover Medical School, Comprehensive Cancer Center Hannover, 30625 Hannover, Germany
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Haier J, Beller J, Adorjan K, Bleich S, de Greck M, Griesinger F, Heppt MV, Hurlemann R, Mees ST, Philipsen A, Rohde G, Schilling G, Trautmann K, Combs SE, Geyer S, Schaefers J. Differences in Stakeholders' Perception of the Impact of COVID-19 on Clinical Care and Decision-Making. Cancers (Basel) 2022; 14:cancers14174317. [PMID: 36077852 PMCID: PMC9454870 DOI: 10.3390/cancers14174317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Pandemics are related to changes in clinical management. Factors that are associated with individual perceptions of related risks and decision-making processes focused on prevention and vaccination, but perceptions of other healthcare consequences are less investigated. Different perceptions of patients, nurses, and physicians on consequences regarding clinical management, decisional criteria, and burden were compared. Study Design: Cross-sectional OnCoVID questionnaire studies. Methods: Data that involved 1231 patients, physicians, and nurses from 11 German institutions that were actively involved in clinical treatment or decision-making in oncology or psychiatry were collected. Multivariate statistical approaches were used to analyze the stakeholder comparisons. Results: A total of 29.2% of professionals reported extensive changes in workload. Professionals in psychiatry returned severe impact of pandemic on all major aspects of their clinical care, but less changes were reported in oncology (p < 0.001). Both patient groups reported much lower recognition of treatment modifications and consequences for their own care. Decisional and pandemic burden was intensively attributed from professionals towards patients, but less in the opposite direction. Conclusions: All of the groups share concerns about the impact of the COVID-19 pandemic on healthcare management and clinical processes, but to very different extent. The perception of changes is dissociated in projection towards other stakeholders. Specific awareness should avoid the dissociated impact perception between patients and professionals potentially resulting in impaired shared decision-making.
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Affiliation(s)
- Joerg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Correspondence:
| | - Johannes Beller
- Comprehensive Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Hospital, 80336 Munich, Germany
| | - Stefan Bleich
- Department of Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany
| | - Moritz de Greck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, 60590 Frankfurt am Main, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany
| | - Markus V. Heppt
- Department of Dermatology, University Hospital Erlangen, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - René Hurlemann
- Department of Psychiatry, Karl-Jaspers-Hospital, 26160 Oldenburg, Germany
| | - Soeren Torge Mees
- Department of General, Visceral and Thoracic Surgery, Friedrichstadt General Hospital, 01067 Dresden, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital, 53127 Bonn, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine and Allergology, University Hospital, 60590 Frankfurt am Main, Germany
| | - Georgia Schilling
- Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Tumorzentrum, 22763 Hamburg, Germany
| | - Karolin Trautmann
- Department of Hematology and Oncology, University Hospital, 01307 Dresden, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum Rechts der Isar, 81675 Munich, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany
| | - Juergen Schaefers
- Comprehensive Cancer Center Hannover, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Stuschke M, Eberhardt W, Passlick B, Groeschel A, Christopoulos P, Reck M, Grah C, Hoffknecht P, Ludwig P, Hipper A, Chiabudini M, Spring L, Jaenicke M, Andres-Pons A, Christoph D, Bernhardt C, Reiser M, Nusch A, Sebastian M, Griesinger F, Thomas M. EP05.01-030 CRISP: First Real-World Evidence of NSCLC Stage I, II and III in Germany - AIO-TRK-0315. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Fischer R, George J, Scheel A, Schloesser H, Brossart P, Engel-Riedel W, Griesinger F, Grohé C, Kern J, Panse J, Sebastian M, Serke M, Wiewrodt R, Michels S, Nogova L, Riedel R, Weber JP, Büttner R, Thomas R, Wolf J. 1028P BIOLUMA: A phase II trial of nivolumab in combination with ipilimumab to evaluate efficacy and safety in lung cancer and to evaluate biomarkers predictive for response – results from the NSCLC cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Willborn K, Wagner J, Roeper J, Falk M, Heukamp L, Griesinger F. 966P Evaluation of the prognostic marker of PD-L1 expression after combined radio-chemotherapy in patients with non-small cell lung cancer (NSCLC) stage III. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Besse B, Griesinger F, Curigliano G, Thomas M, Subbiah V, Baik C, Tan D, Lee D, Garralda E, Kim DW, Van Der Wekken A, Gainor J, Paz-Ares L, Liu S, Bowles D, Zalutskaya A, Ruf T, Rahman A, Chen G, Mazieres J. 1170P Updated efficacy and safety data from the phase I/II ARROW study of pralsetinib in patients (pts) with advanced RET fusion+ non-small cell lung cancer (NSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Roeper J, Blanksma A, Kathmann L, Ansmann L, Griesinger F. 1155P Adherence to treatment recommendations from multidisciplinary tumor boards: Initial data from 644 lung cancer cases. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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32
