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Friedlaender A, Perol M, Banna GL, Parikh K, Addeo A. Oncogenic alterations in advanced NSCLC: a molecular super-highway. Biomark Res 2024; 12:24. [PMID: 38347643 PMCID: PMC10863183 DOI: 10.1186/s40364-024-00566-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
Lung cancer ranks among the most common cancers world-wide and is the first cancer-related cause of death. The classification of lung cancer has evolved tremendously over the past two decades. Today, non-small cell lung cancer (NSCLC), particularly lung adenocarcinoma, comprises a multitude of molecular oncogenic subsets that change both the prognosis and management of disease.Since the first targeted oncogenic alteration identified in 2004, with the epidermal growth factor receptor (EGFR), there has been unprecedented progress in identifying and targeting new molecular alterations. Almost two decades of experience have allowed scientists to elucidate the biological function of oncogenic drivers and understand and often overcome the molecular basis of acquired resistance mechanisms. Today, targetable molecular alterations are identified in approximately 60% of lung adenocarcinoma patients in Western populations and 80% among Asian populations. Oncogenic drivers are largely enriched among non-smokers, east Asians, and younger patients, though each alteration has its own patient phenotype.The current landscape of druggable molecular targets includes EGFR, anaplastic lymphoma kinase (ALK), v-raf murine sarcoma viral oncogene homolog B (BRAF), ROS proto-oncogene 1 (ROS1), Kirstin rat sarcoma virus (KRAS), human epidermal receptor 2 (HER2), c-MET proto-oncogene (MET), neurotrophic receptor tyrosine kinase (NTRK), rearranged during transfection (RET), neuregulin 1 (NRG1). In addition to these known targets, others including Phosphoinositide 3-kinases (PI3K) and fibroblast growth factor receptor (FGFR) have garnered significant attention and are the subject of numerous ongoing trials.In this era of personalized, precision medicine, it is of paramount importance to identify known or potential oncogenic drivers in each patient. The development of targeted therapy is mirrored by diagnostic progress. Next generation sequencing offers high-throughput, speed and breadth to identify molecular alterations in entire genomes or targeted regions of DNA or RNA. It is the basis for the identification of the majority of current druggable alterations and offers a unique window into novel alterations, and de novo and acquired resistance mechanisms.In this review, we discuss the diagnostic approach in advanced NSCLC, focusing on current oncogenic driver alterations, through their pathophysiology, management, and future perspectives. We also explore the shortcomings and hurdles encountered in this rapidly evolving field.
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Affiliation(s)
- Alex Friedlaender
- Clinique Générale Beaulieu, Geneva, Switzerland
- Oncology Department, University Hospital Geneva, Rue Gentil Perret 4. 1205, Geneva, Switzerland
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Giuseppe Luigi Banna
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | | | - Alfredo Addeo
- Oncology Department, University Hospital Geneva, Rue Gentil Perret 4. 1205, Geneva, Switzerland.
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Dessemon J, Perol O, Chauvel C, Noelle H, Coudon T, Grassot L, Foray N, Belladame E, Fayette J, Fournie F, Swalduz A, Neidhart EM, Saintigny P, Tabutin M, Boussageon M, Gomez F, Avrillon V, Perol M, Charbotel B, Fervers B. Survival of bronchopulmonary cancers according to radon exposure. Front Public Health 2024; 11:1306455. [PMID: 38328545 PMCID: PMC10847230 DOI: 10.3389/fpubh.2023.1306455] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Introduction Residential exposure is estimated to be responsible for nearly 10% of lung cancers in 2015 in France, making it the second leading cause, after tobacco. The Auvergne-Rhône-Alpes region, in the southwest of France, is particularly affected by this exposure as 30% of the population lives in areas with medium or high radon potential. This study aimed to investigate the impact of radon exposure on the survival of lung cancer patients. Methods In this single-center study, patients with a histologically confirmed diagnosis of lung cancer, and newly managed, were prospectively included between 2014 and 2020. Univariate and multivariate survival analyses were carried out using a non-proportional risk survival model to consider variations in risk over time. Results A total of 1,477 patients were included in the analysis. In the multivariate analysis and after adjustment for covariates, radon exposure was not statistically associated with survival of bronchopulmonary cancers (HR = 0.82 [0.54-1.23], HR = 0.92 [0.72-1.18], HR = 0.95 [0.76-1.19] at 1, 3, and 5 years, respectively, for patients residing in category 2 municipalities; HR = 0.87 [0.66-1.16], HR = 0.92 [0.76-1.10], and HR = 0.89 [0.75-1.06] at 1, 3, and 5 years, respectively, for patients residing in category 3 municipalities). Discussion Although radon exposure is known to increase the risk of lung cancer, in the present study, no significant association was found between radon exposure and survival of bronchopulmonary cancers.
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Affiliation(s)
- Juliette Dessemon
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Olivia Perol
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Cécile Chauvel
- Center of Excellence in Respiratory Pathogens (CERP), Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Hugo Noelle
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Thomas Coudon
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Lény Grassot
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Nicolas Foray
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Elodie Belladame
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Jérôme Fayette
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Françoise Fournie
- Département Interdisciplinaire de Soins de Support du Patient en Oncologie, Center Léon Bérard, Lyon, France
| | - Aurélie Swalduz
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | | | - Pierre Saintigny
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Mayeul Tabutin
- Département de Chirurgie Cancérologique, Center Léon Bérard, Lyon, France
| | - Maxime Boussageon
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
| | - Frédéric Gomez
- Département de Santé Publique, Center Léon Bérard, Lyon, France
| | - Virginie Avrillon
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Maurice Perol
- Département de Cancérologie Médicale, Center Léon Bérard, Lyon, France
| | - Barbara Charbotel
- Université de Lyon, Université Lyon 1, Université Gustave Eiffel-Ifsttar, Umrestte, UMR, Lyon, France
- CRPPE-Lyon, Center Régional de Pathologies Professionnelles et Environnementales de Lyon, Center Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Center Léon Bérard, Lyon, France
- Inserm UMR1296, “Radiation: Defense, Health Environment,” Center Léon Bérard, Lyon, France
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Belaroussi Y, Bouteiller F, Bellera C, Pasquier D, Perol M, Debieuvre D, Filleron T, Girard N, Schott R, Mathoulin-Pélissier S, Martin AL, Cousin S. Survival outcomes of patients with metastatic non-small cell lung cancer receiving chemotherapy or immunotherapy as first-line in a real-life setting. Sci Rep 2023; 13:9584. [PMID: 37311845 DOI: 10.1038/s41598-023-36623-1] [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] [Received: 10/17/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
Treatment of metastatic non-small cell lung cancer (mNSCLC) has been modified due to the development of immunotherapy. We assessed survival outcomes (overall [OS] and progression-free [rwPFS] survivals, time-to-next-treatment [TNT]) in mNSCLC patients after first-line immunotherapy and chemotherapy in real-life settings. Association between rwPFS and TNT, two candidate surrogate endpoints (SE), with OS was assessed. This retrospective multi-center study uses data from patients included in the Epidemio-Strategy Medico-Economic program with mNSCLC over 2015-2019. The impact of treatment on rwPFS/OS was evaluated with Cox models. Individual-level associations between SE and OS were estimated with an iterative multiple imputation approach and joint survival models. The population included 5294 patients (63 years median age). Median OS in immunotherapy group was 16.4 months (95%CI [14.1-NR]) and was higher than in chemotherapy group (11.6 months; 95%CI [11.0-12.2]). Improved OS was observed for the immunotherapy group after 3 months for subjects with performance status 0-1 (HR = 0.59; 95%CI [0.42-0.83], p < 0.01). The associations between rwPFS and TNT with OS were close ([Formula: see text]=0.57). Results emphasized a survival improvement with immunotherapy for patients in good health condition. There was moderate evidence of individual-level association between candidate SE and OS.
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Affiliation(s)
- Yaniss Belaroussi
- UMR 1219, Univ. Bordeaux, Bordeaux Population Health Research Center, Epicene Team, 33000, Bordeaux, France.
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France.
| | - Fanny Bouteiller
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - Carine Bellera
- UMR 1219, Univ. Bordeaux, Bordeaux Population Health Research Center, Epicene Team, 33000, Bordeaux, France
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - David Pasquier
- Radiotherapy Department, Centre Oscar Lambret, 59000, Lille, France
| | - Maurice Perol
- Medical Oncology Department, Centre Léon Bérard, 69373, Lyon, France
| | | | - Thomas Filleron
- Biostatistic and Health Data Science Unit, Institut Claudius Régaud IUTC-O, 31300, Toulouse, France
| | - Nicolas Girard
- Medical Oncology Department, Institut du Thorax Curie-Montsouris, 75014, Paris, France
| | - Roland Schott
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, 67200, Strasbourg, France
| | - Simone Mathoulin-Pélissier
- UMR 1219, Univ. Bordeaux, Bordeaux Population Health Research Center, Epicene Team, 33000, Bordeaux, France
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000, Bordeaux, France
| | - Anne-Laure Martin
- Health Data and Partnership Department, Unicancer, 75654, Paris, France
| | - Sophie Cousin
- Early Phase Trials Unit, Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, 229 Cours de L'Argonne, 33000, Bordeaux, France
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Bringuier M, Carton M, Debieuvre D, Pasquier D, Perol M, Filleron T, Léna H, Quantin X, Simon G, Baldini C. Enrolment of older adults with advanced or metastatic non-small cell lung cancer in first-line clinical trials in the multicentre ESME cohort. J Geriatr Oncol 2023; 14:101423. [PMID: 36657245 DOI: 10.1016/j.jgo.2022.101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/30/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION There is a great need for data based on clinical trials for the older population in order to improve treatment. Historically, the inclusion rate of older adults in clinical trials has been low, but the rate specific to lung cancer is unknown, as are the factors associated with enrolment. MATERIALS AND METHODS We used the national Epidemio-Strategy and Medical Economics Advanced or Metastatic Lung Cancer (AMLC) Data Platform, a multicentre real-life database. Inclusion criteria were patients with advanced or metastatic non-small cell lung cancer (AMNSCLC) aged 70 years or older, with at least one line of systemic treatment from 01 January 2015 to 31 December 2018. The primary objective was to evaluate the proportion of older adults enrolled in clinical trials. Secondary objectives were to identify factors associated with enrolment in clinical trials for older patients and to compare the overall survival of older adults included in trials versus those not included. RESULTS There were 3488 patients aged ≥70 years (median age at AMNSCLC 75 years). Among older patients, 234 (6.7%) were enrolled in a clinical trial in the first-line setting. Significant factors associated with enrolment in the multivariable analysis in older patients were: good Eastern Cooperative Oncology Group (ECOG) Performance Status (PS 0) (p < 0.001), de novo versus recurrent presentation at diagnosis (p < 0.001), and non-central nervous system (CNS) metastases versus advanced setting or CNS metastases (p < 0.001). Medical history was associated with fewer inclusions (odds ratio [OR] = 0.74, 95% confidence interval [CI] [0.56; 0.99]). Among older patients, being enrolled in a trial in the first-line setting was not associated with better overall survival (OS) (hazard ratio [HR] = 1.03; 95%CI 0.86-1.22) in the multivariable analysis. DISCUSSION In this large database, few older AMNSCLC patients were enrolled in a trial. Factors associated with enrolment were: good ECOG PS, absence of medical history, de novo AMNSCLC, and presentation with non-CNS metastases.
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Affiliation(s)
- Michael Bringuier
- Department of Medical Oncology and Department of Supportive Care, Institut Curie, PSL Research University, Saint-Cloud, France.
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, PSL Research University, Saint-Cloud, France.
| | - Didier Debieuvre
- Pneumology Department, Groupe hospitalier de la région de Mulhouse Sud Alsace, Mulhouse, France.
| | - David Pasquier
- Department of Radiotherapy, Centre Oscar Lambret, Lille, France; Lille University, CRIStAL UMR, 9189 Lille, France.
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France.
| | - Thomas Filleron
- Biostastistic and Health Data science Unit, Institut Claudius Régaud IUCT-O, Toulouse, France.
| | - Herve Léna
- Pneumology Department, Centre Hospitalier Universitaire, Rennes, France.
| | - Xavier Quantin
- Department of Medical Oncology, Institut régional du cancer de Montpellier, Université de Montpellier, INSERM Unité, 1194 Montpellier, France.
| | - Gaëtane Simon
- Real-world Data Department, Unicancer, Paris, France.
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Gervais R, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay-Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaïd C, Decroisette C. First-line single-agent pembrolizumab for PD-L1-positive (tumor proportion score ≥ 50%) advanced non-small cell lung cancer in the real world: impact in brain metastasis: a national French multicentric cohort (ESCKEYP GFPC study). Cancer Immunol Immunother 2023; 72:91-99. [PMID: 35729418 DOI: 10.1007/s00262-022-03232-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few real-world data are available in patients with advanced metastatic non-small cell lung cancer (NSCLC) treated with first-line immunotherapy, particularly in those with brain metastases at treatment initiation. METHODS This was a national, retrospective, multicenter study that consecutively included all patients with PD-L1-positive (tumor proportion score ≥ 50%) advanced NSCLC who initiated first-line treatment with pembrolizumab as a single agent between May 2017 (date of availability of pembrolizumab in this indication in France) to November 22, 2019 (approval of the pembrolizumab-chemotherapy combination). Data were collected from medical records with local response assessment. RESULTS The cohort included 845 patients and 176 (20.8%) had brain metastases at diagnosis. There were no significant differences in outcomes for patients with and without brain metastases: 9.2 (95% CI 5.6-15) and 8 (95% CI 6.7-9.2, p = 0.3) months for median progression-free survival (PFS) and, 29.5 (95% CI 17.2-NA) and 22 (95% CI 17.8-27.1, p = 0.3) months for median overall survival (OS), respectively. Overall response rates were 47% and 45% in patients with and without cerebral metastases. In multivariate analysis, performance status 2-4 vs. 0-1 and neutrophil-to-lymphocyte ratio ≥ 4 vs. < 4 were the main independent negative factors for OS; brain metastasis was not an independent factor for OS. CONCLUSION In this large multicenter cohort, nearly 20% of patients initiating pembrolizumab therapy for advanced NSCLC had cerebral metastases. There was no significant difference in response rates, PFS and OS between patients with and without brain metastases.
