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Nadal E, Rodríguez-Abreu D, Simó M, Massutí B, Juan O, Huidobro G, López R, De Castro J, Estival A, Mosquera J, Sullivan I, Felip E, Blasco A, Guirado M, Pereira E, Vilariño N, Navarro V, Bruna J. Phase II Trial of Atezolizumab Combined With Carboplatin and Pemetrexed for Patients With Advanced Nonsquamous Non-Small-Cell Lung Cancer With Untreated Brain Metastases (Atezo-Brain, GECP17/05). J Clin Oncol 2023; 41:4478-4485. [PMID: 37603816 PMCID: PMC10553096 DOI: 10.1200/jco.22.02561] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/14/2023] [Accepted: 06/23/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE The Atezo-Brain study evaluated atezolizumab combined with chemotherapy in patients with advanced non-small-cell lung cancer (NSCLC) with untreated brain metastases, a population traditionally excluded from trials. METHODS This single-arm phase II clinical trial enrolled patients with advanced nonsquamous NSCLC with untreated brain metastases without neurologic symptoms or asymptomatic with medical treatment. Dexamethasone was allowed up to 4 mg once daily. Atezolizumab plus carboplatin and pemetrexed was given for four to six cycles followed by atezolizumab plus pemetrexed until progression for a maximum of 2 years. The primary end points were to determine the progression-free survival (PFS) rate at 12 weeks and the incidence of grade ≥3 adverse events during the first 9 weeks. Intracranial outcomes were assessed using response assessment in neuro-oncology brain metastases criteria. RESULTS Forty patients were enrolled and 22 (55%) were receiving corticosteroids at baseline. The overall 12-week PFS rate was 62.2% (95% credibility interval [CrI], 47.1 to 76.2). The rate of grade 3/4 adverse events during the first 9 weeks was 27.5%. Most neurologic events were grade 1 and 2 but five patients (12.5%) experienced grade 3-4 neurologic events. With a median follow-up of 31 months, intracranial median PFS was 6.9 months and response rate was 42.7% (95% CrI, 28.1 to 57.9). Systemic median PFS was 8.9 months and response rate was 45% (95% CrI, 28.1 to 57.9). The median overall survival (OS) was 11.8 months (95% CI, 7.6 to 16.9) and the 2-year OS rate was 27.5% (95% CI, 16.6 to 45.5). CONCLUSION Atezolizumab plus carboplatin and pemetrexed demonstrates activity in patients with advanced nonsquamous NSCLC with untreated brain metastases with an acceptable safety profile.
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Affiliation(s)
- Ernest Nadal
- Department of Medical Oncology, Institut Català d’Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
- Preclinical and Experimental Research in Thoracic Tumors (PReTT) Group, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Delvys Rodríguez-Abreu
- Department of Medical Oncology, Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO, IDIBELL, L'Hospitalet, Barcelona, Spain
| | - Bartomeu Massutí
- Department of Medical Oncology, Hospital General de Alicante, Alicante, Spain
| | - Oscar Juan
- Department of Medical Oncology, Hospital Universitari La Fe, Valencia, Spain
| | - Gerardo Huidobro
- Department of Medical Oncology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Rafael López
- Department of Medical Oncology, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Javier De Castro
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Anna Estival
- Department of Medical Oncology, Institut Català d’Oncologia (ICO), Badalona, Spain
| | - Joaquín Mosquera
- Department of Medical Oncology, Hospital Universitario A Coruña, A Coruña, Spain
| | - Ivana Sullivan
- Department of Medical Oncology, Hospital Sant Pau, Barcelona, Spain
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Ana Blasco
- Department of Medical Oncology, Hospital General de Valencia, Valencia, Spain
| | - Maria Guirado
- Department of Medical Oncology, Hospital Universitario de Elche, Elche, Spain
| | | | - Noelia Vilariño
- Department of Medical Oncology, Institut Català d’Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
- Preclinical and Experimental Research in Thoracic Tumors (PReTT) Group, Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO, IDIBELL, L'Hospitalet, Barcelona, Spain
| | - Valentín Navarro
- Department of Medical Oncology, Institut Català d’Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO, IDIBELL, L'Hospitalet, Barcelona, Spain
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Rodriguez-Vida A, Maroto P, Font A, Martin C, Mellado B, Corbera A, Orrillo M, Reig O, Querol R, Rios-Hoyo A, Cano L, Alonso J, Martinez G, Galtes S, Taus A, Martinez-Garcia M, Juanpere N, Juan O, Bellmunt J. Safety and efficacy of avelumab plus carboplatin in patients with metastatic castration-resistant prostate cancer in an open-label Phase Ib study. Br J Cancer 2023; 128:21-29. [PMID: 36289372 PMCID: PMC9814154 DOI: 10.1038/s41416-022-01991-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Single-agent PD-1/PD-L1 inhibitors have shown limited efficacy in unselected mCRPC. The evidence of a survival benefit with sipuleucel-T and ipilimumab, provides a rationale to study further increasing immunogenicity in mCRPC through combinations. METHODS Safety and efficacy avelumab plus carboplatin was investigated in a single-arm Phase Ib study in mCRPC, progressing to at least one taxane and one androgen-receptor inhibitor. The primary endpoint was safety. Secondary endpoints included PSA/radiographic responses, progression-free survival (PFS) and overall survival (OS). Germline/somatic mutation analysis was performed. RESULTS In total, 26 patients were included. Patients were heavily pretreated: 76.9% received ≥3 and 42.3% ≥4 prior lines. A DNA damage repair (DDR) alteration was found in three patients (11.5%). The safety profile was acceptable with 73% Grade 3-4 treatment-related adverse events. PSA response rate ≥50% was seen in 7.7% of patients. The objective response rate was 17.6%, including one complete response (5.9%). Two of these responders had a known DDR alteration (one BRCA2, one ATM). The median response duration was 6 months. Median radiographic PFS was 6.6 months (95% CI 4.28-9.01), and median OS 10.6 months (95% CI 6.68-NR). CONCLUSIONS Avelumab plus carboplatin has an acceptable safety profile and was associated with a prolonged OS given the heavily pretreated population.