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Sebastian M, Griesinger F, von der Heyde E, Dörfel S, Wiegand J, Schiefer C, Losem C, Jänicke M, Fleitz A, Zacharias S, Hipper A, Dietel C, Bleckmann A, Benkelmann R, Boesche M, Grah C, Müller A, Eberhardt W, Thomas M. 1164P Patient-reported outcomes in patients with advanced NSCLC before and during the COVID-19 pandemic in the German prospective CRISP Registry real-world cohort (AIO-TRK-0315). Ann Oncol 2022. [PMCID: PMC9472486 DOI: 10.1016/j.annonc.2022.07.1287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Eberhardt W, Passlick B, Stuschke M, Groeschel A, Christopoulos P, Reck M, Ludwig P, Hipper A, Chiabudini M, Spring L, Jänicke M, Andres-Pons A, Christoph D, Bernhardt C, Reiser M, Sebastian M, Griesinger F, Thomas M. 963P Clinical research platform Into molecular testing, treatment and outcome of non-Small cell lung carcinoma Patients (CRISP): Real-world evidence of NSCLC patients treated with radiochemotherapy in Germany – AIO-TRK-0315. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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34
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Wagner J, Roeper J, Ansmann L, Griesinger F. 393P Adherence to treatment recommendations from multidisciplinary tumor boards: Initial data from 562 colorectal cancer cases. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Roeper J, Ansmann L, Blanksma A, Griesinger F. EP04.01-014 Adherence to Treatment Recommendations From Multidisciplinary Tumor Boards. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Griesinger F, Jänicke M. Was können Register leisten? Präv Gesundheitsf 2022. [PMCID: PMC9395927 DOI: 10.1007/s11553-022-00969-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hintergrund Register sind strukturierte Datensammlungen einer definierten Gruppe von Patienten. Registerdaten aus der Routineversorgung können zur Beantwortung zahlreicher wissenschaftlicher und praxisrelevanter Fragestellungen herangezogen werden. Ziel der Arbeit Ziel der vorliegenden Übersichtsarbeit ist ein Einblick in Anwendungsbereiche von Registerdaten. Material und Methoden Drei zentrale Anwendungsbereiche werden beispielhaft erläutert basierend auf einer explorativen Literaturrecherche. Ergebnisse Registerdaten schaffen Transparenz, indem sie Aufschluss über die Routineversorgung (z. B. die Anwendungen und Wirksamkeit von Therapien unter Alltagsbedingungen) geben und dienen somit der Qualitätssicherung. Sie ermöglichen Aussagen zu Patienten, die an randomisierten klinischen Prüfungen, dem Standard in der klinischen Arzneimittelforschung, nicht teilnehmen können (z. B. ältere Patienten mit Begleiterkrankungen). Sie ermöglichen die Langzeitbeobachtung von Erkrankungsverläufen und das Identifizieren von seltenen Nebenwirkungen. Des Weiteren können Registerdaten zur Versorgungsforschung, v. a. zur Hypothesengenerierung genutzt werden. So können Fragen zur optimalen Therapie bestimmter Patientengruppen, zur Wirksamkeit von Therapien, für die es keine vergleichenden Daten aus klinischen Prüfungen gibt oder auch zu Risikoprofilen von Patienten untersucht werden. Ein neueres Anwendungsgebiet ist außerdem die Verwendung von Registerdaten im Rahmen der Zulassung und Nutzenbewertung von Arzneimitteln. Schlussfolgerung Viele Fragen rund um die optimale Versorgung von Patienten können mit randomisierten kontrollierten Prüfungen allein nicht beantwortet werden. Qualitätsgesicherte Daten aus prospektiven Registern können diese Lücke schließen.
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Affiliation(s)
- Frank Griesinger
- Klinik für Hämatologie und Onkologie, Innere Medizin-Onkologie, Koordinator Cancer Center Oldenburg, Pius-Hospital, Medizinischer Campus Universität Oldenburg, Georgstr. 12, 26121 Oldenburg, Deutschland
| | - Martina Jänicke
- Abteilungsleitung Clinical Epidemiology and Health Economics, iOMEDICO, Ellen-Gottlieb-Straße 19, 79106 Freiburg, Deutschland
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von Kutzleben M, Galuska JC, Hein A, Griesinger F, Ansmann L. Needs of Lung Cancer Patients Receiving Immunotherapy and Acceptance of Digital and Sensor-Based Scenarios for Monitoring Symptoms at Home—A Qualitative-Explorative Study. IJERPH 2022; 19:ijerph19159265. [PMID: 35954619 PMCID: PMC9368591 DOI: 10.3390/ijerph19159265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023]
Abstract
Background: The development of immunotherapy in the treatment for lung cancer has changed the outlook for both patients and health care practitioners. However, reporting and management of side effects are crucial to ensure effectiveness and safety of treatment. The aim of this study was to learn about the subjective experiences of patients with lung cancer receiving immunotherapy and to explore their potential acceptance of digital and sensor-based systems for monitoring treatment-related symptoms at home. Methods: A qualitative-explorative interview study with patients with lung cancer (n = 21) applying qualitative content analysis. Results: Participants had trouble to classify and differentiate between symptoms they experienced and it seemed challenging to assess whether symptoms are serious enough to be reported and to figure out the right time to report symptoms to health care practitioners. We identified four basic needs: (1) the need to be informed, (2) the need for a trustful relationship, (3) the need to be taken seriously, and (4) the need for needs-oriented treatment concepts. The idea of digital and sensor-based monitoring initially provoked rejection, but participants expressed more differentiated attitudes during the interviews, which could be integrated into a preliminary model to explain the acceptance of digital and sensor-based monitoring scenarios. Conclusions: Supporting lung cancer patients and their health care providers in communicating about treatment-related symptoms is important. Technology-based monitoring systems are considered to be potentially beneficial. However, in view of the many unfulfilled information needs and the unsatisfactory reporting of symptoms, it must be critically questioned what these systems can and should compensate for, and where the limits of such monitoring lie.