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Affiliation(s)
- Renaud Descourt
- Oncology Department, Brest University Hospital, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations Department, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Aix Marseille University, Marseille, France
| | - Maurice Perol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Charles Ricordel
- Pneumology Department, Rennes University Hospital, Rennes, France
| | - Jean-Bernard Auliac
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France
| | - Lionel Falchero
- Pneumology Department, Hôpital Nord-Ouest, Villefranche-sur-Saône Hospital, Gleize, France
| | - Radj Gervais
- Oncology Department, Caen François-Baclesse Cancer Center, Caen, France
| | - Rémi Veillon
- Pneumology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Florian Guisier
- Pneumology Department, Rouen University Hospital, Rouen, France
| | - Marie Marcq
- Pneumology Department, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | | | | | - Marie Bernardi
- Pneumology Department, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Pierre Fournel
- Oncology Department, Institut de Cancérologie de La Loire Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Hélène Doubre
- Pneumology Department, Hôpital Foch, Suresnes, France
| | - Julian Pinsolle
- Pneumology Department, Chambéry Métropole Savoie Hospital, Chambéry, France
| | - Karim Amrane
- Oncology Department, Morlaix Hospital, Morlaix, France
| | - Christos Chouaïd
- Pneumology Department, Creteil University Hospital, CHI Créteil, 40 Avenue de Verdun, 94010, Creteil, France.
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Greillier L, Monville F, Leca V, Vely F, Garcia S, Ciccolini J, Sabatier F, Ferrani G, Boudai N, Ghezali L, Landri M, Marin C, Hamimed M, Arnaud L, Karlsen M, Atsou K, Bokobza S, Fleury P, Boyer A, Audigier-Valette C, Martinez S, Pegliasco H, Ray P, Falchero L, Serre A, Cloarec N, Lebas L, Hominal S, Barre P, Zahi S, Frikha A, Bory P, Ray ML, Laborde L, Martin V, Malkoun R, Roumieux M, Mazieres J, Perol M, Vivier E, Benzekry S, Fieschi J, Barlesi F. Abstract LB120: Comprehensive biomarkers analysis to explain resistances to PD1-L1 ICIs: The precision immuno-oncology for advanced non-small cell lung cancer (PIONeeR) trial. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-lb120] [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: 11/16/2022]
Abstract
Abstract
Background: Resistance to PD1/L1 immune checkpoint inhibitors (ICIs) in advanced NSCLC patients is observed in about 80% of individuals with no robust predictive biomarker yet. The PIONeeR trial (NCT03493581) aims to predict such resistances through a comprehensive multiparametric biomarkers analysis.
Methodology: Among the >300 advanced NSCLC patients (pts) recruited in PIONeeR, we focused on the first 137 ≥2nd line ECOG PS0-1 pts treated with single-agent nivolumab, pembrolizumab or atezolizumab. Tumor tissue was collected at baseline and pts were re-biopsied at 6 weeks, and blood-sampled every cycle throughout the 24 weeks post C1D1. Response to PD1/L1 ICIs was assessed by RECIST 1.1 every 6 weeks. Immune contexture was characterized in tumor & blood of each pt through FACS for circulating immune cell subtypes quantification and endothelial activation, blood soluble factors dosage, dual- & multiplex IHC/digital pathology to quantify immune cells infiltrating the tumor, WES for TMB & ICI plasma dosage, leading to 331 measured biomarkers in addition to routine clinical parameters. Multivariable (MV) logistic regression was used to examine the association of each biomarker (controlled by sex, age, smoking status, histological type & PDL1+ Tumor Cells) with the risk of Early Progression (EP), i.e. within 3.5 months of treatment. Multivariable Cox regression analysis was conducted for association with PFS and OS.
Results: Overall, the 137 pts were mainly male (64%), smokers (92%) and <70yrs (68%). Tumors were mainly non-squamous (79%) with >1% PDL1+ TC in 36% of the cases, and 21% of pts were still on treatment at data cut-off. Archived samples were available for 80% of pts at inclusion and re-biopsy was available in 52.9% of these cases. The median follow up was 19.8 months, 22.5% of pts did not progress at data cut-off while 62% presented EP. Tumor Cytotoxic T-cells density, especially PD1+ were lower in EP (MV OR=0.45, p=0.022); conversely, higher proportions of circulating cytotoxic T-cells and activated T-cells (HLA-DR+) were observed in EP (MV OR=3.8, p<0.001). Among other biomarkers, Tregs (MV OR=0.44, p=0.018), NK cell subsets (MV OR≤0.44, p<0.05), albumin (MV OR=0.4, p<0.01) and PDL1 TC % (MV OR=0.27, p<0.01) were decreased whereas alkaline phosphatase was increased (OR=3, p=0.018). >65% inter-pt variability was observed in plasma exposures for all ICIs, with 8-10% of pts displaying trough levels below the target engagement threshold. Data will be presented through unsupervised clustering algorithms & multi-modal supervised learning methods. Changes after 6 weeks of treatment will be analyzed to further investigate drugs mechanisms of action.
Conclusion: The PIONeeR trial provides with the 1st comprehensive biomarkers’ analysis to establish predictive models of resistance in advanced NSCLC pts treated with PD1/L1 ICIs and highlights how tumor and circulating biomarkers are complementary.
Citation Format: Laurent Greillier, Florence Monville, Vanina Leca, Frédéric Vely, Stephane Garcia, Joseph Ciccolini, Florence Sabatier, Gilbert Ferrani, Nawel Boudai, Lamia Ghezali, Marcellin Landri, Clémence Marin, Mourad Hamimed, Laurent Arnaud, Melanie Karlsen, Kevin Atsou, Sivan Bokobza, Pauline Fleury, Arnaud Boyer, Clarisse Audigier-Valette, Stéphanie Martinez, Hervé Pegliasco, Patrice Ray, Lionel Falchero, Antoine Serre, Nicolas Cloarec, Louisiane Lebas, Stephane Hominal, Patricia Barre, Sarah Zahi, Ahmed Frikha, Pierre Bory, Maryannick Le Ray, Lilian Laborde, Virginie Martin, Richard Malkoun, Marie Roumieux, Julien Mazieres, Maurice Perol, Eric Vivier, Sebastien Benzekry, Jacques Fieschi, Fabrice Barlesi. Comprehensive biomarkers analysis to explain resistances to PD1-L1 ICIs: The precision immuno-oncology for advanced non-small cell lung cancer (PIONeeR) trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB120.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Antoine Serre
- 13Institut Cancerologie du Gard, Oncogard, Nimes, France
| | | | - Louisiane Lebas
- 15Centre Hospitalier du Val d'Ariège, St Jean de Verges, France
| | | | | | - Sarah Zahi
- 18Centre Hospitalier de Montauban, Montauban, France
| | | | - Pierre Bory
- 20Centre Hospitalier de Bastia, Bastia, France
| | | | | | | | | | | | | | | | - Eric Vivier
- 24Aix Marseille Université, APHM, Innate Pharma, Marseille, France
| | | | | | - Fabrice Barlesi
- 25Gustave Roussy, Aix Marseille Université, Villejuif, France
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Peters S, Gadgeel SM, Mok TSK, Nadal E, Kilickap S, Perol M, Cadranel J, Sugawara S, Chiu CH, Moskovitz M, Yu CJ, Tanaka T, Nersesian R, Shagan SM, Maclennan M, Mathisen M, Bhagawati Prasad VNS, Archer VR, Dziadziuszko R. Efficacy/safety of entrectinib in patients (pts) with ROS1-positive (ROS1+) advanced/metastatic NSCLC from the Blood First Assay Screening Trial (BFAST). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.17_suppl.lba9023] [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
LBA9023 Background: Tissue-based biomarker testing remains challenging as tumor biopsies are often inadequate for comprehensive biomarker testing and repeat biopsies can be risky in pts with advanced/metastatic NSCLC. These challenges could be overcome by using blood-based testing to identify the most appropriate targeted therapy. BFAST (NCT03178552) is a global open-label, multicohort trial evaluating the efficacy and safety of selected therapies in pts with advanced/metastatic NSCLC harboring actionable genetic alterations, as identified by next-generation sequencing (NGS) in cell-free DNA (liquid biopsies). We present data from the ROS1+ cohort: this is the first evaluation of entrectinib efficacy in pts identified by prospective blood-based NGS. Methods: In this single-arm analysis, adults (≥18 years) with treatment-naïve measurable stage IIIB/IV NSCLC, identified as ROS1+ by the FoundationOne®Liquid CDx CTA blood-based NGS test, received oral entrectinib 600 mg/day until disease progression (PD), unacceptable toxicity, consent withdrawal or death. Pts with asymptomatic brain metastases at screening were eligible. Tumor scans were performed at baseline and every 8 weeks thereafter for all disease involvement areas (brain imaging not mandated in pts without baseline CNS disease). Primary endpoint: investigator (INV)-assessed objective response rate (ORR; RECIST 1.1). Secondary endpoints: INV-assessed duration of response (DoR) and progression-free survival (PFS); independent review facility (IRF)-assessed ORR, DoR, PFS; overall survival (OS); time to CNS PD; safety. Results: 55 pts with ROS1+ NSCLC identified by blood-based NGS were enrolled and treated with entrectinib. Median age was 56 yrs; 58% of pts were female and 75% had no history of tobacco use. Non-squamous adenocarcinoma was the most common histology (n = 48/55; 87%); 4 pts (7.3%) had baseline CNS disease. Median follow-up: 18.3 months. At data cut-off (26 Nov 2021, n = 54 pts with measurable disease), confirmed ORR was 81.5% (n = 44/54; 95% CI 68.6–90.8) by INV (2 complete responses [CR], 42 partial responses [PR]) and IRF (3 CR, 41 PR). Median DoR was 13.0 months (95% CI 6.3–18.4) by INV and 16.7 months (95% CI 5.6–24.0) by IRF. Median PFS was 12.9 months (95% CI 8.7–18.5) by INV, and 14.8 months (95% CI 7.2–24.0) by IRF. OS data were immature with 20 events (36.4%) recorded. Median time to CNS PD was not reached (INV: 9 events; IRF: 6 events). Most treatment-related adverse events were non-serious with no treatment-related deaths. Conclusion: These data support the clinical value of blood-based NGS as another method to inform clinical decision-making in ROS1+ NSCLC. Pts with ROS1+ NSCLC (by blood-based NGS) treated with entrectinib showed deep and durable responses, consistent with results from entrectinib trials that used tissue-based testing. No new safety signals were observed. Clinical trial information: NCT03178552.
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Affiliation(s)
- Solange Peters
- Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Tony S. K. Mok
- State Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Ernest Nadal
- Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Saadettin Kilickap
- Istinye University Faculty of Medicine, Department of Medical Oncology, Istanbul, Turkey
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, APHP, Hôpital Tenon and GRC04 Theranoscan Sorbonne Université, Paris, France
| | - Shunichi Sugawara
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Chao-Hua Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mor Moskovitz
- Thoracic Cancer Service, Rambam Health Care Campus, Haifa, Israel
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy and Early Clinical Trials Unit, Medical University of Gdansk, Gdańsk, Poland
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8
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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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9
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Schoenfeld AJ, Antonia SJ, Awad MM, Felip E, Gainor J, Gettinger SN, Hodi FS, Johnson ML, Leighl NB, Lovly CM, Mok T, Perol M, Reck M, Solomon B, Soria JC, Tan DSW, Peters S, Hellmann MD. Clinical definition of acquired resistance to immunotherapy in patients with metastatic non-small-cell lung cancer. Ann Oncol 2021; 32:1597-1607. [PMID: 34487855 DOI: 10.1016/j.annonc.2021.08.2151] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 06/04/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022] Open
Abstract
Acquired resistance (AR) to programmed cell death protein 1/programmed death-ligand 1 [PD-(L)1] blockade is frequent in non-small-cell lung cancer (NSCLC), occurring in a majority of initial responders. Patients with AR may have unique properties of persistent antitumor immunity that could be re-harnessed by investigational immunotherapies. The absence of a consistent clinical definition of AR to PD-(L)1 blockade and lack of uniform criteria for ensuing enrollment in clinical trials remains a major barrier to progress; such clinical definitions have advanced biologic and therapeutic discovery. We examine the considerations and potential controversies in developing a patient-level definition of AR in NSCLC treated with PD-(L)1 blockade. Taking into account the specifics of NSCLC biology and corresponding treatment strategies, we propose a practical, clinical definition of AR to PD-(L)1 blockade for use in clinical reports and prospective clinical trials. Patients should meet the following criteria: received treatment that includes PD-(L)1 blockade; experienced objective response on PD-(L)1 blockade (inclusion of a subset of stable disease will require future investigation); have progressive disease occurring within 6 months of last anti-PD-(L)1 antibody treatment or rechallenge with anti-PD-(L)1 antibody in patients not exposed to anti-PD-(L)1 in 6 months.