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Affiliation(s)
- Alejo Rodriguez-Vida
- Medical Oncology Department, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Pablo Maroto
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Albert Font
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Barcelona, Spain
| | - Cristina Martin
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Begoña Mellado
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Lab, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Uro-Oncology Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Alex Corbera
- Medical Oncology Department, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Mayra Orrillo
- Medical Oncology Department, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Oscar Reig
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
- Translational Genomics and Targeted Therapeutics in Solid Tumors Lab, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Uro-Oncology Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Rosa Querol
- Medical Oncology Department, Hospital de Mataró, Barcelona, Spain
| | - Alejandro Rios-Hoyo
- Medical Oncology Department, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Laia Cano
- Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
| | - Judith Alonso
- Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
| | - Gemma Martinez
- Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
| | - Susana Galtes
- Clinical Trials Unit, Hospital del Mar, Barcelona, Spain
| | - Alvaro Taus
- Medical Oncology Department, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Maria Martinez-Garcia
- Medical Oncology Department, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain
| | - Nuria Juanpere
- Pathology Department, Hospital del Mar, Barcelona, Spain
| | - Oscar Juan
- Pivotal SLU Clinical Research Organization, Madrid, Spain
| | - Joaquim Bellmunt
- Medical Oncology Department, Hospital del Mar-CIBERONC, IMIM Research Institute, Barcelona, Spain.
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
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3
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Palanca-Ballester C, Hervas D, Villalba M, Valdes-Sanchez T, Garcia D, Alcoriza-Balaguer MI, Benet M, Martinez-Tomas R, Briones-Gomez A, Galbis-Caravajal J, Calvo A, Juan O, Lahoz A, Cases E, Sandoval J. Translation of a tissue epigenetic signature to circulating free DNA suggests BCAT1 as a potential noninvasive diagnostic biomarker for lung cancer. Clin Epigenetics 2022; 14:116. [PMID: 36123616 PMCID: PMC9487112 DOI: 10.1186/s13148-022-01334-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
Lung cancer patients are diagnosed at late stages when curative treatments are no longer possible; thus, molecular biomarkers for noninvasive detection are urgently needed. In this sense, we previously identified and validated an epigenetic 4-gene signature that yielded a high diagnostic performance in tissue and invasive pulmonary fluids. We analyzed DNA methylation levels using the ultrasensitive digital droplet PCR in noninvasive samples in a cohort of 83 patients. We demonstrated that BCAT1 is the candidate that achieves high diagnostic efficacy in circulating DNA derived from plasma (area under the curve: 0.85). Impact of potentially confounding variables was also explored.
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Affiliation(s)
- Cora Palanca-Ballester
- Biomarkers and Precision Medicine Unit, Health Research Institute La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - David Hervas
- Department of Applied Statistics and Operational Research and Quality, Universitat Politècnica de València, Valencia, Spain
| | - Maria Villalba
- CIBERONC, ISCIII, 28029, Madrid, Spain.,IDISNA and Program in Solid Tumors, Center for Applied Medical Research (CIMA) and Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain
| | | | - Diana Garcia
- Epigenomics Unit, Health Research Institute La Fe, Valencia, Spain
| | - Maria Isabel Alcoriza-Balaguer
- Biomarkers and Precision Medicine Unit, Health Research Institute La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Marta Benet
- Biomarkers and Precision Medicine Unit, Health Research Institute La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | | | | | | | - Alfonso Calvo
- CIBERONC, ISCIII, 28029, Madrid, Spain.,IDISNA and Program in Solid Tumors, Center for Applied Medical Research (CIMA) and Department of Pathology, Anatomy and Physiology, School of Medicine, University of Navarra, Pamplona, Spain
| | - Oscar Juan
- Biomarkers and Precision Medicine Unit, Health Research Institute La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Agustin Lahoz
- Biomarkers and Precision Medicine Unit, Health Research Institute La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Enrique Cases
- Pneumology Service, University Hospital La Fe, Valencia, Spain
| | - Juan Sandoval
- Biomarkers and Precision Medicine Unit, Health Research Institute La Fe, Av. Fernando Abril Martorell, 106, 46026, Valencia, Spain. .,Epigenomics Unit, Health Research Institute La Fe, Valencia, Spain.