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Affiliation(s)
- Milena von Kutzleben
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr, 140, 26129 Oldenburg, Germany; (J.C.G.); (L.A.)
- Correspondence: ; Tel.: +49-441-798-4540
| | - Jan Christoph Galuska
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr, 140, 26129 Oldenburg, Germany; (J.C.G.); (L.A.)
| | - Andreas Hein
- Division for Assistance Systems and Medical Technology, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr, 140, 26129 Oldenburg, Germany;
| | - Frank Griesinger
- Department of Hematology and Oncology at the Pius-Hospital Oldenburg, Georgstraße, University Department Internal Medicine-Oncology, 12, 26121 Oldenburg, Germany;
| | - Lena Ansmann
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerlaender Heerstr, 140, 26129 Oldenburg, Germany; (J.C.G.); (L.A.)
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Christopoulos P, Kluck K, Kirchner M, Lüders H, Roeper J, Falkenstern-Ge RF, Szewczyk M, Sticht F, Saalfeld FC, Wesseler C, Hackanson B, Dintner S, Faehling M, Kuon J, Janning M, Kauffmann-Guerrero D, Kazdal D, Kurz S, Eichhorn F, Bozorgmehr F, Shah R, Tufman A, Wermke M, Loges S, Brueckl WM, Schulz C, Misch D, Frost N, Kollmeier J, Reck M, Griesinger F, Grohé C, Hong JL, Lin HM, Budczies J, Stenzinger A, Thomas M. The impact of TP53 co-mutations and immunologic microenvironment on outcome of lung cancer with EGFR exon 20 insertions. Eur J Cancer 2022; 170:106-118. [DOI: 10.1016/j.ejca.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/22/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
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Neugebauer S, Griesinger F, Dippel S, Heidenreich S, Gruber N, Chruscz D, Lempfert S, Kaskel P. Use of algorithms for identifying patients in a German claims database: learnings from a lung cancer case. BMC Health Serv Res 2022; 22:834. [PMID: 35765059 PMCID: PMC9241287 DOI: 10.1186/s12913-022-07982-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background The analysis of statutory health insurance (SHI) data is a little-used approach for understanding treatment and care as well as resource use of lung cancer (LC) patients in Germany. The aims of this observational, retrospective, longitudinal analysis of structured data were to analyze the healthcare situation of LC patients in Germany based on routine data from SHI funds, to develop an algorithm that sheds light on LC types (non-small cell / NSCLC vs. small cell / SCLC), and to gain new knowledge to improve needs-based care. Methods Anonymized billing data of approximately four million people with SHI were analyzed regarding ICD-10 (German modification), documented medical interventions based on the outpatient SHI Uniform Assessment Standard Tariff (EBM) or the inpatient Operations and Procedure Code (OPS), and the dispensing of prescription drugs to outpatients (ATC classification). The study included patients who were members of 64 SHI funds between Jan-1st, 2015 and Dec-31st, 2016 and who received the initial diagnosis of LC in 2015 and 2016. Results The analysis shows that neither the cancer type nor the cancer stage can be unambiguously described by the ICD-10 coding. Furthermore, an assignment based on the prescribed medication provides only limited information: many of the drugs are either approved for both LC types or are used off-label, making it difficult to assign them to a specific LC type. Overall, 25% of the LC patients were unambiguously identifiable as NSCLC vs SCLC based on the ICD-10 code, the drug therapy, and the billing data. Conclusions The current coding system appears to be of limited suitability for drawing conclusions about LC and therefore the SHI patient population. This makes it difficult to analyze the healthcare data with the aim of gathering new knowledge to improve needs-based care. The approach chosen for this study did not allow for development of a LC differentiation algorithm based on the available healthcare data. However, a better overview of patient specific needs could make it possible to modify the range of services provided by the SHI funds. From this perspective, it makes sense, in a first step, to refine the ICD-10 system to facilitate NSCLC vs. SCLC classification. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07982-8.
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Affiliation(s)
- Sina Neugebauer
- MSD SHARP & DOHME GmbH, Levelingstrasse 4A, 81673, Munich, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Internal Medicine-Oncology, Pius Hospital, Medical Campus University of Oldenburg, Cancer Center Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Sabine Dippel
- Organon GmbH, Weystrasse 20, 6006, Lucerne, Switzerland
| | | | - Nina Gruber
- MSD SHARP & DOHME GmbH, Levelingstrasse 4A, 81673, Munich, Germany
| | - Detlef Chruscz
- CONVEMA Versorgungsmanagement GmbH, Karl-Marx-Allee 90A, 10243, Berlin, Germany
| | - Sebastian Lempfert
- HCSL Healthcare Consulting Sebastian Lempfert e.K., Bekwisch 32, 22848, Norderstedt, Germany
| | - Peter Kaskel
- MSD SHARP & DOHME GmbH (former address of MSD), Lindenplatz 1, 85540, Haar, Germany.