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Affiliation(s)
- A J Schoenfeld
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, USA; Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, USA
| | - S J Antonia
- Department of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, USA
| | - M M Awad
- Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - J Gainor
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, USA; Harvard Medical School, Boston, USA
| | - S N Gettinger
- Department of Medicine, Medical Oncology, Yale School of Medicine, New Haven, USA
| | - F S Hodi
- Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M L Johnson
- Department of Medicine, Sarah Cannon Research Institute, Nashville, USA
| | - N B Leighl
- Princess Margaret Cancer Centre, Toronto, Canada
| | - C M Lovly
- Department of Medicine and Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, USA
| | - T Mok
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, China
| | - M Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - M Reck
- Department of Thoracic Oncology, Airway Research Center North (ARCN), German Center for Lung Research, LungenClinic Grosshansdorf, Grosshansdorf, Germany
| | - B Solomon
- Peter MacCallum Cancer Center, Melbourne, Australia
| | - J-C Soria
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - D S W Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - M D Hellmann
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, USA.
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10
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Girard N, Perol M, Simon G, Audigier Valette C, Gervais R, Debieuvre D, Schott R, Quantin X, Coudert B, Lena H, Carton M, Robain M, Filleron T, Chouaid C. Treatment strategies for unresectable locally advanced non-small cell lung cancer in the real-life ESME cohort. Lung Cancer 2021; 162:119-127. [PMID: 34775215 DOI: 10.1016/j.lungcan.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cisplatin-based chemotherapy administered concurrently to thoracic radiation therapy is the recommended treatment for fit patients with unresectable stage III NSCLC. The aim of this study was to describe patient profiles and clinical outcomes for the different treatment strategies in a real-word setting. METHODS The epidemio-strategy and medical economics (ESME) database for advanced and metastatic lung cancer is a French, national, multicenter, observational cohort. Out of 8514 Patients, 822 patients with unresectable locally advanced NSCLC in 2015-016 were selected (mean age, 65.3 years; male gender, 69%; performance status 0-1, 77%; smokers or former smokers, 89%). RESULTS Treatment was initiated for 736 (90%) of patients (concurrent chemoradiotherapy, n = 283; sequential chemoradiotherapy, n = 121; chemotherapy alone, n = 194; radiotherapy alone, n = 121; targeted therapy alone, n = 8; other, n = 9). Compared to the other treatment strategy groups, patients with radiotherapy alone appeared the most fragile (e.g. higher age, lower body weight or higher frequency of chronic obstructive pulmonary disease). OS rates at 12 and 24 months were 79.5% (95% CI, 73.4-84.3) and 55.3% (95% CI, 44.9-64.5) for concurrent chemoradiotherapy, and 64.3% (95% CI, 52.8-73.8) and 53.2 (95% CI, 33.2-69.6) for sequential chemoradiotherapy. CONCLUSIONS Real-world evidence shows that concurrent chemoradiotherapy is administered to the most fit patients with non resectable locally-advanced NSCLC. Clinical outcomes are actually higher than those reported in landmark clinical trials, which suggests that an optimized and individualized selection of patients allows for prolonged survival. Long-term outcomes are similar after sequential or concurrent chemoradiotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Xavier Quantin
- Institut de Cancérologie de Montpellier, Montpellier, France
| | | | - Hervé Lena
- Centre Hospitalier Universitaire de Rennes, Rennes, France
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11
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Leca V, Kassambara A, Ghezali L, Outters P, Cotteaux-Lautard C, Arnoux F, Sbarrato T, Monville F, Monville F, Ray ML, Roumieux M, Garcia S, Malkoun R, Resseguier N, Boyer A, Lebas L, Pegliasco H, Barré P, Audigier-valette C, Zahi S, Odier L, Hominal S, Perol M, Mazieres J, Greillier L, Barlesi F, Fieschi-Meric J. 460 Spatial distribution of infiltrating T lymphocytes with Immunoscore® CR T cells exhaustion test helps stratification of NSCLC patients treated with PD1/PDL1 inhibitors in the PIONeeR project. J Immunother Cancer 2021. [DOI: 10.1136/jitc-2021-sitc2021.460] [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] [Indexed: 11/03/2022] Open
Abstract
BackgroundPD1/L1 Immune Checkpoint Inhibitors (ICI) have significantly improved long-term outcome in about 20% of advanced Non Small Cells Lung Cancer (NSCLC) patients (pts), but 80% present primary or secondary resistance. The PIONeeR project (NCT03493581) aims to predict the response/resistance to PD1/L1 ICIs in advanced NSCLC pts through a comprehensive agnostic multiparametric and longitudinal biomarkers assessment. Data presented here are a focus on the quantification of tumor infiltration by lymphocytes, their activation as potential markers of the resistance to treatment by ICI.MethodsAdvanced NSCLC pts with available archived tumor tissue at screening visit (VS), treated with standard PD1/L1 ICIs (nivolumab, pembrolizumab or atezolizumab), alone (2nd line or more) or combined with chemotherapy (1st line), were re-biopsied at 6 weeks (V2) of treatment. PD1/L1 ICIs overall response rate (ORR) was assessed by RECIST 1.1 every 6 weeks. The multiplex IHC test ”Immunoscore® CR T Cells Exhaustion” (IS TCE) quantifies cytotoxic lymphocytes expressing three checkpoints: PD1, LAG3, TIM3, extrapolating their exhaustion status, both in the stroma and parenchyma. The unsupervised neural-network-based machine learning algorithm SOM (Self-Organizing Maps) was used to classify samples based on the 27 IS TCE variables. Statistical significance of survival differences between groups was evaluated using the log-rank test.ResultsAmong the first 100 pts, (male (64%), smokers (91,8%), <70yrs (69%), with an ECOG PS0/1 (97%), treated in 2nd line setting (86%)), 79 VS + 30 V2 biopsies were tested with IS TCE. SOM clustering highlighted four distinct clusters: a group with moderate T-cells infiltration (group 1), hot tumors with high T cells infiltration in both stroma and parenchyma (group 2), cold tumors with very low T cells infiltration (group 3), and finally, a highly distinguishable group with important T-cells density in stroma only (group 4). None of the 11 responders was present in the Group 3, ”Cold” cluster. The four groups presented different Progression Free Survival (PFS) rates (p=5,2e-4) with better relapse-free survival Groups 1 and 2. Additionally, V2/VS ratios showed lymphocytes recruitment induced by the treatment in parenchyma only: no significant lymphocytes recruitment was observed in the stromal compartment. Interestingly, the most recruited lymphocyte populations expressed PD1.ConclusionsIS TCE test may help stratifying and predicting responders to anti PD1/L1 therapy through checkpoint expressing lymphocytes quantification and spatial distribution. Additional tests performed on the PIONeeR cohort to explore other aspects of the immune response to cancer should complete these results.AcknowledgementsThis work is supported by French National Research Agency (ANR-17-RHUS-0007), a partnership of AMU, APHM, AstraZeneca, Centre Léon Bérard, CNRS, HalioDx, ImCheck Therapeutics, Innate Pharma, Inserm, Institut Paoli Calmettes and sponsored by AP HM. Drug supply is funded by AstraZeneca. Special thanks to patients and families.Trial RegistrationNCT03493581Ethics ApprovalThe study is conducted in accordance with Good Clinical Practice and the French applicable regulatory requirements (Public Health Code, article L.1121-1/La loi n° 2012–300 du 5 mars 2012 relative aux recherches impliquant la personne humaine (dite loi Jardé), the applicable subject privacy requirements, and the ethical principles that are outlined in the Declaration of Helsinski. The study was approved by the French Ethic Committee, CPP Ouest II - Angers, ref. CPP: 2028/08, Ref ANSM (French competent authority) 2018020500208, 2018072600120, 2019083000148. Freely given written informed consent was signed and obtained from each individual participating in the study, before any study specific procedure was undertaken and after the provision of information about the study by the investigator during a physician-patient consultation and sufficient time for reflection.
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12
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Bouteiller F, Cousin S, Sofeu C, Perrocheau G, Gervais R, Perol M, Girard N, Chamorey E, Pasquier D, Dubray Longeras P, Kaderbhai C, Schott R, Filleron T, Chouaid C, Debieuvre D, Valette CA, Quantin X, Bosquet L, Martin A, Bellera C. Exploratory analyses of surrogate endpoints in metastatic non-small cell lung cancer. Rev Epidemiol Sante Publique 2021. [DOI: 10.1016/j.respe.2021.04.056] [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: 10/21/2022] Open
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13
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Descourt R, Greillier L, Perol M, Ricordel C, Auliac JB, Falchero L, Demontrond P, Veillon R, Vieillot S, Guisier F, Marcq M, Justeau G, Bigay Game L, Bernardi M, Fournel P, Doubre H, Pinsolle J, Amrane K, Chouaid C, Decroisette C. First-line pembrolizumab monotherapy for PD-L1-positive (TPS ≥ 50%) advanced non-small cell lung cancer (aNSCLC) in the real world: A national French bispective multicentric cohort—ESCKEYP trial (GFPC 05-2018). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9091] [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
9091 Background: To determine real-world outcomes with first line pembrolizumab monotherapy, for aNSCLC with PD-L1 TPS ≥50%. Methods: Bispective, national and multicentric study including consecutively aNSCLC patients who initiated first-line pembrolizumab monotherapy from May 5, 2017 (marketing authorization of pembrolizumab monotherapy in France) to Nov 22, 2019 (marketing authorization of pembrolizumab-chemotherapy for non-squamous aNSCLC). Data were collected on medical charts. Responses were locally assessed according to RECIST v1.1; overall survival (OS) and real-world progression-free survival (rwPFS) were assessed by Kaplan-Meier method. Results: 845 patients (pts) were included by 33 centres: 67.8% were men, PS 0/1/≥2: 25.5%/46.9%/27.6%, active/former/nonsmokers: 39.1%/51.7%/6.4%, adenocarcinoma: 70.8%; stage IV at diagnosis: 91.6%; median number of metastatic sites at baseline: 2±1 (brain (20.8%), liver (13.9%) and bone (35%)); KRAS mutated: 27.7%, PDL1 TPS > 75%: 53.7% At the cut off date (31 December 2020), on the 783/845 (92.7%) evaluable pts, CR, PR, disease stabilization and progression were reported on 4.7%, 42.6%, 24.1% and 28.6% of cases, respectively; 588 (69.6%) pts had discontinued pembrolizumab, 390 (66.4%) had a first disease progression; 320/390 (82.1%) received a second line treatment, mainly platinum-based chemotherapy (90.6%). With a median follow up of 25,8 [95%CI: 24,8-26,7] months, median rwPFS and median OS were 8,2 [95%CI: 6,9-9,5] and 22,6 [95%CI: 18,5-27,4] months, respectively; 6, 12, 18-months survival rates were 76,8%, 64,8% and 54,3%. 835 adverse events were reported in 48% of the patients, grade ≥3 in 13.8% of cases, mainly asthenia, colitis, pneumonitis. For evaluable patients receiving a platinum-based doublet in second line (266/290, 89%), CR, PR, disease stabilization and progression were reported on 1.9%, 41%, 35.3% and 21.8% of cases, respectively. Uni and multivariate analysis of factors related to OS will be presented at the congress. Conclusions: Despite a less stringent selection of patients, pembrolizumab as a single agent achieves similar tumor shrinkage, rwPFS and OS than those of pivotal clinical trials.