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4
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Hernandez S, Rodriguez Carrillo J, Caminoa A, Benito A, Martinez R, Alonso M, Clave S, Arriola E, Esteban-Rodriguez I, De Castro J, Sansano I, Felip E, Abdulkader I, Garcia J, Rojo F, Domine M, Teixido C, Reguart N, Compañ D, Insa A, Mancheño N, Palanca S, Juan O, Baixeras N, Nadal E, Cebollero M, Calles A, Martin P, Salas C, Provencio M, Aranda I, Massuti B, Lopez-Vilaro L, Majem M, Garrido P, Paz-Ares L, Lopez-Rios F, Conde E. P2.07-02 RET Fusion Testing with FISH and Real-Time PCR: a Comparison with RNA-Based Next-Generation Sequencing in RET Positive NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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5
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Poveda A, Lopez-Reig R, Oaknin A, Redondo A, Rubio MJ, Guerra E, Fariñas-Madrid L, Gallego A, Rodriguez-Freixinos V, Fernandez-Serra A, Juan O, Romero I, Lopez-Guerrero JA. Phase 2 Trial (POLA Study) of Lurbinectedin plus Olaparib in Patients with Advanced Solid Tumors: Results of Efficacy, Tolerability, and the Translational Study. Cancers (Basel) 2022; 14:cancers14040915. [PMID: 35205662 PMCID: PMC8870416 DOI: 10.3390/cancers14040915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 02/11/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Genomic instability (GI) is a transversal phenomenon in oncology, constituting a hallmark of cancer. In gynecological malignancies, the predictive value of GI has been described and is mainly caused by alterations in the homologous recombination repair (HRR) genes, such as BRCA1/2. The POLA clinical trial constitutes an ideal substrate used to study the correlation between GI and response to combined therapy of lurbinectedin plus olaparib in solid tumors. In this context, we developed an approach based on next-generation sequencing, capable of shedding information about Copy Number Variations (CNV) as a surrogate of GI and genotyping of homologous recombination repair genes. Additionally, some algorithms used to extract GI parameters were tested and benchmarked, selecting the most informative mutational and GI features as potential predictive biomarkers for the drug combination explored in the POLA trial. Abstract We hypothesized that the combination of olaparib and lurbinectedin maximizes DNA damage, thus increasing its efficacy. The POLA phase 1 trial established the recommended phase 2 dose of lurbinectedin as being 1.5 mg (day 1) and that of olaparib as being 250 mg/12 h (days 1–5) for a 21-day cycle. In phase 2, we explore the efficacy of the combination in terms of clinical response and its correlation with mutations in the HRR genes and the genomic instability (GI) parameters. Results: A total of 73 patients with high-grade ovarian (n = 46), endometrial (n = 26), and triple-negative breast cancer (n = 1) were treated with lurbinectedin and olaparib. Most patients (62%) received ≥3 lines of prior therapy. The overall response rate (ORR) and disease control rate (DCR) were 9.6% and 72.6%, respectively. The median progression-free survival (PFS) was 4.54 months (95% CI 3.0–5.2). Twelve (16.4%) patients were considered long-term responders (LTR), with a median PFS of 13.3 months. No clinical benefit was observed for cases with HRR gene mutation. In ovarian LTRs, although a direct association with GI and a total loss of heterozygosity (LOH) events was observed, the association did not reach statistical significance (p = 0.055). Globally, the total number of LOHs might be associated with the ORR (p =0.074). The most common grade 3–4 toxicities were anemia and thrombocytopenia, in 6 (8.2%) and 3 (4.1%) patients, respectively. Conclusion: The POLA study provides evidence that the administration of lurbinectedin and olaparib is feasible and tolerable, with a DCR of 72.6%. Different GI parameters showed associations with better responses.
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Affiliation(s)
- Andres Poveda
- Oncogynecologic Department, Initia Oncology, Hospital Quironsalud, Avda Blasco Ibañez, 14, 46010 Valencia, Spain
- Correspondence:
| | - Raquel Lopez-Reig
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain; (R.L.-R.); (A.F.-S.); (J.A.L.-G.)
- IVO-CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF), 46012 Valencia, Spain
| | - Ana Oaknin
- Medical Oncology Department, Vall d’Hebron University Hospital, Vall d´Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (A.O.); (L.F.-M.); (V.R.-F.)
| | - Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain; (A.R.); (A.G.)
| | - Maria Jesus Rubio
- Medical Oncology Department, Universitary Hospital Reina Sofia, 14004 Cordoba, Spain;
| | - Eva Guerra
- Medical Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Lorena Fariñas-Madrid
- Medical Oncology Department, Vall d’Hebron University Hospital, Vall d´Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (A.O.); (L.F.-M.); (V.R.-F.)
| | - Alejandro Gallego
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Madrid (UAM), 28049 Madrid, Spain; (A.R.); (A.G.)
| | - Victor Rodriguez-Freixinos
- Medical Oncology Department, Vall d’Hebron University Hospital, Vall d´Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain; (A.O.); (L.F.-M.); (V.R.-F.)
- Department of Medical Oncology and Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Antonio Fernandez-Serra
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain; (R.L.-R.); (A.F.-S.); (J.A.L.-G.)
- IVO-CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF), 46012 Valencia, Spain
| | - Oscar Juan
- Medical Oncology, Pivotal SLU, 28023 Madrid, Spain;
| | - Ignacio Romero
- Medical Oncology, Fundacion Instituto Valenciano de Oncologia, 46009 Valencia, Spain;
| | - Jose A. Lopez-Guerrero
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain; (R.L.-R.); (A.F.-S.); (J.A.L.-G.)