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Popat S, Liu SV, Scheuer N, Hsu GG, Lockhart A, Ramagopalan SV, Griesinger F, Subbiah V. Addressing challenges with real-world synthetic control arms to demonstrate the comparative effectiveness of Pralsetinib in non-small cell lung cancer. Nat Commun 2022; 13:3500. [PMID: 35715405 PMCID: PMC9205915 DOI: 10.1038/s41467-022-30908-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/25/2022] [Indexed: 11/20/2022] Open
Abstract
As advanced non-small cell lung cancer (aNSCLC) is being increasingly divided into rare oncogene-driven subsets, conducting randomised trials becomes challenging. Using real-world data (RWD) to construct control arms for single-arm trials provides an option for comparative data. However, non-randomised treatment comparisons have the potential to be biased and cause concern for decision-makers. Using the example of pralsetinib from a RET fusion-positive aNSCLC single-arm trial (NCT03037385), we demonstrate a relative survival benefit when compared to pembrolizumab monotherapy and pembrolizumab with chemotherapy RWD cohorts. Quantitative bias analyses show that results for the RWD-trial comparisons are robust to data missingness, potential poorer outcomes in RWD and residual confounding. Overall, the study provides evidence in favour of pralsetinib as a first-line treatment for RET fusion-positive aNSCLC. The quantification of potential bias performed in this study can be used as a template for future studies of this nature. Real-world data (RWD) based control arms provide an option to compare the effectiveness of single-arm trials. By performing multiple quantitative bias analyses to alleviate concerns about trial-RWD comparability, here the authors show that the RET inhibitor pralsetinib provides survival benefit in patients with RET fusion-positive non-small cell lung cancer from the ARROW single-arm trial, (NCT03037385) when compared to pembrolizumab monotherapy and pembrolizumab with chemotherapy RWD cohorts.
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Affiliation(s)
- Sanjay Popat
- Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - Stephen V Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | | | | | - Frank Griesinger
- Department of Medical Oncology, Pius-Hospital Oldenburg, Oldenburg, Germany
| | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Shu CA, Goto K, Ohe Y, Besse B, Lee SH, Wang Y, Griesinger F, Yang JCH, Felip E, Sanborn RE, Bernabe Caro R, Curtin JC, Chen J, Mahoney JM, Trani L, Bauml JM, Knoblauch RE, Thayu M, Cho BC. Amivantamab and lazertinib in patients with EGFR-mutant non–small cell lung (NSCLC) after progression on osimertinib and platinum-based chemotherapy: Updated results from CHRYSALIS-2. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
9006 Background: Initial results with the amivantamab (ami) and lazertinib (laz) regimen showed encouraging efficacy in patients (pts) whose disease progressed after standard-of-care osimertinib (osi) and platinum-based chemotherapy (pt-chemo; Shu Ann Oncol 2021; 32:S949-1039; 1193MO). We present updated results of this population (Cohort A) from the CHRYSALIS-2 study (NCT04077463). Methods: Cohort A evaluated ami and laz in pts with EGFR exon 19 deletion or L858R NSCLC whose disease progressed on 1st/2nd-line osi followed by pt-chemo as last line of therapy (target population, n=106) and among a more heavily-pretreated population (n=56) whose disease progressed after osi and pt-chemo ± other therapies without regard to number and sequence of these therapies. Pts received 1050 mg IV ami (1400 mg, ≥80 kg) + 240 mg oral laz. Investigator (INV)- and blinded independent central review (BICR)-assessed response per RECIST v1.1 is reported for efficacy-evaluable pts, defined as pts who initiated study treatment on or before 17 Mar 2021, allowing for ≥6 mo of follow-up for response durability. Results: As of 6 Nov 2021, 162 pts were enrolled in Cohort A (median 62 y, 65% women, 61% Asian, median 3 [range, 2–14] prior lines). Median time between last osi treatment to first dose of ami + laz was 6.3 mo and 2.0 mo for the target and heavily-pretreated populations, respectively. Of 50 efficacy-evaluable pts in the target population, the overall response rate (ORR) by BICR was 36% (95% CI, 23–51), with 1 complete response (CR) and 17 partial responses (PRs), and the clinical benefit rate (CBR) was 58% (95% CI, 43–72); full results for all enrolled pts will be reported at the meeting. Median duration of response (mDOR) was not reached based on BICR. At a median follow-up of 8.3 mo, 7 responders (39%) have achieved a DOR lasting ≥6 mo by BICR. INV-assessed responses were consistent with BICR. Of 56 efficacy-evaluable pts in the heavily-pretreated population (8.7-mo median follow-up), ORR by INV was 29% (95% CI, 17–42), with 1 CR and 15 PRs. CBR was 55% (95% CI, 42–69) and mDOR was 8.6 mo (95% CI, 4.2–NR). BICR results are pending. Preliminary evidence of CNS antitumor activity was reported among 8 pts with baseline brain lesions (7 non-target, 1 target) who had not received radiation within 1 year prior to study enrollment. Most frequent adverse events (AE) were infusion-related reaction (65%), paronychia (49%), rash (41%), and stomatitis (39%). Most common grade ≥3 treatment-related AEs (TRAEs) were infusion-related reactions (7%), acneiform dermatitis (5%), and hypoalbuminemia (4%). TRAEs leading to discontinuation of either or both ami and laz occurred in 12% and 7%, respectively. Conclusions: Among an unselected population that has exhausted SOC osi and pt-chemo, ami and laz demonstrates encouraging antitumor activity with a manageable safety profile. Clinical trial information: NCT04077463.