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Affiliation(s)
- Renaud Descourt
- Thoracic Oncology Department, Hospital Morvan, Brest, France
| | - Laurent Greillier
- Multidisciplinary Oncology and Therapeutic Innovations, Hôpital Nord, Marseille, France
| | - Maurice Perol
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | | | | | - Lionel Falchero
- Pneumology Department, Hopital Nord Ouest Villefranche Sur Saone, Villefranche Sur Saone, France
| | | | - Remi Veillon
- CHU Bordeaux, Service Des Maladies Respiratoires, Bordeaux, France
| | | | | | - Marie Marcq
- Centre Hospitalier, La Roche-Sur-Yon, France
| | | | | | | | - Pierre Fournel
- Pneumology Department, Institut de Cancérologie de la Loire Lucien Neuwirth, Saint-Priest-En-Jarez, France
| | | | | | | | - Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
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Chouaid C, Filleron T, Debieuvre D, Perol M, Girard N, Dansin E, Gervais R, Cousin S, Otto J, Schott R, Planchard D, Madroszyk A, Kaderbhai C, Dubray-Longeras P, Hiret S, Pichon E, Clement-Duchene CA, Martin AL, Simon G, Quantin X. EGFR Exon 20 insertion: Prognostic and predictive values in advanced non-small cell lung cancer, a real-world study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.9062] [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
9062 Background: In Europe, 10-15% of non-squamous non-small cell lung cancer (nsqNSCLC) have EGFR mutations of which 5-12% are an Exon 20 insertion (20ins). Methods: Analysis of Epidemio-Strategy and Medical Economics (ESME) Advanced and Metastatic Lung cancer (AMLC) Data Platform (NCT03848052), a multicenter real-life database using a supervised, retrospective data collection process. The database includes 13737 advanced nsqNSCLC treated from January 2015 at participating centres. The cut-off date for patient follow-up for this analysis was June 30, 2020. The aim of the study was to assess real-world patient characteristics, treatment patterns and clinical outcomes of advanced nsqNSCLC EGFR 20ins. Overall survival (OS) of EGFR cohorts (20ins, 19del/L858R without 20ins, other EGFR mutations) and EGFR wild-type/not tested cohort were assessed. Results: 1549 (11.3%) nsqNSCLC had an EGFR mutation, 61 (3.9%) of whom being an EGFR 20ins. These 61 patients (pts) are mainly female (68.9%), non-smoker (55.7%), with de novo stage IIIB/IV disease (78.6%), PS 0-1 (76.9%). Median age was 68.0 years (q1-q3: 54-74). PD-L1 status was assessed in 34 (55.7%) pts, mainly (n = 20) before first line and 22 (64.7%) had negative result. Most (63.9%) pts had EGFR 20ins positive result available before first line. Almost all pts (95.1%, n = 58) received a systemic therapy with a median number of 3 (q1-q3: 1-4) lines. In first line setting, 74% of the pts received chemotherapy (mainly chemotherapy combination), 13.7% received EGFR TKI (mainly as monotherapy) and 8.6% received immunotherapy only. Median treatment duration for pts treated with CarboPem (n = 19), CisplatinPem (n = 16) and CarboTaxol (n = 6) were 4.7 (q1-q3: 2.6-6.6), 7.4 (q1-q3: 5.0-12.8) and 3.3 (q1-q3: 2.8-3.8) months, respectively. For afatinib (n = 3), erlotinib (n = 2) and gefitinib (n = 1), median treatment durations were 1.6 (q1-q3: 0.5-2.8); 1.8 (q1-q3: 1.4-2.1) and 2.3 months, respectively. After a median follow up of 36.3 (95%CI: 34.1-39.8) months, median OS was 24.3 (95%CI: 19.1-32.6) months; 1 and 2-years OS rates were 82.5% (95%CI: 69.7-90.2) and 52.6% (95%CI: 37.3-65.9), respectively. For pts with 19del/L858R without 20ins (n = 1049) and those with other EGFR mutations (n = 439) median OS were 35.4 (95%CI: 32.6-37.5) and 41.7 (95%CI: 31.9-53.5), respectively compared to 20.7 (95%CI: 20.0-21.8] months for pts EGFR wild type/not tested (n = 12188). Conclusions: This large, national real-world analysis based on medical chart data’s confirm that EGFR 20ins is a rare disease (0.4% of advanced nsqNSCLC). Currently available EGFR TKIs appear to have low efficacy and response to chemotherapy seems identical to that of EGFR wild-type/not tested pts. Prognosis for NSCLC pts with EGFR 20ins mutations was in line with that of EGFR wild type/not tested but worse than common EGFR mutations highlighting the need for advancements for this rare population.
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Affiliation(s)
- Christos Chouaid
- Pneumology, Centre Hospitalier Intercommunal (CHI) Creteil, Créteil, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud-IUCT, Toulouse, France
| | - Didier Debieuvre
- Groupe Hospitalier de la région Mulhouse Sud Alsace, Mulhouse, France
| | - Maurice Perol
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | - Nicolas Girard
- Institut Curie, Institut du Thorax Curie-Montsouris, Paris, France
| | - Eric Dansin
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | | | - Sophie Cousin
- Medical Oncology, Institute Bergonié, Bordeaux, France
| | - Josiane Otto
- Oncology, Centre Antoine Lacassagne, Nice, France
| | - Roland Schott
- Institut de Cancérologie Strasbourg Europe ICANS, Strasbourg, France
| | - David Planchard
- Gustave Roussy, Department of Medical Oncology, Villejuif, France
| | - Anne Madroszyk
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Sandrine Hiret
- Institut de Cancérologie de l’Ouest, Saint-Herblain, France
| | - Eric Pichon
- Centre Hospitalier Universitaire, Tours, France
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15
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Peters S, Dafni U, Perol M, Felip E, Polito L, Pal N, Ton T, Merritt D, Morris S, Stahel R. VP2-2021: Effectiveness of PD-(L)1 inhibitors alone or in combination with platinum-doublet chemotherapy in first-line (1L) non-squamous non-small cell lung cancer (Nsq-NSCLC) with high PD-L1 expression using real-world data. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Nakagawa K, Nagasaka M, Felip E, Pacheco J, Baik C, Goto Y, Saltos A, Li B, Udagawa H, Gadgeel S, Murakami H, Planchard D, Bazhenova L, Paz-Ares L, Perol M, Mazieres J, Barlesi F, Saxena K, Shiga R, Acharyya S, Cheng Y, Shahidi J, Jänne P, Smit E. OA04.05 Trastuzumab Deruxtecan in HER2-Overexpressing Metastatic Non-Small Cell Lung Cancer: Interim Results of DESTINY-Lung01. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.285] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Goto K, Wolf J, Elamin Y, Santini F, Soldatenkova V, Sashegyi A, Lin AB, Lin B, Novello S, Arriola Aperribay E, Perol M, Loong H, Drilon A, Park K, Solomon B, Zhou C. FP14.05 LIBRETTO-431: Selpercatinib in Treatment-Naïve Patients with RET Fusion-Positive Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Smit E, Nakagawa K, Nagasaka M, Felip E, Goto Y, Li B, Pacheco J, Murakami H, Barlesi F, Saltos A, Perol M, Udagawa H, Saxena K, Shiga R, Guevara F, Acharyya S, Shahidi J, Planchard D, Jänne P. MA11.03 Trastuzumab Deruxtecan in HER2-Mutated Metastatic Non-Small Cell Lung Cancer (NSCLC): Interim Results of DESTINY-Lung01. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Heudel P, Chabaud S, Perol D, Flechon A, Fayette J, Combemale P, Tredan O, Desseigne F, de la Fouchardiere C, Boyle H, Perol M, Bachelot T, Cassier P, Avrillon V, Terret C, Michallet AS, Neidhardt-Berard EM, Nicolas-Virelizier E, Dufresne A, Belhabri A, Brahmi M, Lebras L, Nicolini F, Sarabi M, Rey P, Bonneville-Levard A, Rochefort P, Provensal AM, Eberst L, Assaad S, Swalduz A, Saintigny P, Toussaint P, Guillermin Y, Castets M, Coutzac C, Meeus P, Dupré A, Durand T, Crochet H, Fervers B, Gomez F, Rivoire M, Gregoire V, Claude L, Chassagne-Clement C, Pilleul F, Mognetti T, Russias B, Soubirou JL, Lasset C, Chvetzoff G, Mehlen P, Beaupère S, Zrounba P, Ray-Coquard I, Blay JY. Immune checkpoint inhibitor treatment of a first cancer is associated with a decreased incidence of second primary cancer. ESMO Open 2021; 6:100044. [PMID: 33516148 PMCID: PMC7844579 DOI: 10.1016/j.esmoop.2020.100044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background Second primary cancers (SPCs) are diagnosed in over 5% of patients after a first primary cancer (FPC). We explore here the impact of immune checkpoint inhibitors (ICIs) given for an FPC on the risk of SPC in different age groups, cancer types and treatments. Patients and methods The files of the 46 829 patients diagnosed with an FPC in the Centre Léon Bérard from 2013 to 2018 were analyzed. Structured data were extracted and electronic patient records were screened using a natural language processing tool, with validation using manual screening of 2818 files of patients. Univariate and multivariate analyses of the incidence of SPC according to patient characteristics and treatment were conducted. Results Among the 46 829 patients, 1830 (3.9%) had a diagnosis of SPC with a median interval of 11.1 months (range 0-78 months); 18 128 (38.7%) received cytotoxic chemotherapy (CC) and 1163 (2.5%) received ICIs for the treatment of the FPC in this period. SPCs were observed in 7/1163 (0.6%) patients who had received ICIs for their FPC versus 437/16 997 (2.6%) patients receiving CC and no ICIs for the FPC versus 1386/28 669 (4.8%) for patients receiving neither CC nor ICIs for the FPC. This reduction was observed at all ages and for all histotypes analyzed. Treatment with ICIs and/or CC for the FPC are associated with a reduced risk of SPC in multivariate analysis. Conclusion Immunotherapy with ICIs alone and in combination with CC was found to be associated with a reduced incidence of SPC for all ages and cancer types. From 2013 to 2018, 3.9% of the 46 829 patients diagnosed with a first cancer presented with an SPC. Treatment of the first cancer with ICIs was associated with a major reduction of SPC. CC given for an FPC was also associated with a lower magnitude of reduction of SPC. There were no SPC in cancer patients treated with ICIs in the localized phase of their first cancer.
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Affiliation(s)
- P Heudel
- Centre Léon Bérard, Lyon, France
| | | | - D Perol
- Centre Léon Bérard, Lyon, France
| | | | | | | | - O Tredan
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - H Boyle
- Centre Léon Bérard, Lyon, France
| | - M Perol
- Centre Léon Bérard, Lyon, France
| | - T Bachelot
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - C Terret
- Centre Léon Bérard, Lyon, France
| | | | | | | | - A Dufresne
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | - M Brahmi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - L Lebras
- Centre Léon Bérard, Lyon, France
| | - F Nicolini
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - M Sarabi
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Rey
- Centre Léon Bérard, Lyon, France
| | | | | | | | - L Eberst
- Centre Léon Bérard, Lyon, France
| | - S Assaad
- Centre Léon Bérard, Lyon, France
| | | | - P Saintigny
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | | | | | - M Castets
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - C Coutzac
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France
| | - P Meeus
- Centre Léon Bérard, Lyon, France
| | - A Dupré
- Centre Léon Bérard, Lyon, France
| | - T Durand
- Centre Léon Bérard, Lyon, France
| | | | | | - F Gomez
- Centre Léon Bérard, Lyon, France
| | - M Rivoire
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - L Claude
- Centre Léon Bérard, Lyon, France
| | | | - F Pilleul
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | | | | | - C Lasset
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | | | - P Mehlen
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - S Beaupère
- Centre Léon Bérard, Lyon, France; Unicancer, Paris, France
| | | | - I Ray-Coquard
- Centre Léon Bérard, Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France
| | - J-Y Blay
- Centre Léon Bérard, Lyon, France; Cancer Research Center of Lyon (CRCL), Lyon, France; Centre Léon Bérard & Université Claude Bernard, Lyon, France; Unicancer, Paris, France.
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20
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Ortiz-Cuaran S, Mezquita L, Swalduz A, Aldea M, Mazieres J, Leonce C, Jovelet C, Pradines A, Avrillon V, Chumbi Flores WR, Lacroix L, Loriot Y, Westeel V, Ngo-Camus M, Tissot C, Raynaud C, Gervais R, Brain E, Monnet I, Giroux Leprieur E, Caramella C, Mahier-Aït Oukhatar C, Hoog-Labouret N, de Kievit F, Howarth K, Morris C, Green E, Friboulet L, Chabaud S, Guichou JF, Perol M, Besse B, Blay JY, Saintigny P, Planchard D. Circulating Tumor DNA Genomics Reveal Potential Mechanisms of Resistance to BRAF-Targeted Therapies in Patients with BRAF-Mutant Metastatic Non-Small Cell Lung Cancer. Clin Cancer Res 2020; 26:6242-6253. [PMID: 32859654 DOI: 10.1158/1078-0432.ccr-20-1037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/11/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The limited knowledge on the molecular profile of patients with BRAF-mutant non-small cell lung cancer (NSCLC) who progress under BRAF-targeted therapies (BRAF-TT) has hampered the development of subsequent therapeutic strategies for these patients. Here, we evaluated the clinical utility of circulating tumor DNA (ctDNA)-targeted sequencing to identify canonical BRAF mutations and genomic alterations potentially related to resistance to BRAF-TT, in a large cohort of patients with BRAF-mutant NSCLC. EXPERIMENTAL DESIGN This was a prospective study of 78 patients with advanced BRAF-mutant NSCLC, enrolled in 27 centers across France. Blood samples (n = 208) were collected from BRAF-TT-naïve patients (n = 47), patients nonprogressive under treatment (n = 115), or patients at disease progression (PD) to BRAF-TT (24/46 on BRAF monotherapy and 22/46 on BRAF/MEK combination therapy). ctDNA sequencing was performed using InVisionFirst-Lung. In silico structural modeling was used to predict the potential functional effect of the alterations found in ctDNA. RESULTS BRAFV600E ctDNA was detected in 74% of BRAF-TT-naïve patients, where alterations in genes related with the MAPK and PI3K pathways, signal transducers, and protein kinases were identified in 29% of the samples. ctDNA positivity at the first radiographic evaluation under treatment, as well as BRAF-mutant ctDNA positivity at PD were associated with poor survival. Potential drivers of resistance to either BRAF-TT monotherapy or BRAF/MEK combination were identified in 46% of patients and these included activating mutations in effectors of the MAPK and PI3K pathways, as well as alterations in U2AF1, IDH1, and CTNNB1. CONCLUSIONS ctDNA sequencing is clinically relevant for the detection of BRAF-activating mutations and the identification of alterations potentially related to resistance to BRAF-TT in BRAF-mutant NSCLC.