- IVO-CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF), 46012 Valencia, Spain
- Department of Pathology, School of Medicine, Catholic University of Valencia ‘San Vicente Mártir’, 46001 Valencia, Spain
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6
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Calvo V, Carcereny E, Abreu DR, Lopez-Castro R, Guirado M, Camps C, Cobo M, Ortega A, Bernabé R, Massuti B, Mosquera J, Del Barco E, Gonzalez - Larriba J, Bosch - Barrera J, Ojeda CG, Domine M, Juan O, Martínez-Cutillas M, Benítez G, Collazo-Lorduy A, Cucurull M, Provencio M. OA14.01 Family History of Cancer and Lung Cancer: Information from the Thoracic Tumors Registry (TTR Study). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.080] [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: 10/20/2022]
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7
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Conde E, Hernandez S, Caminoa A, Benito A, Martinez R, Alonso M, Jimenez B, Boni V, Remon J, Pijuan L, Clave S, Arriola E, Esteban I, De Castro J, Sansano I, Felip E, Abdulkader I, Garcia J, Rojo F, Domine M, Teixido C, Reguart N, Compañ D, Insa A, Mancheño N, Palanca S, Juan O, Baixeras N, Nadal E, Cebollero M, Calles A, Martin P, Salas C, Provencio M, Aranda I, Massuti B, Lopez-Vilaro L, Majem M, Enguita A, Paz-Ares L, Garrido P, Lopez-Rios F. MA14.02 RET Fusion Testing in Advanced Non-Small Cell Lung Carcinoma Patients: the RETING Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.183] [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: 11/25/2022]
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8
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Jantus-Lewintre E, Massutí Sureda B, González Larriba JL, Rodríguez-Abreu D, Juan O, Blasco A, Dómine M, Provencio Pulla M, Garde J, Álvarez R, Maestu I, Pérez de Carrión R, Artal Á, Rolfo C, de Castro J, Guillot M, Oramas J, de Las Peñas R, Ferrera L, Martínez N, Serra Ò, Rosell R, Camps C. Prospective Exploratory Analysis of Angiogenic Biomarkers in Peripheral Blood in Advanced NSCLC Patients Treated With Bevacizumab Plus Chemotherapy: The ANGIOMET Study. Front Oncol 2021; 11:695038. [PMID: 34381717 PMCID: PMC8350788 DOI: 10.3389/fonc.2021.695038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
Finding angiogenic prognostic markers in advanced non-small-cell lung cancer is still an unmet medical need. We explored a set of genetic variants in the VEGF-pathway as potential biomarkers to predict clinical outcomes of patients with non-small-cell lung cancer treated with chemotherapy plus bevacizumab. We prospectively analyzed the relationship between VEGF-pathway components with both pathological and prognostic variables in response to chemotherapy plus bevacizumab in 168 patients with non-squamous non-small-cell lung cancer. Circulating levels of VEGF and VEGFR2 and expression of specific endothelial surface markers and single-nucleotide polymorphisms in VEGF-pathway genes were analyzed. The primary clinical endpoint was progression-free survival. Secondary endpoints included overall survival and objective tumor response. VEGFR-1 rs9582036 variants AA/AC were associated with increased progression-free survival (p = 0.012 and p = 0.035, respectively), and with improved overall survival (p = 0.019) with respect to CC allele. Patients with VEGF-A rs3025039 harboring allele TT had also reduced mortality risk (p = 0.049) compared with the CC allele. The VEGF-A rs833061 variant was found to be related with response to treatment, with 61.1% of patients harboring the CC allele achieving partial treatment response. High pre-treatment circulating levels of VEGF-A were associated with shorter progression-free survival (p = 0.036). In conclusion, in this prospective study, genetic variants in VEGFR-1 and VEGF-A and plasma levels of VEGF-A were associated with clinical benefit, progression-free survival, or overall survival in a cohort of advanced non-squamous non-small-cell lung cancer patients receiving chemotherapy plus antiangiogenic therapy.