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Affiliation(s)
| | - Koichi Goto
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Benjamin Besse
- Paris-Sacaly University, Institut Gustave Roussy, Villejuif, France
| | - Se-Hoon Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yongsheng Wang
- Institute of Clinical Trial Center and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Enriqueta Felip
- Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Rachel E. Sanborn
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR
| | - Reyes Bernabe Caro
- Hospital Universitario Virgen Del Rocio, Instituto de Biomedicina de Seville, Seville, Spain
| | | | | | | | | | | | | | | | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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42
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Camidge DR, Kim HR, Ahn MJ, Yang JCH, Han JY, Hochmair M, Lee KH, Delmonte A, Campelo RG, Kim DW, Griesinger F, Felip E, Califano R, Spira AI, Thomas M, Gettinger SN, Tiseo M, Liu Y, Zhang P, Popat S. Association of depth of target lesion response to brigatinib with outcomes in patients with ALK inhibitor-naive ALK+ NSCLC in ALTA-1L. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9072 Background: In patients (pts) with crizotinib (CRZ)-refractory advanced ALK+ NSCLC in the phase 2 ALTA trial (NCT02094573), the depth of target lesion response to brigatinib (BRG) correlated with PFS and OS. Here, we examine the association of maximum decrease in target lesions with PFS and OS in ALTA-1L (NCT02737501), a randomized phase 3 trial of BRG vs CRZ in pts with ALK inhibitor-naive advanced ALK+ NSCLC. Methods: Pts were randomized 1:1 to receive BRG 180 mg qd (7-day lead-in at 90 mg; n=137) or CRZ 250 mg bid (n=138). Pts with target lesion assessment by blinded independent review committee (BIRC) were grouped based on greatest decrease from baseline per RECIST v1.1: none–50%, 51%–75%, and 76%–100% shrinkage. Outcomes in the ≤50% target lesion shrinkage group served as the comparator for outcomes in the 51%–75% and 76%–100% groups. Results: At study end (last pt contact: Jan 29, 2021), 124/137 pts in the BRG arm and 125/138 pts in the CRZ arm had ≥1 evaluable target lesion assessment; female (BRG/CRZ), 51%/59%; median age, 57.5/60.0 years. Median follow-up was 40.8/15.7 months. In BRG/CRZ arms, 76%-100% shrinkage was observed in 56%/34% of pts, 51%-75% shrinkage in 27%/30%, and ≤50% shrinkage in 16%/35%, respectively. BRG was associated with significantly more pts with target lesion shrinkage >75% vs CRZ ( P=0.0005), and a Cochran-Armitage trend analysis demonstrated significantly deeper response across all shrinkage groups for BRG compared with CRZ ( P<0.0001). A majority of pts in the BRG arm experienced 76%–100% target lesion shrinkage in all subgroups analyzed. Pts treated with BRG or CRZ with target lesion shrinkage >50% had lower risk of a PFS event (BRG HR [95% CI]: 51%–75% shrinkage, 0.58 [0.29–1.18]; 76%–100%, 0.23 [0.12–0.46]; CRZ: 51%–75% shrinkage, 0.68 [0.41–1.12]; 76%–100%, 0.26 [0.15–0.45]) or an OS event (BRG: 51%–75% shrinkage, 0.39 [0.17–0.89]; 76%–100%, 0.15 [0.07–0.35]; CRZ: 51%–75% shrinkage, 0.43 [0.21–0.85]; 76%–100%, 0.23 [0.10–0.50]) than pts with ≤50% shrinkage. Longer median time to PFS and OS and higher 4-year estimated OS rates were associated with depth of response in both arms (Table). Conclusions: In this exploratory post hoc analysis, BRG demonstrated significantly deeper target lesion response vs CRZ. Pts with >75% shrinkage had significantly reduced risk of a PFS or OS event vs pts with ≤50% target lesion shrinkage. Clinical trial information: NCT02737501. [Table: see text]
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Affiliation(s)
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung-Ju Ahn
- Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - James Chih-Hsin Yang
- National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ji-Youn Han
- National Cancer Center, Goyang-Si, South Korea
| | - Maximilian Hochmair
- Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Department of Respiratory and Critical Care Medicine, Krankenhaus Nord, Klinik Floridsdorf, Vienna, Austria
| | - Ki Hyeong Lee
- Chungbuk National University Hospital, Cheongju, South Korea
| | - Angelo Delmonte
- Istituto Romagnolo per lo Studio dei Tumori Dino Amadori-RCCS, Meldola, Italy
| | | | - Dong-Wan Kim
- Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
| | - Frank Griesinger
- Pius-Hospital Oldenburg, University of Oldenburg, Oldenburg, Germany
| | | | | | | | - Michael Thomas
- Internistische Onkologie der Thoraxtumoren, Thoraxklinik im Universitätsklinikum Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Yuyin Liu
- Takeda Development Center Americas, Inc., Lexington, MA
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Dingemans AMC, Griesinger F, Paz-Ares L, Perol M, Ren S, Höglander E, Kurtsikidze N, Siena S. A randomized phase 3 study of entrectinib versus crizotinib in patients (pts) with locally advanced/metastatic ROS1 fusion-positive (fp) NSCLC with or without baseline CNS metastases (mets). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps9141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS9141 Background: ROS proto-oncogene 1 ( ROS1) fusions are found in 1–2% of NSCLC cases. As CNS mets are common in pts with ROS1-fp NSCLC and associated with poor prognosis, CNS-active treatments are needed for these pts. Entrectinib and crizotinib are tyrosine kinase inhibitors (TKIs) of ROS1, recommended as first-line treatments for ROS1-fp NSCLC. Both drugs have shown robust systemic efficacy and good tolerability in pts with ROS1-fp NSCLC. While crizotinib may have suboptimal CNS activity, entrectinib has shown intracranial efficacy in pts with baseline CNS mets by blinded independent central review (BICR, PMIDs 30215676; 33646820). We hypothesized that entrectinib may have greater CNS activity than crizotinib, potentially addressing the unmet need for pts with ROS1-fp NSCLC with CNS mets. Methods: This randomized, open-label, multicenter, phase 3 trial (NCT04603807) aims to compare the efficacy and safety of entrectinib vs crizotinib in adult pts with TKI-naïve advanced/metastatic ROS1-fp NSCLC, with or without CNS mets. Key eligibility criteria: advanced/recurrent/metastatic NSCLC with ROS1 fusion determined locally by certified clinical laboratory testing; measurable systemic disease (RECIST 1.1); age ≥18 years; ECOG PS ≤2; no prior ROS1 TKI or systemic treatment for advanced/metastatic disease; adequate hematologic, renal and hepatic functions; prior radiotherapy ≥14 days before randomization and neurologically stable CNS mets per RECIST 1.1 are permitted. Pts will be randomized 1:1 to receive 600 mg entrectinib once a day or 250 mg crizotinib twice a day. Stratification factors are baseline CNS mets (none/measurable/non-measurable) and prior brain radiotherapy ≤2 months (yes/no); to allow sufficient power, ≥30% of randomized pts will have baseline CNS mets. Study treatment will continue until progressive disease, unacceptable toxicity, death or withdrawal from the study. Pts with radiographic disease progression or isolated asymptomatic CNS progression may continue treatment at the investigator’s discretion. Tumor assessments (brain MRI and chest, abdomen and pelvis CT/MRI) will occur at screening, Wk 4, Wk 8 and every 8 wks thereafter. Blood samples will be collected at every visit. Primary endpoint: progression-free survival (PFS) by BICR in pts with baseline CNS mets (CNS population, target HR = 0.57). Secondary endpoints: CNS-PFS by BICR and ORR, duration of response (DoR) and PFS (by BICR and investigator) in the intent-to-treat (ITT) population; overall survival in the CNS and ITT populations; CNS-ORR and CNS-DoR by BICR in the CNS population. Impact on quality of life, functioning and lung cancer-specific symptoms will be evaluated via questionnaires in the ITT population. Safety endpoints and biomarkers will also be evaluated. As of 12 Jan 2022, 8 pts are enrolled (first pt enrolled in Oct 2021). Clinical trial information: NCT04603807.
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Affiliation(s)
| | - Frank Griesinger
- Department of Haematology and Oncology, Pius-Hospital Oldenburg Medical Campus, Oldenburg, Germany
| | - Luis Paz-Ares
- Hospital Universitario Doce de Octubre and CNIO, Madrid, Spain
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Shengxiang Ren
- Department of Oncology, Shanghai Pulmonary Hospital & Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Elen Höglander
- Oncology Biomarker Development, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Nino Kurtsikidze
- Product Development and Medical Affairs, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Salvatore Siena
- Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, and Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milano, Italy
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Haier J, Beller J, Adorjan K, Bleich S, De Greck M, Griesinger F, Hein A, Hurlemann R, Mees ST, Philipsen A, Rohde G, Schilling G, Trautmann K, Combs SE, Geyer S, Schäfers J. Decision Conflicts in Clinical Care during COVID-19: A Patient Perspective. Healthcare (Basel) 2022; 10:healthcare10061019. [PMID: 35742070 PMCID: PMC9222354 DOI: 10.3390/healthcare10061019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/16/2022] Open
Abstract
(1) Background: Uncertainty is typical for a pandemic or similar healthcare crisis. This affects patients with resulting decisional conflicts and disturbed shared decision making during their treatment occurring to a very different extent. Sociodemographic factors and the individual perception of pandemic-related problems likely determine this decisional dilemma for patients and can characterize vulnerable groups with special susceptibility for decisional problems and related consequences. (2) Methods: Cross-sectional data from the OnCoVID questionnaire study were used involving 540 patients from 11 participating institutions covering all major regions in Germany. Participants were actively involved in clinical treatment in oncology or psychiatry during the COVID-19 pandemic. Questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, perception of consequences for patients) and very basic demographic data (age, gender, stage of treatment and educational background). Decision uncertainties and distress were operationalized using equidistant five-point scales. Data analysis was performed using descriptive and various multivariate approaches. (3) Results: A total of 11.5% of all patients described intensive uncertainty in their clinical decisions that was significantly correlated with anxiety, depression, loneliness and stress. Younger and female patients and those of higher educational status and treatment stage had the highest values for these stressors (p < 0.001). Only 15.3% of the patients (14.9% oncology, 16.2% psychiatry; p = 0.021) considered the additional risk of COVID-19 infections as very important for their disease-related decisions. Regression analysis identified determinants for patients at risk of a decisional dilemma, including information availability, educational level, age group and requirement of treatment decision making. (4) Conclusions: In patients, the COVID-19 pandemic induced specific decisional uncertainty and distress accompanied by intensified stress and psychological disturbances. Determinants of specific vulnerability were related to female sex, younger age, education level, disease stages and perception of pandemic-related treatment modifications, whereas availability of sufficient pandemic-related information prevented these problems. The most important decisional criteria for patients under these conditions were expected side effects/complications and treatment responses.