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Affiliation(s)
- Sandra Ortiz-Cuaran
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.
| | - Laura Mezquita
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France.,Department of Medical Oncology, Hospital Clinic, Laboratory of Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Aurélie Swalduz
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.,Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - Mihalea Aldea
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Julien Mazieres
- Department of Respiratory Disease, Larrey Hospital, University Hospital of Toulouse, Paul Sabatier University, Toulouse, France
| | - Camille Leonce
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Cecile Jovelet
- Translational Research Laboratory, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Virginie Avrillon
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | | | - Ludovic Lacroix
- Translational Research Laboratory, Gustave Roussy Cancer Campus, Villejuif, France
| | - Yohann Loriot
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Maud Ngo-Camus
- Department of Early Drug Development, Gustave Roussy Cancer Campus, Villejuif, France
| | - Claire Tissot
- University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | | | | | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | | | - Caroline Caramella
- Department of Radiology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | | | | | | | | | | | - Luc Friboulet
- Université Paris-Saclay, Gustave Roussy Cancer Campus, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Sylvie Chabaud
- Department of Clinical Research, Centre Léon Bérard, Lyon, France
| | - Jean-François Guichou
- Centre de Biochimie Structurale (CBS), INSERM, CNRS, Université de Montpellier, Montpellier, France
| | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - Pierre Saintigny
- Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France. .,Department of Medical Oncology, Centre Léon Bérard & Université Claude Bernard Lyon I/Université de Lyon, Lyon, France
| | - David Planchard
- Department of Cancer Medicine, Gustave Roussy Cancer Campus, Villejuif, France.
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21
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Assaad S, Avrillon V, Fournier ML, Mastroianni B, Russias B, Swalduz A, Cassier P, Eberst L, Steineur MP, Kazes M, Perol M, Michallet AS, Rey P, Erena-Penet AS, Morel A, Brahmi M, Dufresne A, Tredan O, Chvetzoff G, Fayette J, de la Fouchardiere C, Ray-Coquard I, Bachelot T, Saintigny P, Tabutin M, Dupré A, Nicolas-Virelizier E, Belhabri A, Roux PE, Fuhrmann C, Pilleul F, Basle A, Bouhamama A, Galvez C, Herr AL, Gautier J, Chabaud S, Zrounba P, Perol D, Blay JY. High mortality rate in cancer patients with symptoms of COVID-19 with or without detectable SARS-COV-2 on RT-PCR. Eur J Cancer 2020; 135:251-259. [PMID: 32540204 PMCID: PMC7275994 DOI: 10.1016/j.ejca.2020.05.028] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [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: 05/06/2020] [Revised: 05/22/2020] [Accepted: 05/31/2020] [Indexed: 02/06/2023]
Abstract
Background Cancer patients presenting with COVID-19 have a high risk of death. In this work, predictive factors for survival in cancer patients with suspected SARS-COV-2 infection were investigated. Methods PRE-COVID-19 is a retrospective study of all 302 cancer patients presenting to this institute with a suspicion of COVID-19 from March 1st to April 25th 2020. Data were collected using a web-based tool within electronic patient record approved by the Institutional Review Board. Patient characteristics symptoms and survival were collected and compared in SARS-COV-2 real-time or reverse-transcriptase PCR (RT-PCR)–positive and RT-PCR–negative patients. Results Fifty-five of the 302 (18.2%) patients with suspected COVID-19 had detectable SARS-COV-2 with RT-PCR in nasopharyngeal samples. RT-PCR–positive patients were older, had more frequently haematological malignancies, respiratory symptoms and suspected COVID-19 pneumonia of computed tomography (CT) scan. However, respectively, 38% and 20% of SARS-COV-2 RT-PCR–negative patients presented similar respiratory symptoms and CT scan images. Thirty of the 302 (9.9%) patients died during the observation period, including 24 (80%) with advanced disease. At the median follow-up of 25 days after the first symptoms, the death rate in RT-PCR–positive and RT-PCR–negative patients were 21% and 10%, respectively. In both groups, independent risk factors for death were male gender, Karnofsky performance status <60, cancer in relapse and respiratory symptoms. Detection of SARS-COV-2 on RT-PCR was not associated with an increased death rate (p = 0.10). None of the treatment given in the previous month (including cytotoxics, PD1 Ab, anti-CD20, VEGFR2…) correlated with survival. The survival of RT-PCR–positive and –negative patients with respiratory symptoms and/or COVID-19 type pneumonia on CT scan was similar with a 18.4% and 19.7% death rate at day 25. Most (22/30, 73%) cancer patients dying during this period were RT-PCR negative. Conclusion The 30-day death rate of cancer patients with or without documented SARS-COV-2 infection is poor, but the majority of deaths occur in RT-PCR–negative patients.
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Affiliation(s)
- Souad Assaad
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Virginie Avrillon
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Marie-Line Fournier
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Benedicte Mastroianni
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Bruno Russias
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Aurélie Swalduz
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Philippe Cassier
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Lauriane Eberst
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Marie-Pierre Steineur
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Marianne Kazes
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Maurice Perol
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Anne-Sophie Michallet
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Philippe Rey
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Anne-Sophie Erena-Penet
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Astrid Morel
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Mehdi Brahmi
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Armelle Dufresne
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Olivier Tredan
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Gisèle Chvetzoff
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Jérome Fayette
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Christelle de la Fouchardiere
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Isabelle Ray-Coquard
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Thomas Bachelot
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Pierre Saintigny
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Mayeul Tabutin
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Aurélien Dupré
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Emmanuelle Nicolas-Virelizier
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Amine Belhabri
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Pierre-Eric Roux
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Christine Fuhrmann
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Franck Pilleul
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Alexandre Basle
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Amine Bouhamama
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Christelle Galvez
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Andrée-Laure Herr
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Julien Gautier
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Sylvie Chabaud
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Philippe Zrounba
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - David Perol
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France
| | - Jean-Yves Blay
- Centre Léon Bérard, 28 Rue Laënnec, 69373, Lyon Cedex 08, France; Université Claude Bernard Lyon I, France; Unicancer, Paris, France.
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22
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Sebastian M, Audigier-Valette C, Butts CA, Debieuvre D, Dixmier A, Gröschel A, Gutz S, Juergens RA, Labbe C, Moro-Sibilot D, Perol M, Schumann C, Juarez-Garcia A, Lakhdari K, Penrod JR, Pettersson F, Reynaud D, Waldenberger D, Allan V, Barlesi F. Two-year survival with nivolumab in previously treated, advanced non-small cell lung cancer: A pooled analysis of real-world patients from France, Germany and Canada. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21714] [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
e21714 Background: Data from clinical studies demonstrate a long-term survival benefit of nivolumab in previously treated advanced non-small cell lung cancer (NSCLC) patients with overall survival (OS) at two-years of 27%, however real-world data are limited. We report OS in patients pooled from two prospective multi-centre observational cohort studies in France (EVIDENS, NCT03382496) and Germany (ENLARGE, NCT02910999) and a third retrospective registry of patients treated through expanded access to nivolumab in Canada. Methods: Individual patient data from each cohort were pooled and harmonised in eligibility criteria and variable definitions. Included patients had locally advanced or metastatic (stage IIIB/IV) NSCLC, received nivolumab after at least one prior systemic therapy and had no other concurrent primary cancers. OS was estimated from nivolumab initiation until death or censoring using Kaplan-Meier method. Equality of survival distributions across cohorts was measured using log-rank test. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated from unstratified Cox proportional hazards regression models to explore survival among subgroups. Data on bone and liver metastases, PD-L1 and safety were available and analysed for France and Germany only. Results: Data from 2582 patients (48% France; 34% Germany; 18% Canada) were pooled. Baseline characteristics were: median age 66 years, 64% male, 82% ECOG 0-1, 69% 1 prior line of therapy, 68% non-squamous histology, and 18% with brain metastases (treated or untreated). Median follow-up was 8 months. No difference in OS was observed between countries. The 2-year OS was 28% (95%CI 25-31) for all patients, 26% (95%CI 21-31) for squamous histology and 29% (95%CI 26-33) for non-squamous histology. Bone metastases (HR 1.42; 95%CI 1.26-1.60; P= < .0001) and liver metastases (HR 1.60; 95%CI 1.39-1.85; P= < .0001) were associated with shorter survival, while ECOG PS 0-1 (HR 0.61; 95%CI 0.52-0.71; P= < .0001) and PD-L1 positivity (HR 0.75; 95%CI 0.60-0.93; P= < .0001) were associated with prolonged survival. Rates of any grade and grade 3/4 treatment-related adverse events (TRAE) were 32% and 7% respectively. Conclusions: In this three-country pooled analysis of nivolumab in previously treated advanced NSCLC, real-world overall survival at 2-years was consistent with pivotal nivolumab trials overall and in subgroups. Rates of grade 3/4 TRAEs were comparable, but events of lower grade may be underreported in the real world.
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Affiliation(s)
- Martin Sebastian
- University Hospital, Goethe-University Frankfurt, Department of Hematology and Medical Oncology, Frankfurt, Germany
| | | | | | | | | | - Andreas Gröschel
- Dept. of Pulmonary and Critical Care Medicine, Clemenshospital, Münster, Germany
| | - Sylvia Gutz
- Ev. Diakonissenkrankenhaus, Leipzig, Germany
| | | | - Catherine Labbe
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada
| | - Denis Moro-Sibilot
- Thoracic Oncology unit, SHUPP, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | | | - Christian Schumann
- Klinikverbund Allgäu, Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Kempten Und Immenstadt, Germany
| | | | | | | | | | | | | | - Victoria Allan
- Centre for Observational Research and Data Science, Bristol-Myers Squibb, Uxbridge, United Kingdom
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23
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Smit EF, Nakagawa K, Nagasaka M, Felip E, Goto Y, Li BT, Pacheco JM, Murakami H, Barlesi F, Saltos AN, Perol M, Udagawa H, Saxena K, Shiga R, Guevara FM, Acharyya S, Shahidi J, Planchard D, Janne PA. Trastuzumab deruxtecan (T-DXd; DS-8201) in patients with HER2-mutated metastatic non-small cell lung cancer (NSCLC): Interim results of DESTINY-Lung01. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9504] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
9504 Background: T-DXd is an antibody-drug conjugate composed of an anti-HER2 antibody, cleavable tetrapeptide-based linker, and topoisomerase I inhibitor payload. In a phase I trial, patients (pts) with HER2-mutated NSCLC who received T-DXd had a confirmed objective response rate (ORR) of 72.7% (8/11) (Tsurutani et al, WCLC 2018). DESTINY-Lung01 (NCT03505710) is an ongoing, multicenter, phase II study of T-DXd in pts with non-squamous NSCLC overexpressing HER2 or containing a HER2-activating mutation. We report data for the cohort with HER2 mutations after a median follow-up of 8.0 mo (range, 1.4-14.2 mo). Methods: Pts were treated with T-DXd 6.4 mg/kg every 3 weeks. The primary endpoint was confirmed ORR (complete response [CR] + partial response [PR]) by ICR. Additional endpoints were disease control rate (DCR; CR + PR + stable disease), duration of response (DOR), progression-free survival (PFS), and safety. Results: At data cutoff (25 Nov 2019), 42 pts (64.3% female) had received T-DXd. Median age was 63.0 years (range, 34-83 years; < 65 y, 59.5%); 45.2% had central nervous system metastases; ECOG performance status was 0 in 23.8% of pts and 1 in 76.2%. HER2 mutations were predominantly in the kinase domain (90.5%). Most pts (90.5%) had prior platinum-based chemotherapy and 54.8% had anti–PD-1 or –PD-L1 treatment; median number of prior treatment lines was 2 (range, 1-6). Median treatment duration was 7.75 mo (range, 0.7-14.3 mo); 45.2% of pts remained on treatment. Confirmed ORR by ICR among the 42 pts was 61.9% (95% CI, 45.6%-76.4%); median DOR was not reached at data cutoff; 16 of 26 responders remained on treatment at data cutoff; DCR was 90.5% (95% CI, 77.4%-97.3%); estimated median PFS was 14.0 mo (95% CI, 6.4-14.0 mo). All pts (42/42) had treatment-emergent adverse events (TEAEs); 64.3% were grade ≥ 3 (52.4% drug-related), including decreased neutrophil count (26.2%) and anemia (16.7%). There were 5 cases (11.9%) of drug-related interstitial lung disease (ILD) as adjudicated by an independent committee (all grade 2, no grade ≥ 3) and 1 case of grade 1 ILD is pending adjudication. TEAEs led to dose interruption in 25 pts (59.5%), dose reduction in 16 pts (38.1%), and treatment discontinuation in 10 pts (23.8%). Conclusions: T-DXd demonstrated promising clinical activity with high ORR and durable responses in pts with HER2-mutated NSCLC. The safety profile was generally consistent with previously reported studies. Clinical trial information: NCT03505710 .