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Affiliation(s)
- Eloisa Jantus-Lewintre
- Departamento de Biotecnología, Universitat Politècnica de València, Unidad Mixta TRIAL, Fundación para la Investigación del Hospital General Universitario de Valencia/Centro de Investigación Príncipe Felipe, CIBERONC, Valencia, Spain
| | | | | | - Delvys Rodríguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Oscar Juan
- Servicio de Oncología Médica, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Ana Blasco
- Consorcio Hospital General Universitario de Valencia, CIBERONC, Valencia, Spain
| | - Manuel Dómine
- Servicio de Oncología Médica, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Javier Garde
- Departamento de Oncología Médica, Hospital Arnau de Vilanova, Valencia, Spain
| | - Rosa Álvarez
- Departamento de Oncología Médica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Inmaculada Maestu
- Departamento de Oncología Médica, Hospital Universitari Doctor Peset, Valencia, Spain
| | | | - Ángel Artal
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Christian Rolfo
- Experimental Therapeutics Program, Greenbaum Comprehensive Cancer Center, University of Maryland, School of Medicine, Baltimore, MD, United States
| | - Javier de Castro
- Servicio de Oncología Médica, Hospital Universitario La Paz, Madrid, Spain
| | - Mónica Guillot
- Servicio de Oncología Médica, Hospital Son Espases, Palma de Mallorca, Spain
| | - Juana Oramas
- Departamento de Oncología Médica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Ramón de Las Peñas
- Departamento de Oncología Médica, Hospital Provincial de Castelló, Castellón, Spain
| | - Lioba Ferrera
- Servicio de Oncología Médica, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Natividad Martínez
- Departamento de Oncología, Hospital General Universitario de Elche, Elche, Spain
| | - Òlbia Serra
- Departamento de Oncología Médica, Hospital General de l' Hospitalet, L'Hospitalet de Llobregat, Spain
| | - Rafael Rosell
- Programa de la Biología del Cáncer y Medicina de Precisión, Institut de Recerca Germans Trias i Pujol, Badalona, Spain/Instituto Oncológico Dr. Rosell, Barcelona, Spain
| | - Carlos Camps
- Departamento de Medicina, Universitat Politècnica de València, Unidad Mixta TRIAL, Fundación para la Investigación del Hospital General Universitario de Valencia/Centro de Investigación Príncipe Felipe, CIBERONC, Valencia, Spain
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9
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Franco F, Carcereny E, Guirado M, Ortega AL, López-Castro R, Rodríguez-Abreu D, García-Campelo R, Del Barco E, Juan O, Aparisi F, González-Larriba JL, Domine M, Trigo JM, Cobo M, Cerezo S, Calzas J, Massutí B, Bosch-Barrera J, García Coves P, Domènech M, Provencio M. Epidemiology, treatment, and survival in small cell lung cancer in Spain: Data from the Thoracic Tumor Registry. PLoS One 2021; 16:e0251761. [PMID: 34077442 PMCID: PMC8171958 DOI: 10.1371/journal.pone.0251761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/02/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Small-cell lung cancer (SCLC) is an aggressive disease with high metastatic potential and poor prognosis. Due to its low prevalence, epidemiological and clinical information of SCLC patients retrieved from lung cancer registries is scarce. PATIENTS AND METHODS This was an observational multicenter study that enrolled patients with lung cancer and thoracic tumors, recruited from August 2016 to January 2020 at 50 Spanish hospitals. Demographic and clinical data, treatment patterns and survival of SCLC patients included in the Thoracic Tumor Registry (TTR) were analyzed. RESULTS With a total of 956 cases, the age of 64.7 ± 9.1 years, 78.6% were men, 60.6% smokers, and ECOG PS 0, 1 or ≥ 2 in 23.1%, 53.0% and 23.8% of cases, respectively. Twenty percent of patients had brain metastases at the diagnosis. First-line chemotherapy (CT), mainly carboplatin or cisplatin plus etoposide was administered to >90% of patients. In total, 36.0% and 13.8% of patients received a second and third line of CT, respectively. Median overall survival was 9.5 months (95% CI 8.8-10.2 months), with an estimated rate of 70.3% (95% CI 67.2-73.4%), 38.9% (95% CI 35.4-42.4%), and 14.8% (95% CI 11.8-17.8%) at 6, 12 and 24 months respectively. Median progression-free survival was 6.3 months. Higher mortality and progression rates were significantly associated with male sex, older age, smoking habit, and ECOG PS 1-2. Long-term survival (> 2 years) was confirmed in 6.6% of patients, showing a positive correlation with better ECOG PS, poor smoking and absence of certain metastases at diagnosis. CONCLUSION This study provides an updated overview of the clinical situation and treatment landscape of ES-SCLC in Spain. Our results might assist oncologists to improve current clinical practice towards a better prognosis for these patients.
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Affiliation(s)
- Fernando Franco
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Enric Carcereny
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
| | - Maria Guirado
- Hospital General Universitario de Elche, Elche, Spain
| | | | | | | | | | | | - Oscar Juan
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - Manuel Domine
- Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Jose M Trigo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Manuel Cobo
- Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | - Sara Cerezo
- Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Julia Calzas
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | | | | | | | - Marta Domènech
- Catalan Institute of Oncology, Hospital Universitari Germans Trias i Pujol, B-ARGO, IGTP, Badalona, Spain
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10
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Provencio M, Terrasa J, Garrido P, Campelo RG, Aparisi F, Diz P, Aguiar D, García-Giron C, Hidalgo J, Aguado C, González JG, Esteban E, Gómez-Aldavarí L, Moran T, Juan O, Chara LE, Marti JL, Castro RL, Ortega AL, Moreno EM, Coves J, Sánchez Peña AM, Bosch-Barrera J, Gastaldo AS, Núñez NF, Del Barco E, Cobo M, Isla D, Majem M, Navarro F, Calvo V. Osimertinib in advanced EGFR-T790M mutation-positive non-small cell lung cancer patients treated within the Special Use Medication Program in Spain: OSIREX-Spanish Lung Cancer Group. BMC Cancer 2021; 21:230. [PMID: 33676426 PMCID: PMC7937205 DOI: 10.1186/s12885-021-07922-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AURA study reported 61% objective response rate and progression-free survival of 9.6 months with osimertinib in patients with EGFR/T790M+ non-small cell lung cancer. Due to lack of real-world data, we proposed this study to describe the experience with osimertinib in Spain. METHODS Post-authorization, non-interventional Special Use Medication Program, multicenter, retrospective study in advanced EGFR/T790M+ non-small cell lung cancer. One hundred-fifty five patients were enrolled (August 2016-December 2018) from 30 sites. PRIMARY OBJECTIVE progression-free survival. Secondary objectives: toxicity profile, objective response rate, and use of health service resources. RESULTS 70% women, median age 66. 63.9% were non-smokers and 99% had adenocarcinoma. Most patients had received at least one prior treatment (97%), 91.7% had received previous EGFR-tyrosine kinase inhibitors and 2.8% osimertinib as first-line treatment. At data cutoff, median follow-up was 11.8 months. One hundred-fifty five patients were evaluable for response, 1.3% complete response, 40.6% partial response, 31% stable disease and 11.6% disease progression. Objective response rate was 42%. Median progression-free survival was 9.4 months. Of the 155 patients who received treatment, 76 (49%) did not reported any adverse event, 51% presented some adverse event, most of which were grade 1 or 2. The resource cost study indicates early use is warranted. CONCLUSION This study to assess the real-world clinical impact of osimertinib showed high drug activity in pretreated advanced EGFR/T790M+ non-small cell lung cancer, with manageable adverse events. TRIAL REGISTRATION Clinical trial registration number: NCT03790397 .