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Affiliation(s)
- Jörg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.)
- Correspondence:
| | - Johannes Beller
- Comprehensive Cancer Center Hannover, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.)
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany;
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, 81377 Munich, Germany;
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, 30625 Hannover, Germany;
| | - Moritz De Greck
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt am Main, 60528 Frankfurt, Germany;
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital Oldenburg, Carl von Ossietzky University, 26129 Oldenburg, Germany;
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Erlangen University Hospital, 91054 Erlangen, Germany;
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany
| | - René Hurlemann
- Department of Psychiatry, Carl von Ossietzky University, 26129 Oldenburg, Germany;
| | - Sören Torge Mees
- Department of General, Visceral and Thoracic Surgery, Friedrichstadt General Hospital, 01067 Dresden, Germany;
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, 53105 Bonn, Germany;
| | - Gernot Rohde
- Department of Respiratory Medicine and Allergology, University Hospital, Goethe University, 60590 Frankfurt am Main, Germany;
| | - Georgia Schilling
- Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Hospital Altona, Asklepios Tumorzentrum, 22763 Hamburg, Germany;
| | - Karolin Trautmann
- Department of Hematology and Oncology, University Hospital Carl Gustav Carus, 01307 Dresden, Germany;
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, 30625 Hannover, Germany;
| | - Jürgen Schäfers
- Comprehensive Cancer Center Hannover, Hannover Medical School, 30625 Hannover, Germany; (J.B.); (J.S.)
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Frost N, Griesinger F, Hoffmann H, Länger F, Nestle U, Schütte W, Wolf J, Reck M. Lung Cancer in Germany. J Thorac Oncol 2022; 17:742-750. [PMID: 35623674 DOI: 10.1016/j.jtho.2022.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, University Medicine Oldenburg, Pius-Hospital, Oldenburg, Germany
| | - Hans Hoffmann
- Division of Thoracic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Society, Zertifizierungskommission Lungenkrebszentrum, Berlin, Germany
| | - Florian Länger
- Institute of Pathology, Hanover Medical School, Hanover, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, Medical Center Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha-Maria Halle-Dölau, Halle (Saale), Germany
| | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I of Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungenClinic, Grosshansdorf, Germany.
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46
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Momotow J, Bühnen I, Trautmann-Grill K, Kobbe G, Hahn D, Schroers R, Heinrich B, Gaska T, Forstbauer H, Schmidt B, Boger R, Hüttmann A, Heil G, Kraemer DM, Krüger W, Zeremski V, Grobe N, Jentsch-Ullrich K, Griesinger F, Fuchs M, von Tresckow B, Borchmann P, Engert A, Bröckelmann PJ. Outcomes of anti-programmed death 1 treatment for relapsed/refractory Hodgkin lymphoma: A German Hodgkin Study Group multicentre real-world analysis. Br J Haematol 2022; 198:401-404. [PMID: 35538912 DOI: 10.1111/bjh.18231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Jesko Momotow
- Department I of Internal Medicine, Centre of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), Cologne, Germany
| | - Ina Bühnen
- German Hodgkin Study Group (GHSG), Cologne, Germany
| | | | - Guido Kobbe
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - Dennis Hahn
- Stuttgart General Hospital, Stuttgart, Germany
| | | | - Bernhard Heinrich
- Hämatologisch-onkologische Praxis Heinrich/Bangerter, Augsburg, Germany
| | - Tobias Gaska
- Brüderkrankenhaus St. Josef Paderborn, Paderborn, Germany
| | | | | | - Regina Boger
- Hospital Schwarzwald-Baar, Villingen Schwenningen, Germany
| | - Andreas Hüttmann
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | | | - William Krüger
- Klinik für Innere Medizin C - Hämatologie, Onkologie, Stammzelltransplantation, Palliativmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Vanja Zeremski
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Norbert Grobe
- Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Germany
| | | | | | - Michael Fuchs
- Department I of Internal Medicine, Centre of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), Cologne, Germany
| | - Bastian von Tresckow
- German Hodgkin Study Group (GHSG), Cologne, Germany.,Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter Borchmann
- Department I of Internal Medicine, Centre of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), Cologne, Germany
| | - Andreas Engert
- Department I of Internal Medicine, Centre of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), Cologne, Germany
| | - Paul J Bröckelmann