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Affiliation(s)
| | | | | | | | | | - Bob T. Li
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Fabrice Barlesi
- Aix Marseille University, CNRS, INSERM, CRCM, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | | | | | | | | | | | | | | | | | | | - Pasi A. Janne
- Dana-Farber Cancer Institute and the Belfer Center for Applied Cancer Science, Boston, MA
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Peters S, Mok TSK, Gadgeel SM, Rosell R, Dziadziuszko R, Kim DW, Perol M, Ou SHI, Shaw AT, Bordogna W, Smoljanovic V, Hilton M, Ruf T, Archer VR, Camidge DR. Updated overall survival (OS) and safety data from the randomized, phase III ALEX study of alectinib (ALC) versus crizotinib (CRZ) in untreated advanced ALK+ NSCLC. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.9518] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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
9518 Background: Final, mature PFS from the global phase III ALEX study (NCT02075840) of ALC vs CRZ in untreated, advanced/metastatic ALK+ NSCLC have been previously published: ALC 34.8 months (m) (95% CI 17.7–NR) vs CRZ 10.9 m (95% CI 9.1–12.9), (HR 0.43, 95% CI 0.32–0.58). We report 5-year OS and updated safety data from ALEX with a further 12 m follow-up (FU) (cutoff date: Nov 29, 2019). Methods: Patients (pts) with stage IIIB/IV ALK+ NSCLC (by central IHC), ECOG PS 0–2 and no prior systemic therapy for advanced NSCLC were randomized 1:1 to ALC 600 mg BID (n = 152) or CRZ 250 mg BID (n = 151). Asymptomatic CNS metastases (mets) at baseline (BL) were allowed. OS was a secondary endpoint, and no formal statistical testing was planned. Results: Median duration of FU: 48.2 m with ALC vs 23.3 m with CRZ. OS data remain immature (events: 37%; stratified HR 0.67 [95% CI 0.46–0.98]); median OS with CRZ was 57.4 m (95% CI 34.6–not estimable [NE]) vs NE with ALC. The 5-year survival rate was 62.5% (95% CI 54.3–70.8) with ALC vs 45.5% (95% CI 33.6–57.4) with CRZ (Table). In pts with CNS mets at BL the OS HR was 0.58 (95% CI 0.34–1.00) and 0.76 (95% CI 0.45–1.26) in pts without CNS mets at BL. The OS benefit of ALC vs CRZ was generally consistent across all subgroups. Considering the longer treatment duration for ALC (28.1 m) vs the previous analysis (27.7 m), the safety profile of ALC remains consistent; no new safety signals were observed. With ALC, 35% of pts remain on study treatment vs 9% of pts remaining on CRZ. In pts with ≥1 known post-progression treatment (ALC: 32.2%; CRZ: 45.7%), lorlatinib was the most common ALK TKI received after first-line ALC (7.2%), compared with ceritinib after first-line CRZ (15.2%). Conclusions: This is the first global randomized study of a 2nd generation ALK TKI to demonstrate a clinically meaningful improvement in OS vs CRZ in ALK+ NSCLC (5-year survival rate: 62.5%, ALC vs 45.5%, CRZ); longer FU is required as OS data remain immature. Clinical trial information: NCT02075840 . [Table: see text]
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Affiliation(s)
- Solange Peters
- Lausanne University Hospital (CHUV), Lausanne University, Lausanne, Switzerland
| | - Tony S. K. Mok
- State Key Laboratory of Translational Oncology, Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Shirish M. Gadgeel
- Department of Internal Medicine, Rogel Cancer Center/University of Michigan, Ann Arbor, MI
| | | | - Rafal Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Dong-Wan Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Maurice Perol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Sai-Hong Ignatius Ou
- Chao Family Comprehensive Cancer Center, University of California Irvine, Orange, CA
| | - Alice Tsang Shaw
- Institute of Cancer Sciences, Massachusetts General Hospital, Boston, MA
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Marine S, Stéphane R, Nicolas P, Felizzi F, Paracha N, Benjamin M, Perol M. Cost-effectiveness of atezolizumab versus docetaxel and nivolumab in the treatment of non-small cell lung cancer as a second line in France. J Med Econ 2020; 23:464-473. [PMID: 31951770 DOI: 10.1080/13696998.2020.1718156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aim: To estimate the cost-effectiveness of atezolizumab compared with docetaxel and nivolumab for the treatment of advanced non-small cell lung cancer (NSCLC), as a second-line treatment, in a French setting.Materials and methods: A three-state partitioned-survival model was developed (progression-free survival, post-progression survival, death) based on the phase IIIOAK trial on a 10-year time horizon. The comparison between nivolumab and atezolizumab came from a network meta-analysis. Utilities were estimated from the OAK trial EQ-5D applying the French utility tariffs. Overall survival (OS), progression-free survival (PFS), and treatment duration were estimated using parametric models selected using Akaike and Bayesian information criterion. Extrapolation beyond the trial duration followed NICE DSU TSD 14. Economic perspective was the one of all payers, discount rate fixed at 4% on benefits and costs. This analysis was aligned with French Haute Autorité de Santé recommendations. Results were expressed in total cost (2019) and €/QALY (Quality Adjusted Life Year). Model robustness was checked through sensitivity analyses, and a probabilistic sensitivity analysis was conducted.Results: In comparison to docetaxel, atezolizumab costs 49,429€ more and increased life expectancy by 8 months, generating 0.47 QALY. Incremental cost-effectiveness ratio was estimated at 104,835€/QALY. When comparing nivolumab to atezolizumab, a cost minimization analysis was conducted since no clear evidence supporting a difference in terms of survival benefit was reported. Using list price, and the Market Access Authorization regimens, atezolizumab saved approximately 6,000€, 9.5% of its total costs. Sensitivity analyses confirmed the robustness of our findings.Conclusion: Atezolizumab is more efficient and more costly than docetaxel in the second-line treatment of NSCLC of stage IIIB or IV, in France, with results consistent to previous French authorities' evaluation of immunotherapies in similar indication. Lastly, atezolizumab is a cost saving alternative to nivolumab, based on list price.
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Affiliation(s)
| | | | | | | | | | | | - Maurice Perol
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
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26
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Domblides C, Leroy K, Monnet I, Mazières J, Barlesi F, Gounant V, Baldacci S, Mennecier B, Toffart AC, Audigier-Valette C, Doucet L, Giroux-Leprieur E, Guisier F, Ricordel C, Molinier O, Perol M, Pichon E, Robinet G, Templement-Grangerat D, Ruppert AM, Rabbe N, Antoine M, Wislez M. Efficacy of Immune Checkpoint Inhibitors in Lung Sarcomatoid Carcinoma. J Thorac Oncol 2020; 15:860-866. [PMID: 31991225 DOI: 10.1016/j.jtho.2020.01.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Immune checkpoint inhibitors (ICIs) have improved cancer prognosis but have not been evaluated specifically in sarcomatoid carcinoma (SC), a rare lung cancer subtype with poor prognosis. As such, our study sought to retrospectively assess the efficacy of ICI in SC. METHODS All consecutive patients with centrally confirmed SC treated using ICI as a second-line treatment or beyond between 2011 and 2017 were enrolled. Programmed death-ligand 1 (PD-L1) tumor expression was assessed using immunohistochemistry (SP263 clone) and the tumor mutational burden (TMB) with the Foundation One panel. TMB was considered high if it was greater than or equal to 10 mutations per megabase. RESULTS Overall, 37 patients with SC were evaluated, predominantly men (73%) with a median age of 63.2 years (36.8-79.7) and who were current or former smokers (94.6%). Immunotherapy (nivolumab, 86.5% of cases) was given as a second-line treatment in 54% of the patients and as third-line treatment or beyond in 46% of the patients. The objective response rate was 40.5% and disease control rate was 64.8%, regardless of PD-L1 status. Median overall survival was 12.7 months (range: 0.3-45.7). One-third of patients exhibited early progression. The median PD-L1 expression was 70% (0-100). There was a trend toward higher PD-L1 expression in responsive diseases, with an objective response rate of 58.8% in patients with PD-L1+ and 0% in the one patient with PD-L1- (p = 0.44). The median TMB was 18 (4-39) mutations per megabase, with 87.5% of the cases displaying a high TMB. There was a trend toward higher TMB in responders versus stable or progressive diseases (p = 0.2). CONCLUSIONS Patients with SC exhibited high response rates and prolonged overall survival under ICI treatment. These data support the prospective investigation of ICI in patients with SC who are under first-line treatment.
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Affiliation(s)
- Charlotte Domblides
- Department of Medical Oncology, Hôpital Saint-André, Bordeaux University Hospital-CHU Bordeaux, Bordeaux, France; ImmunoConcEpt, CNRS UMR 5164, University of Bordeaux, Bordeaux, France
| | - Karen Leroy
- Genetic and Molecular Biology Department, AP-HP, Groupe Hospitalier HUPC, Hôpital Cochin, Paris, France
| | | | - Julien Mazières
- Department of Pneumology, Hôpital Larrey, Université Paul Sabatier, Toulouse, France
| | - Fabrice Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Department, Aix Marseille University, CNRS, INSERM, CRCM, APHM, Marseille, France
| | | | - Simon Baldacci
- Thoracic Oncology Department, Lille University Hospital, Lille, France
| | | | | | | | - Ludovic Doucet
- Department of Medical Oncology, Hôpital Saint-Louis, Paris, France
| | | | - Florian Guisier
- Department of Pneumology, Hôpital Charles Nicolle, Rouen, France
| | | | | | - Maurice Perol
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Eric Pichon
- Department of Pneumology, CHRU Bretonneau, Tours, France
| | | | | | - Anne-Marie Ruppert
- Sorbonne Université, GRC n°04, Theranoscan, Paris, France; Department of Pneumology, AP-HP, Groupe Hospitalier HUEP, Hôpital Tenon, Paris, France
| | - Nathalie Rabbe
- Department of Thoracic Oncology, AP-HP, Groupe Hospitalier HUPC, Hôpital Cochin, Paris, France; Centre de Recherche des Cordeliers, Université Paris Descartes, Complement, Inflammation and Cancer, Paris, France
| | - Martine Antoine
- Pathology Department, AP-HP, Groupe Hospitalier HUEP, Hôpital Tenon, Paris, France
| | - Marie Wislez
- Department of Thoracic Oncology, AP-HP, Groupe Hospitalier HUPC, Hôpital Cochin, Paris, France; Centre de Recherche des Cordeliers, Université Paris Descartes, Complement, Inflammation and Cancer, Paris, France.
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27
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Nicholson AG, Sauter JL, Nowak AK, Kindler HL, Gill RR, Remy-Jardin M, Armato SG, Fernandez-Cuesta L, Bueno R, Alcala N, Foll M, Pass H, Attanoos R, Baas P, Beasley MB, Brcic L, Butnor KJ, Chirieac LR, Churg A, Courtiol P, Dacic S, De Perrot M, Frauenfelder T, Gibbs A, Hirsch FR, Hiroshima K, Husain A, Klebe S, Lantuejoul S, Moreira A, Opitz I, Perol M, Roden A, Roggli V, Scherpereel A, Tirode F, Tazelaar H, Travis WD, Tsao MS, van Schil P, Vignaud JM, Weynand B, Lang-Lazdunski L, Cree I, Rusch VW, Girard N, Galateau-Salle F. EURACAN/IASLC Proposals for Updating the Histologic Classification of Pleural Mesothelioma: Towards a More Multidisciplinary Approach. J Thorac Oncol 2020; 15:29-49. [DOI: 10.1016/j.jtho.2019.08.2506] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
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28
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Bylicki O, Guisier F, Monnet I, Doubre H, Gervais R, Janicot H, Perol M, Fournel P, Lamy R, Auliac JB, Chouaid C. Efficacy and safety of programmed cell-death-protein-1 and its ligand inhibitors in pretreated patients with epidermal growth-factor receptor-mutated or anaplastic lymphoma kinase-translocated lung adenocarcinoma. Medicine (Baltimore) 2020; 99:e18726. [PMID: 32011450 PMCID: PMC7220079 DOI: 10.1097/md.0000000000018726] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Immune-checkpoint inhibitor (ICI) efficacy in patients with non-small cell lung cancer (NSCLC) harboring molecular alterations remains poorly elucidated. This study was undertaken to determine ICI efficacy against epidermal growth-factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)/c-ros oncogene 1 (ROS1)-mutated NSCLC patients in the real-world setting.In this retrospective, multicenter study on adults with ICI-treated EGFR-mutated or ALK- or ROS1-translated NSCLCs, we analyzed clinical characteristics and outcomes: ICI-treatment duration, and progression-free survival (PFS), objective response rate, duration of response, and overall survival (OS) from immunotherapy initiation.Fifty-one NSCLC patients (mean age, 58.0 years) were included from 20 French centers: 61% were never-smokers and 59% were women. Among them, 82% had EGFR-activating mutations, 16% ALK translocations, or 2% ROS1 translocations. Before ICI therapy, patients had received a median of 3 treatment lines (including tyrosine-kinase inhibitor). The median PFS was 2.1 (95% confidence interval [CI], 1.5-3.2) months for the entire cohort, 2.2 (95% CI, 1.4-3.2) for EGFR-mutated patients, and 2.4 (95% CI, 2.1-not reached) months for ALK-translocated patients. The median OS was 14.7 (95% CI, 12.1-19.2) months for the entire population and 13.9 (95% CI, 8.8-20.0) and 19.2 (95% CI, 13.1-not reached) months for EGFR-mutated and ALK-translocated patients, respectively. Seven (13.7%) patients were treated with ICI for >9 months. Toxicities were reported in 22% (11/51), including 8% (4/51) grade ≥3.In this real-world setting, analysis of ICI PFS against EGFR-mutated or ALK-translocated NSCLC patients appeared close to that observed in pretreated unselected NSCLC patients. The more promising OS probably linked to post-ICI treatments. Large prospective studies on these patient subsets are needed.