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Affiliation(s)
- Mariano Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Health Research Institute, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Universidad Autónoma de Madrid, Madrid, Spain.
| | - Josefa Terrasa
- Medical Oncology Department, Hospital Universitari Son Espases, Islas Balears, Palma de Mallorca, Spain
| | - Pilar Garrido
- Medical Oncology Department, IRYCIS Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rosario García Campelo
- Medical Oncology Department, Hospital Universitario A Coruña, A Coruña, Spain.,Instituto de Investigación Biomédica A Coruña INIBIC, A Coruña, Spain
| | - Francisco Aparisi
- Medical Oncology Department Valencia, Hospital General Universitario de Valencia, Madrid, Spain
| | - Pilar Diz
- Medical Oncology Department León, Complejo Asistencial Universitario de León, Madrid, Spain
| | - David Aguiar
- Medical Oncology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de GC, Spain
| | - Carlos García-Giron
- Medical Oncology Department, Hospital Universitario De Burgos, Burgos, Spain
| | - Julia Hidalgo
- Medical Oncology Department, Hospital Lluís Alcanyis, Xátiva, Valencia, Spain
| | - Carlos Aguado
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Jorge García González
- Medical Oncology Department Santiago de Compostela, Hospital Clínico Universitario de Santiago, Madrid, Spain
| | - Emilio Esteban
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lorenzo Gómez-Aldavarí
- Medical Oncology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Teresa Moran
- Institut Català d'Oncologia Badalona, Medical Oncology Department, Badalona, Barcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Barcelona, Badalona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Badalona Applied Research Group in Oncology, Barcelona, Spain.,Fundació Germans Trias i Pujol, Barcelona, Spain
| | - Oscar Juan
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luís Enrique Chara
- Medical Oncology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Juan L Marti
- Medical Oncology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Rafael López Castro
- Medical Oncology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ana Laura Ortega
- Medical Oncology Department, Complejo Hospitalario de Jaen, Jaen, Spain
| | | | - Juan Coves
- Medical Oncology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Ana M Sánchez Peña
- Medical Oncology Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Joaquim Bosch-Barrera
- Department of Oncology, Catalan Institute of Oncology. Dr. Josep Trueta University Hospital, Girona, Spain
| | | | | | - Edel Del Barco
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Manuel Cobo
- Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Unidad de Gestión Clínica Intercentros de Oncología Médica, Málaga, Spain
| | - Dolores Isla
- Medical Oncology Department, Hospital Universitario Lozano Blesa, Zaragoza, Aragón, Spain
| | - Margarita Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fátima Navarro
- Medical Oncology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Virginia Calvo
- Medical Oncology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. .,Health Research Institute, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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11
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Franco F, Carcereny E, Rodríguez-Abreu D, Castro RL, Cobo M, Guirado M, Massuti B, Granados AO, Mosquera J, Juan O, Blasco A, Del Barco E, Caro RB, Bosch-Barrera J, Gonzalez-Larriba J, Sala M, Pérez JT, Oramas J, Estival A, Provencio M. P52.10 Profile of Comorbidities and Cancer History in Patients with mNSCLC in the Spanish Population (Thoracic Tumors Registry). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.923] [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: 11/15/2022]
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12
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Calvo V, Ruano-Ravina A, Carcereny E, Moran T, Rodríguez-Abreu D, López-Castro R, Cuadrado-Albite E, Guirado M, Gomez-Gonzalez L, Massuti B, Granados AO, Blasco A, Dols MC, Mosquera J, Hernandez-Martinez A, Trigo J, Juan O, De La Rosa CA, Gómez MD, Sala M, Oramas J, Ojea CG, Cerezo S, Provencio M. P52.05 Lung Cancer Symptoms at Diagnosis: Data from the Thoracic Tumors Registry (TTR Study). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.918] [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]
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13
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Gonzalez-Cao M, Morán T, Dalmau J, Garcia-Corbacho J, Bracht JWP, Bernabe R, Juan O, de Castro J, Blanco R, Drozdowskyj A, Argilaguet J, Meyerhans A, Blanco J, Prado JG, Carrillo J, Clotet B, Massuti B, Provencio M, Molina-Vila MA, Mayo de Las Casa C, Garzon M, Cao P, Huang CY, Martinez-Picado J, Rosell R. Assessment of the Feasibility and Safety of Durvalumab for Treatment of Solid Tumors in Patients With HIV-1 Infection: The Phase 2 DURVAST Study. JAMA Oncol 2021; 6:1063-1067. [PMID: 32271353 DOI: 10.1001/jamaoncol.2020.0465] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Therapies targeting the programmed cell death 1 (PD-1) receptor or its ligand (PD-L1), such as the humanized monoclonal antibody durvalumab, have shown durable clinical responses in several tumor types. However, concerns about the safety and feasibility of PD-1/PD-L1 blockade in HIV-1-infected individuals have led to the exclusion of these patients from clinical trials on cancer immunotherapies. Objective To evaluate the feasibility and safety of durvalumab treatment in patients with advanced cancer and virologically controlled HIV-1 infection. Design, Setting, and Participants The DURVAST study