- Department I of Internal Medicine, Centre of Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Hodgkin Study Group (GHSG), Cologne, Germany.,Mildred Scheel School of Oncology Aachen Bonn Cologne Düsseldorf (MSSO ABCD), Cologne, Germany.,Max Planck Institute for the Biology of Ageing, Cologne, Germany
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47
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Popat S, Liu SV, Scheuer N, Gupta A, Hsu GG, Ramagopalan SV, Griesinger F, Subbiah V. Association Between Smoking History and Overall Survival in Patients Receiving Pembrolizumab for First-Line Treatment of Advanced Non-Small Cell Lung Cancer. JAMA Netw Open 2022; 5:e2214046. [PMID: 35612853 PMCID: PMC9133943 DOI: 10.1001/jamanetworkopen.2022.14046] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE There is a need to tailor treatments to patients who are most likely to derive the greatest benefit from them to improve patient outcomes and enhance cost-effectiveness of cancer therapies. OBJECTIVE To compare overall survival (OS) between patients with a current or former history of smoking with patients who never smoked and initiated pembrolizumab monotherapy as first-line (1L) treatment for advanced non-small lung cancer (NSCLC). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study compared patients diagnosed with advanced NSCLC aged 18 or higher selected from a nationwide real-world database originating from more than 280 US cancer clinics. The study inclusion period was from January 1, 2011, to October 1, 2019. EXPOSURES Smoking status at the time of NSCLC diagnosis. MAIN OUTCOMES AND MEASURES OS measured from initiation of 1L pembrolizumab monotherapy. RESULTS In this retrospective cohort study, a total of 1166 patients (median [IQR] age, 72.9 [15.3] years; 581 [49.8%] men and 585 [50.2%] women) were assessed in the primary analysis, including 91 patients [7.8%] with no history of smoking (ie, never-smokers) and 1075 patients [92.2%] who currently or formerly smoked (ie, ever-smokers). Compared with ever-smokers, never-smokers were older (median age [IQR] of 78.2 [12.0] vs 72.7 [15.5] years), more likely to be female (61 [67.0%] vs 524 [48.7%]) and to have been diagnosed with nonsquamous tumor histology (70 [76.9%] vs 738 [68.7%]). After adjustment for baseline covariates, ever-smokers who initiated 1L pembrolizumab had significantly prolonged OS compared to never-smokers (median OS: 12.8 [10.9-14.6] vs 6.5 [3.3-13.8] months; hazard ratio (HR): 0.69 [95% CI, 0.50-0.95]). This trend was observed across all sensitivity analyses for the 1L pembrolizumab cohort, but not for initiators of 1L platinum chemotherapy, for which ever-smokers showed significantly shorter OS compared with never-smokers (HR, 1.2 [95% CI, 1.07-1.33]). CONCLUSIONS AND RELEVANCE In patients with advanced NSCLC who received 1L pembrolizumab monotherapy in routine clinical practices in the US, patients who reported a current or former history of smoking at the time of diagnosis had consistently longer OS than never-smokers. This finding suggests that in never-smoking advanced NSCLC, 1L pembrolizumab monotherapy may not be the optimal therapy selection, and genomic testing for potential genomically matched therapies should be prioritized over pembrolizumab in never-smokers.
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Affiliation(s)
- Sanjay Popat
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Stephen V. Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | | | | | | | - Frank Griesinger
- Department of Medical Oncology, Pius-Hospital Oldenburg, Oldenburg, Germany
| | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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48
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Griesinger F, Sebastian M, Bethge A, Christopoulos P, Hoffknecht P, Waller C, Benkelmann R, Jänicke M, Fleitz A, Hanselmann J, Hipper A, Groth A, Weichert W, Nusch A, Rauh J, Fietz T, Illmer T, Depenbusch R, Eberhardt W, Thomas M. 49P EGFR exon 20 insertion mutations in patients with locally advanced or metastatic NSCLC in the German prospective, CRISP Registry real-world cohort (AIO-TRK-0315). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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49
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Tiseo M, Popat S, Kim H, Ahn MJ, Yang J, Han JY, Hochmair M, Lee K, Delmonte A, Garcia Campelo M, Kim DW, Griesinger F, Felip E, Califano R, Spira A, Gettinger S, Lin H, Liu Y, Vranceanu F, Camidge D. 29P Brigatinib (BRG) vs crizotinib (CRZ) in anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor-naive ALK+ non-small cell lung cancer (NSCLC): ALTA-1L final results. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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50
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Roeper J, Ansmann L, Kathmann L, Blanksma A, Wedeken K, Griesinger F. 70P Adherence to treatment recommendations from multidisciplinary tumor boards. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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