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Affiliation(s)
- Olivier Bylicki
- Service de Pneumologie, Hôpital d’Instruction des Armées Percy, Clamart
| | - Florian Guisier
- Service de Pneumologie, Centre Hospitalier Universitaire de Rouen, Rouen
| | - Isabelle Monnet
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil
| | | | - Radj Gervais
- Département d’oncologie, Centre François Baclesse, Caen
| | - Henri Janicot
- Service de Pneumologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand
| | - Maurice Perol
- Service d’Oncologie Thoracique, Centre Léon Bérard, Lyon
| | - Pierre Fournel
- Département d’oncologie, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez
| | - Régine Lamy
- Service de Pneumologie, Centre Hospitalier Bretagne Sud-Lorient, Lorient
| | - Jean-Bernard Auliac
- Service de Pneumologie, Centre Hospitalier F. Quesnay, Mantes-la-Jolie, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Créteil, Créteil
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Dixmier, Asselain B, Barlesi F, Debieuvre D, Valette CA, Gröschel A, Gütz S, Liersch R, Moro-Sibilot D, Müller-Huesmann H, Perol M, Raspaud C, Schulte C, Schulz H, Schumann C, Allan V, Calvet C, Rothnie K, Wünsch V, Sebastian M. IO-synthesise NSCLC: A pooled analysis of real-world survival outcomes for non-small cell lung cancer patients treated with nivolumab in France and Germany. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Boussageon M, Ortiz-Cuaran S, Chabaud S, Pérol D, Avrillon V, Mastroianni B, Fayette J, Ghiringhelli F, Neidhardt E, Swalduz A, Paulus V, Kaderbhai C, Fumet J, Saintigny P, Perol M. P1.01-116 Early Immune-Related Adverse Events Under PD-1/PD-L1 Inhibitors Predict Better Progression-Free Survival in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barlesi F, Dixmier A, Debieuvre D, Raspaud C, Auliac J, Benoit N, Bombaron P, Moro-Sibilot D, Audigier-Valette C, Asselain B, Lamoureux P, Cotté FE, Allan V, Daumont M, Ozan N, Calvet C, Perol M. Effectiveness and safety of nivolumab in the treatment of lung cancer patients in France: Updated survival and subgroup analysis from the real-world EVIDENS study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ortiz-Cuaran S, Mezquita L, Swalduz A, Aldea M, Mazieres J, Jovelet C, Flores WC, Lacroix L, Loriot Y, Friboulet L, Westeel V, Ngocamus M, Pradines A, Tissot C, Duchene CC, Raynaud C, Quantin X, Gervais R, Brain E, Monnet I, Leprieur EG, Avrillon V, Mahier-Aït Oukhatar C, Hoog-Labouret N, De Kievit F, Howarth K, Guichou J, Morris C, Green E, Perol M, Besse B, Blay J, Saintigny P, Planchard D. MA21.07 Circulating Tumor DNA Analysis Depicts Potential Mechanisms of Resistance to BRAF-Targeted Therapies in BRAF+ Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ortiz - Cuaran S, Mezquita L, Swalduz A, Aldea M, Mazieres J, Jovelet C, Lacroix L, Pradines A, Avrillon V, MahierAït Oukhatar C, Hoog-Labouret N, Howarth K, Guichou JF, Morris C, Green E, Perol M, Besse B, Blay JY, Saintigny P, Planchard D. Circulating tumour DNA (ctDNA) analysis depicts mechanisms of resistance and tumour response to BRAF inhibitors in BRAF-mutant non-small cell lung cancer (NSCLC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mok T, Shaw A, Camidge R, Gadgeel S, Rosell R, Dziadziuszko R, Kim DW, Perol M, Ou SH, Bordogna W, Smoljanović V, Hilton M, Peters S. Final PFS, updated OS and safety data from the randomised, phase III ALEX study of alectinib (ALC) versus crizotinib (CRZ) in untreated advanced ALK+ NSCLC. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz260.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barlesi F, Pérol D, Mazieres J, Perol M, Varoqueaux N, Monville F, Audigier-Valette C, Barre P, Domergue F, Falchero L, Foa C, Frikha A, Hominal S, Le Treut J, Zahi S, Roumieux M, Olive D, Vivier E. P1.04-30 Pioneer Study: Precision Immuno-Oncology for Advanced Non-Small Cell Lung Cancer Patients with PD1/L1 ICI Resistance. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.933] [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]
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Gobbini E, Toffart A, Perol M, Assié J, Duruisseaux M, Coupez D, Gervais R, Westeel V, Delaunay M, Guisier F, Veillon R, Gounant V, Leprieur EG, Vanel F, Chaabane N, Dansin E, Babey H, Decroisette C, Barlesi F, Girard N, Fournel P, Mezquita L, Oulkhouir Y, Canellas A, Duchemann B, Molinier O, Moro-Sibilot D, Levra MG. MA07.05 Immune Checkpoint Inhibitor (ICPi) Re-Challenge: Outcomes Analysis in a French National Cohort of Non-Small-Cell Lung Cancer (NSCLC) Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.550] [Citation(s) in RCA: 5] [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] [Indexed: 10/25/2022]
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Gadgeel S, Mok T, Peters S, Alexander J, Leighl N, Sriuranpong V, Perol M, De Castro G, Nadal E, De Marinis F, Han JY, Yan M, Riehl T, Schleifman E, Paul S, Mocci S, Shames D, Mathisen M, Dziadziuszko R. Phase II/III blood first assay screening trial (BFAST) in patients (pts) with treatment-naïve NSCLC: Initial results from the ALK+ cohort. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.079] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mascaux C, Sauvajeon S, Cadranel J, Chouaid C, Stern J, Vergnenegre A, Cortot C, Guery L, Belkhiria K, De la Porte I, Urbieta M, Perol M. Crossed looks on lung cancer perception and knowledge from general public and physicians in France: Results of a two-fold survey. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.021] [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: 11/13/2022] Open
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Paulus V, Pana-Katatali H, Perol M, Paget-Bailly S, Trinquart L, Perol D, Calais F, Bonnetain F, Westeel V. Maintenance therapy for advanced non-small cell lung cancer (NSCLC). Hippokratia 2019. [DOI: 10.1002/14651858.cd011631.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Valérie Paulus
- University Hospital of Besançon; Thoracic Oncology; 3, Boulevard Alexandre Fleming Besançon France 25030
| | - Héloïse Pana-Katatali
- University Hospital of Besançon; Thoracic Oncology; 3, Boulevard Alexandre Fleming Besançon France 25030
| | - Maurice Perol
- Centre Leon Berard; Medical Oncology; 28 Rue Laennec Lyon France 69008
| | - Sophie Paget-Bailly
- University Hospital of Besançon; Methodological and Quality of Life in Oncology Unit; 2 Place Saint Jacques Besançon France 25030
| | | | - David Perol
- Centre Leon Berard; Clinical Research Department; 28 rue Laennec Lyon France 69373
| | - François Calais
- University of Franche-Comté; University Library; Besançon France
| | - Franck Bonnetain
- University Hospital of Besançon; Methodological and Quality of Life Unit in Oncology; 2 Place Saint Jacques Besançon France 25030
| | - Virginie Westeel
- University Hospital of Besançon; Methodological and Quality of Life in Oncology Unit; 2 Place Saint Jacques Besançon France 25030
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Descourt R, Perol M, Rousseau-Bussac G, Planchard D, Mennecier B, Wislez M, Cortot A, Guisier F, Galland L, Dô P, Schott R, Dansin E, Arrondeau J, Auliac JB, Chouaid C. Brigatinib in patients with ALK-positive advanced non-small-cell lung cancer pretreated with sequential ALK inhibitors: A multicentric real-world study (BRIGALK study). Lung Cancer 2019; 136:109-114. [PMID: 31491676 DOI: 10.1016/j.lungcan.2019.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 05/13/2019] [Revised: 07/17/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Brigatinib is a next-generation ALK inhibitor initially developed in ALK-positive NSCLC pretreated with crizotinib. MATERIALS AND METHODS This retrospective multicentric study analyzed ALK-positive advanced NSCLC patients pretreated with at least one tyrosine-kinase inhibitor, including crizotinib, and enrolled in the brigatinib French early access program. The primary endpoint was investigator-assessed progression-free survival (PFS). RESULTS 104 patients were included (mean age, 56.6 years; never smokers, 61.5%; adenocarcinoma, 98.1%). Patients had received a median of 3 previous treatment lines, including at least 2 ALK inhibitors (mainly crizotinib then ceritinib). At brigatinib initiation, 59.1% had performance status 0-1, 51.9% had ≥ 3 metastatic sites, 74.5% had central nervous system metastases (CNS) and 8.8% had carcinomatous meningitis. Median duration of brigatinib treatment was 6.7 (95% CI, 0.06-20.7) months. Median PFS was 6.6 (4.8-9.9) months for the entire population. For patients who received 2, 3-4 and >4 lines of treatment before brigatinib, PFS was 4.3 (2.5-8.9), 10.4 (5.9-13.9) and 3.8 (0.8-7.4) months, respectively. In the 91 evaluable patients, disease control rate was 78.2%. From brigatinib start, median overall survival was 17.2 (11.0-not reached) months. Among the 68 patients with progressive disease after brigatinib, CNS was involved in 29.4% of cases. Median OS from the diagnosis of NSCLC was 75.3 (38.2-174.6) months. CONCLUSION These real-world results confirm the efficacy of brigatinib in a cohort of patients heavily pretreated for ALK-positive advanced NSCLC.
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Affiliation(s)
- Renaud Descourt
- Centre Hospitalier Universitaire, Oncology Department, Brest, France.
| | | | | | - David Planchard
- Gustave Roussy, Department of Medical Oncology, Thoracic Group, Villejuif, France
| | - Bertrand Mennecier
- Centre Hospitalier Universitaire de Strasbourg, Chest Department, Strasbourg, France
| | - Marie Wislez
- AP-HP, Hôpitaux Universitaires de l'Est Parisien, Tenon Hospital, Chest Department, Paris, France; AP-HP, Hôpitaux Universitaires Paris Centre, Cochin Hospital, Thoracic Oncology Unit, Department of Pneumology, Paris, France
| | - Alexis Cortot
- Centre Hospitalier Universitaire de Lille, Thoracic Oncology Unit, Lille, France
| | - Florian Guisier
- Centre Hospitalier Universitaire de Rouen, Chest Department, Rouen, France
| | - Loïck Galland
- Georges-François-Leclerc Cancer Center, Medical Oncology Department, Dijon, France
| | - Pascal Dô
- François-Baclesse Cancer Center, Medical Oncology Department, Caen, France
| | - Roland Schott
- Paul-Strauss Cancer Center, Medical Oncology Department, Strasbourg, France
| | - Eric Dansin
- Oscar-Lambret Cancer Center, Medical Oncology Department, Lille, France
| | - Jennifer Arrondeau
- AP-HP, Hôpitaux Universitaires Paris Centre, Cochin Hospital, Thoracic Oncology Unit, Department of Pneumology, Paris, France
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Fumet JD, Richard C, Ledys F, Klopfenstein Q, Joubert P, Routy B, Truntzer C, Gagné A, Hamel MA, Guimaraes CF, Coudert B, Arnould L, Favier L, Lagrange A, Ladoire S, Saintigny P, Ortiz-Cuaran S, Perol M, Foucher P, Hofman P, Ilie M, Chevrier S, Boidot R, Derangere V, Ghiringhelli F. Correction: Prognostic and predictive role of CD8 and PD-L1 determination in lung tumor tissue of patients under anti-PD-1 therapy. Br J Cancer 2019; 121:283. [PMID: 31235866 PMCID: PMC6738095 DOI: 10.1038/s41416-019-0512-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Jean-David Fumet
- Department of Medical Oncology, Center GF Leclerc, Dijon, France.,Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France.,University of Burgundy-Franche Comté, Dijon, France
| | - Corentin Richard
- Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France.,University of Burgundy-Franche Comté, Dijon, France
| | - Fanny Ledys
- Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France.,University of Burgundy-Franche Comté, Dijon, France
| | - Quentin Klopfenstein
- Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France
| | - Philippe Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Bertrand Routy
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Hematology-Oncology Division, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | - Caroline Truntzer
- Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France
| | - Andréanne Gagné
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Marc-André Hamel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Camila Figueiredo Guimaraes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Bruno Coudert
- Department of Medical Oncology, Center GF Leclerc, Dijon, France
| | | | - Laure Favier
- Department of Medical Oncology, Center GF Leclerc, Dijon, France
| | - Aurélie Lagrange
- Department of Medical Oncology, Center GF Leclerc, Dijon, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Center GF Leclerc, Dijon, France.,University of Burgundy-Franche Comté, Dijon, France
| | - Pierre Saintigny
- Department of Medical Oncology, Center Leon Berard, Lyon, France
| | | | - Maurice Perol
- Department of Medical Oncology, Center Leon Berard, Lyon, France
| | - Pascal Foucher
- Department of Thoracic Oncology, Dijon University Hospital, Dijon, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, Nice University Hospital, Université Côte d'Azur, Nice, France.,Hospital-Integrated Biobank (BB-0033-00025), FHU OncoAge, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Marius Ilie
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, Nice University Hospital, Université Côte d'Azur, Nice, France.,Hospital-Integrated Biobank (BB-0033-00025), FHU OncoAge, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Sandy Chevrier
- Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France
| | - Romain Boidot
- Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France
| | - Valentin Derangere
- Research Platform in Biological Oncology, Dijon, France.,GIMI Genetic and Immunology Medical Institute, Dijon, France
| | - François Ghiringhelli
- Department of Medical Oncology, Center GF Leclerc, Dijon, France. .,Research Platform in Biological Oncology, Dijon, France. .,GIMI Genetic and Immunology Medical Institute, Dijon, France. .,University of Burgundy-Franche Comté, Dijon, France. .,INSERM UMR1231, Dijon, France.