was a nonrandomized, open-label, phase 2 clinical trial in patients with any solid tumor type in which anti-PD-1 or anti-PD-L1 antibodies have approved indications or for which there are data of antitumoral activity with no other available curative therapy. All patients had basal undetectable plasma viremia while undergoing combination antiretroviral therapy. Interventions Treatment consisted of intravenous infusion of durvalumab (1500 mg every 4 weeks) until disease progression or unacceptable toxic effects. Main Outcomes and Measures Adverse events were graded with the use of the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03. Tumor response was evaluated using the Response Evaluation Criteria in Solid Tumors version 1.1. Results A total of 20 HIV-1-infected patients with advanced cancer were enrolled; 16 (80%) were male, the median (range) age was 54 (30-73) years, and 12 (60%) had progressed with previous cancer treatment lines. A median (range) of 4 (1-16) cycles of durvalumab were administered. Drug-related adverse events were observed in 50% of patients, and all were grade 1 and 2 (mainly diarrhea, asthenia, and arthromyalgia). Four of 16 response-evaluable patients (25%) had a partial response. Five patients (31%) had stable disease, including 4 with durable stable disease (disease control rate of 50%). CD4+ and CD8+ T-cell counts and plasma HIV-1 viremia remained stable throughout the study. Conclusions and Relevance Durvalumab treatment was feasible and safe in HIV-1-infected patients with cancer receiving combination antiretroviral therapy. HIV-1-infected patients on suppressive antiretroviral therapy with advanced cancer should have access to cancer immunotherapy treatments. Trial Registration ClinicalTrials.gov Identifier: NCT03094286.
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Affiliation(s)
- Maria Gonzalez-Cao
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Teresa Morán
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Germans Trias i Pujol Hospital, Badalona, Spain
| | - Judith Dalmau
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Jillian W P Bracht
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Reyes Bernabe
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Oscar Juan
- Hospital Universitario la Fe de Valencia, Valencia, Spain
| | | | | | - Ana Drozdowskyj
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Jordi Argilaguet
- Infection Biology Laboratory, University Pompeu Fabra, Barcelona, Spain
| | - Andreas Meyerhans
- Infection Biology Laboratory, University Pompeu Fabra, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Julia Blanco
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain.,Germans Trias i Pujol Research Institute and Hospital (IGTP), Badalona, Spain
| | - Julia G Prado
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Germans Trias i Pujol Research Institute and Hospital (IGTP), Badalona, Spain
| | - Jorge Carrillo
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | | | | | - Miguel A Molina-Vila
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Clara Mayo de Las Casa
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Monica Garzon
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Peng Cao
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Department of Pharmacology, School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | | | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Germans Trias i Pujol Research Institute and Hospital (IGTP), Badalona, Spain
| | - Rafael Rosell
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain.,Germans Trias i Pujol Research Institute and Hospital (IGTP), Badalona, Spain
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14
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Mielgo-Rubio X, Garde-Noguera J, Juan O, Couñago F. Stereotactic body radiation therapy: A good dance partner of oligometastatic non-small cell lung cancer to the sound of SINDAS study. World J Clin Oncol 2020; 11:983-989. [PMID: 33437660 PMCID: PMC7769713 DOI: 10.5306/wjco.v11.i12.983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
The European Organization for Research on Treatment of Cancer Research published a consensus statement to establish the key criteria to define oligometastatic disease (OMD). According to those criteria, all lesions (both primary and metastatic) should be amenable to radical intent treatment with acceptable toxicity. Several retrospective studies have shown that adding local ablative therapy to the treatment of OMD improves outcomes; however, due to the diverse selection criteria and treatment strategies used in those studies, it is difficult to compare directly results to draw definitive conclusions. In recent years, prospective phase II trials, such as the SABR-COMET and "Oligomez" trials, have shown that stereotactic body radiation therapy (SBRT) improves outcomes in patients with OMD. More recently, interim results of the randomised phase 3 SINDAS trial were reported at the annual meeting of the American Society of Clinical Oncology 2020 demonstrating that upfront SBRT added to systemic treatment with tyrosine kinase inhibitors yielded a significant benefit in both progression-free survival and overall survival in patients with epidermal growth factor receptor-mutant oligometastatic non-small cell lung cancer. In the present editorial, we review the definition and historical context of advanced non-small cell lung cancer with OMD. In addition, we review the scientific evidence for local ablative therapy and SBRT and discuss the results of recently published prospective studies. We also discuss in depth the results of the SINDAS study, including the strengths and weaknesses of the study and the barriers to extrapolating these results to routine clinical practice.