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Descourt R, Perol M, Rousseau-Bussac G, Planchard D, Mennecier B, Wislez M, Cortot AB, Guisier F, Gervais R, Galland L, Schott R, Dansin E, ARRONDEAU J, Auliac JB, Chouaid C. Brigatinib in pretreated patients with ALK-positive advanced NSCLC. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
9045 Background: Brigatinib is a next-generation ALK inhibitor initially developed in pre-treated ALK+ NSCLC. Data on the efficacy of brigatinib in real world remain rare. Methods: This retrospective multicentric study analyzed ALK-+ advanced NSCLC patients pretreated with at least two tyrosine-kinase inhibitors, including crizotinib, and enrolled in the brigatinib French early access program. The primary endpoint was investigator-assessed progression-free survival (PFS). Results: 104 patients were included (mean age, 56.6 years; never smokers, 61.5%; adenocarcinoma, 98.1%). Patients had received a median of 3 previous treatment lines, including at least 2 ALK inhibitors, mainly crizotinib then ceritinib in 93% patients. At brigatinib initiation, 59.1% had performance status 0-1, 51.9% had ≥ 3 metastatic sites, 74.5% had central nervous system metastases (CNS) and 8.8% had carcinomatous meningitis. Median duration of brigatinib treatment was 6.7 (0.06–20.7) months. Median PFS was 6.6 (95% CI, 4.8–9.9) months for the entire population. In the 91 evaluable patients, disease control rate was 78.2% (stable, 28.2%; partial response, 45.7%; complete response, 4.3%). From brigatinib start, median overall survival was 17.2 (95% CI:11.0–not reached) months. Among the 68 patients with progressive disease after brigatinib, CNS was involved in 29.4% of cases. Ten (9.6%) patients had treatment discontinuation due to intolerance or patient request. Median OS from the diagnostic of NSCLC was 75,3 (95% CI, 38,2-174,6) months. Conclusions: This study confirms the efficacy of brigatinib in a cohort of patients heavily pretreated for ALK-+advanced NSCLC. These real-world results are consistent with clinical data reported in clinical trials.
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Affiliation(s)
| | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | | | - David Planchard
- Medical Oncology Department, Thoracic Group, Gustave Roussy, Villejuif, France
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Campelo RG, Lin HM, Perol M, Jahanzeb M, Popat S, Zhu Y, Zhang P, Camidge DR. Health-related quality of life (HRQoL) results from ALTA-1L: Phase 3 study of brigatinib vs crizotinib as first-line (1L) ALK therapy in advanced ALK+ non-small cell lung cancer (NSCLC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9084 Background: Results from ALTA-1L (NCT 02737501 ), an international, multicenter trial, showed that brigatinib vs crizotinib as 1L ALK therapy significantly prolongs progression-free survival (PFS; HR: 0.49, 95% CI, 0.33, 0.74) in advanced ALK+ NSCLC. HRQoL was evaluated as a secondary objective. Methods: ALK+ NSCLC patients were randomized 1:1 to brigatinib 90 mg daily for 7 days, then 180 mg daily or crizotinib 250 mg twice daily as 1L ALK therapy; treatment cycles were 28 days. HRQoL was assessed with the EORTC QLQ-C30 and LC13. Change from baseline, duration of improvement and time to worsening were analyzed in the ITT-PRO population (n = 131 for both groups). Results: HRQoL compliance was > 90% for brigatinib and crizotinib. Global health status (GHS)/QoL improved starting at cycle 2, with clinically meaningful improvement (≥10-point increase) noted with brigatinib at cycles 5−8, 10−13, 17 and 19 and crizotinib at cycle 6. Brigatinib substantially improved overall HRQoL vs crizotinib, as demonstrated by the estimated mean difference on change from baseline (4.1, P< 0.05) and duration of improvement for GHS/QoL (HR = 0.16, P< 0.001). Improved GHS/QoL with brigatinib vs crizotinib was also supported by improvement in several functional domains (Table) and for these symptoms ( P< 0.05): fatigue, nausea/vomiting and appetite loss. No domains significantly favored crizotinib. Brigatinib showed a trend to prolong time to worsening of dyspnea vs crizotinib (HR 0.65, 95% CI 0.38, 1.12). Table: HRQoL results brigatinib vs crizotinib Clinical trial information: NCT02737501. Conclusions: Consistent with the prolongation of PFS seen in 1L treatment of advanced ALK+ NSCLC, brigatinib improved HRQoL and prolonged the duration of improvement in GHS/QoL, and the majority of functional and symptom domains vs crizotinib.[Table: see text]
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Affiliation(s)
| | - Huamao Mark Lin
- Millennium Pharmaceuticals, Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | - Mohammad Jahanzeb
- University of Miami Sylvester Comprehensive Cancer Center, Deerfield Beach, FL
| | - Sanjay Popat
- The Royal Marsden Hospital, London, United Kingdom
| | - Yanyan Zhu
- Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
| | - Pingkuan Zhang
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA
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Mezquita L, Swalduz A, Jovelet C, Ortiz-Cuaran S, Planchard D, Recondo G, Benitez JC, Howarth K, Morris CD, Green E, Lacroix L, Odier L, Rouleau E, Fournel P, Caramella C, Tissot C, Perol M, Friboulet L, Besse B, Saintigny P. Efficacy of tyrosine kinase inhibitors (TKIs) based on the ALK resistance mutations on amplicon-based liquid biopsy in ALK positive non-small cell lung cancer (NSCLC) patients (pts). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3055] [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
3055 Background: Acquired ALK resistance mutations (mut.) are the main mechanism of tyrosine kinase inhibitor (TKI) resistance (30-50%). While next-generation TKIs are more active on mut. than earlier TKIs, compound ALK resistance are associated with failure to next-generation TKIs. We evaluated the clinical utility of detecting ALK resistance mutations in blood to predict TKI efficacy. Methods: ALK positive advanced NSCLC pts were prospectively enrolled between Oct. 2015 and Aug. 2018 in 8 French institutions. Prospective samples were collected; ctDNA was analyzed by amplicon-based Inivata InVisionFirst-Lung. Results: A total of 101 pts with advanced ALK positive NSCLC were enrolled and 328 samples collected. In samples collected at TKI failure (N=74), we detected 9 single and 7 complex (≥2) ALK resistance mut. (22%), associated with EML4-ALK variant 3 (38%) vs. variant 2 (13%) vs. variant 1 (none); 30% had other somatic mut. (mainly TP53 and KRAS, PI3KCA, MET, etc.). No mutations were detected in 48% of samples (ctDNA neg). ALK mut. were more frequent after 2nd/3rd generation TKI (43% post-lorlatinib (7), 29% post-2nd gen. (31), 11% post-crizotinib (36)). ALKG1202R was the most common, as single (n=3) or complex mut. (n=4). The median overall survival (mOS) was 100.4 mo. (95% CI 41.9-158.9) and the median progression free-survival (mPFS) to subsequent line was 2.8 mo. (0.7-4.9). Patients with ctDNA neg had mOS of 105 mo. (39.3-172.1) vs. 58.5 mo. (33.1-84.0) if ≥1 ALK mut. vs. 44.1 mo. (20.0-68.2) if others ( P=0.001). Pts with the complex ALK mut. had worse OS compared to singles ALK mut. (mOS 26.9 mo. vs. 58.5 mo., P=0.001); ALK complex mut. were associated with poor efficacy to subsequent therapy (PFS <3 mo. in 57%; no cases with PFS >6 mo.) vs. single mut., with longer PFS (PFS >6 mo. in 56%). Detectable ALKG1202R mut. were associated with shorter median OS (58.3 mo.; 7.9-109.1) vs. overall population; 86% of cases developed rapid PD (PFS <3mo.) to subsequent therapy with only one durable response to lorlatinib (PFS >6mo.). Conclusions: The absence of ctDNA mutations at TKI failure was associated with prolonged OS, whereas complex ALK mutations at TKI failure may predict resistance to subsequent therapy. Larger and specifically designed studies should be performed to validate these findings.
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Affiliation(s)
- Laura Mezquita
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Aurélie Swalduz
- Department of Thoracic Oncology, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France
| | - Cecile Jovelet
- Translational Reseach Laboratory, Gustave Roussy, Villejuif, France
| | - Sandra Ortiz-Cuaran
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
| | - David Planchard
- Medical Oncology Department, Thoracic Group, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | - Pierre Fournel
- GFPC (France), Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | | | - Claire Tissot
- Acute Respiratory Medicine and Thoracic Oncology Department Lyon Sud Hospital and Lyon University Cancer Institute, International Agency for Research on Cancer, Molecular Mechanisms and Biomarkers Group, Pierre Benite, France
| | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | | | - Benjamin Besse
- Paris-Sud University, Orsay and Gustave Roussy, Villejuif, France
| | - Pierre Saintigny
- INSERM U1052, CNRS UMR 5286, Cancer Research Center of Lyon, Université de Lyon, Centre Léon Bérard, Université Lyon 1, ISPB, Faculté de Pharmacie de Lyon, Lyon, France
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Sequist LV, Janne PA, Huber RM, Gray JE, Felip E, Perol M, Hirsch FR, Tan DSW, Kuesters G, Zalutskaya A, Santillana S, Pipas JM, Shepherd FA. SHERLOC: A phase 2 study of MM-121 plus with docetaxel versus docetaxel alone in patients with heregulin (HRG) positive advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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
9036 Background: Seribantumab (MM-121) is a human monoclonal IgG2 antibody that blocks the HRG domain of HER3. Preclinical data suggest that seribantumab reverses HRG mediated drug resistance across multiple cancer models. In prior retrospective analyses, addition of seribantumab to standard of care (SOC) appeared to improve outcomes in pts with HRG+ tumors. Here we tested if seribantumab plus SOC improved progression-free survival (PFS) in pts with HRG+ lung adenocarcinoma who had received prior platinum-based therapy. Methods: SHERLOC was a randomized, open-label, multicenter, Phase 2 study in pts with advanced HRG+ adenocarcinoma of the lung. Archival or pre-treatment tumor samples were assessed for HRG+ by RNA in situ hybridization. Eligibility criteria included prior platinum-based therapy for advanced disease with ≤ 2 total prior lines of therapy (prior IO was allowed) and no EGFR or ALK mutations. Pts were randomized 2:1 to receive seribantumab 3000 mg/docetaxel 75 mg IV q3w (experimental; exp) or docetaxel 75 mg IV q3w alone (control). Primary endpoint was PFS. Key secondary endpoints were overall survival (OS), objective response rate (ORR), and adverse event (AEs) profile. Results: At a pre-specified interim analysis of 75% of total PFS events, 108 pts were enrolled (exp n = 71, control n = 37). Median age was 62y (range 34-83y); female 34%; one prior treatment only 39%. Median PFS was 3.0m for exp and 4.0m for control, HR = 1.66m (p = 0.084). Median OS was 7.9m for exp and 8.4m for control, HR = 1.50 (p = 0.235). ORR was 19.7% for exp and 5.6% for control (p = 0.052). Serious AEs were more frequent in the exp arm (40.8%) vs control (24.3%). Most common treatment emergent AEs (TEAEs) in the exp arm were diarrhea (47%), fatigue (37%), and neutropenia (27%). Based on a determination of futility at interim analysis, the study was terminated early. Conclusions: Seribantumab failed to improve PFS when added to docetaxel among previously treated advanced HRG+ NSCLC pts. A higher response rate and a higher incidence of TEAEs were observed in the exp arm. No further study of seribantumab is planned in NSCLC. Clinical trial information: NCT02387216.
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Affiliation(s)
- Lecia V. Sequist
- Massachusetts General Hospital Cancer Center/Harvard Medical School, Boston, MA
| | | | | | | | | | - Maurice Perol
- Department of Thoracic Oncology, Centre Léon Bérard, Lyon, France
| | | | | | | | | | | | | | - Frances A. Shepherd
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Bylicki O, Guisier F, Monnet I, Doubre H, Radj G, Janicot H, Perol M, Fournel P, Le Treut J, Lamy R, Le Caer H, Auliac J, Chouaid C. Efficacité et tolérance des inhibiteurs des immuno-checkpoints (anti-PD-1/PD-L1) chez les patients atteint de CBNPC avec mutation EFGR, ALK/ROS : étude IMAD GFPC 03-2016. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.062] [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]
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Domblides C, Monnet I, Mazieres J, Barlesi F, Gounant V, Baldacci S, Mennecier B, Toffart A, Audigier Valette C, Doucet L, Giroux-Leprieur E, Guisier F, Molinier O, Perol M, Pichon E, Robinet G, Templement Grangerat D, Ruppert AM, Wislez M. Efficacy of immune checkpoint inhibitors in lung sarcomatoid carcinoma: Data from a French multicentric cohort. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.015] [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: 11/13/2022] Open
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Vassal G, Cozic N, Houot R, Brugières L, Aparicio T, Blay JY, Perol M, Brice P, Meriaux E, Geoerger B, El Bejjani M, Moalla S, Bièche I, Lantuejoul S, Mahier Ait Oukhatar C, Hoog Labouret N, Moro-Sibilot D. Biomarker-driven access to crizotinib in ALK, MET or ROS1 positive (+) malignancies in adults and children: The French national AcSé program. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy279.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Perol M. Key roles of immune-check inhibitors for first- and second line treatment for advanced NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy354] [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: 11/13/2022] Open
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