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Affiliation(s)
- Xabier Mielgo-Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
| | - Javier Garde-Noguera
- Department of Medical Oncology, Hospital Arnau de Vilanova, C/Sant Climent, Valencia 46015, Spain
| | - Oscar Juan
- Department of Medical Oncology, La Fe University Hospital, Valencia 46026, Comunitat Valenciana, Spain
- School of Medicine, Catholic University San Vicente Martir, Valencia 46001, Comunitat Valenciana, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28028, Spain
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15
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Pulido I, Ollosi S, Aparisi S, Becker JH, Aliena-Valero A, Benet M, Rodríguez ML, López A, Tamayo-Torres E, Chuliá-Peris L, García-Cañaveras JC, Soucheray M, Dalheim AV, Salom JB, Qiu W, Kaja S, Fernández-Coronado JA, Alandes S, Alcácer J, Al-Shahrour F, Borgia JA, Juan O, Nishimura MI, Lahoz A, Carretero J, Shimamura T. Endothelin-1-Mediated Drug Resistance in EGFR-Mutant Non-Small Cell Lung Carcinoma. Cancer Res 2020; 80:4224-4232. [PMID: 32747363 PMCID: PMC7541638 DOI: 10.1158/0008-5472.can-20-0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/25/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022]
Abstract
Progression on therapy in non-small cell lung carcinoma (NSCLC) is often evaluated radiographically, however, image-based evaluation of said therapies may not distinguish disease progression due to intrinsic tumor drug resistance or inefficient tumor penetration of the drugs. Here we report that the inhibition of mutated EGFR promotes the secretion of a potent vasoconstrictor, endothelin-1 (EDN1), which continues to increase as the cells become resistant with a mesenchymal phenotype. As EDN1 and its receptor (EDNR) is linked to cancer progression, EDNR-antagonists have been evaluated in several clinical trials with disappointing results. These trials were based on a hypothesis that the EDN1-EDNR axis activates the MAPK-ERK signaling pathway that is vital to the cancer cell survival; the trials were not designed to evaluate the impact of tumor-derived EDN1 in modifying tumor microenvironment or contributing to drug resistance. Ectopic overexpression of EDN1 in cells with mutated EGFR resulted in poor drug delivery and retarded growth in vivo but not in vitro. Intratumoral injection of recombinant EDN significantly reduced blood flow and subsequent gefitinib accumulation in xenografted EGFR-mutant tumors. Furthermore, depletion of EDN1 or the use of endothelin receptor inhibitors bosentan and ambrisentan improved drug penetration into tumors and restored blood flow in tumor-associated vasculature. Correlatively, these results describe a simplistic endogenous yet previously unrealized resistance mechanism inherent to a subset of EGFR-mutant NSCLC to attenuate tyrosine kinase inhibitor delivery to the tumors by limiting drug-carrying blood flow and the drug concentration in tumors. SIGNIFICANCE: EDNR antagonists can be repurposed to improve drug delivery in VEGFA-secreting tumors, which normally respond to TKI treatment by secreting EDN1, promoting vasoconstriction, and limiting blood and drug delivery.
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Affiliation(s)
- Inés Pulido
- Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois
- University of Illinois Hospital & Health Sciences System Cancer Center, University of Illinois at Chicago, Chicago, Illinois
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain
| | - Stephen Ollosi
- Biochemistry and Molecular Biology Program, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Salvador Aparisi
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain
| | - Jeffrey H Becker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois
- University of Illinois Hospital & Health Sciences System Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| | - Alicia Aliena-Valero
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Marta Benet
- Biomarkers and Precision Medicine Unit and Analytic Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - María L Rodríguez
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain
| | - Adrián López
- Biomarkers and Precision Medicine Unit and Analytic Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Eva Tamayo-Torres
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain
| | - Lourdes Chuliá-Peris
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain
| | - Juan Carlos García-Cañaveras
- Biomarkers and Precision Medicine Unit and Analytic Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Margaret Soucheray
- Department of Molecular Pharmacology and Neuroscience, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Annika V Dalheim
- Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Juan B Salom
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain
- Unidad Mixta de Investigación Cerebrovascular, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Wei Qiu
- Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Simon Kaja
- Department of Molecular Pharmacology and Neuroscience, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
- Department of Ophthalmology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | | | - Sandra Alandes
- Department of Pathology, Hospital Quirónsalud, Valencia, Spain
| | - Javier Alcácer
- Department of Pathology, Hospital Quirónsalud, Valencia, Spain
| | - Fátima Al-Shahrour
- Bioinformatics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Jeffrey A Borgia
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Oscar Juan
- Biomarkers and Precision Medicine Unit and Analytic Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Michael I Nishimura
- Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Agustín Lahoz
- Biomarkers and Precision Medicine Unit and Analytic Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Julián Carretero
- Departament de Fisiologia, Facultat de Farmàcia, Universitat de València, Burjassot, Spain.
| | - Takeshi Shimamura
- Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois.
- University of Illinois Hospital & Health Sciences System Cancer Center, University of Illinois at Chicago, Chicago, Illinois
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Bracht JW, Gonzalez-Cao M, Moran T, Dalmau J, Garcia-Corbacho J, Bernabe R, Juan O, de Castro J, Gimenez-Capitan A, Blanco R, Aldeguer E, Rodriguez S, Drozdowskyj A, Argilaguet J, Blanco J, Prado J, Brander C, Carrillo J, Clotet B, Massuti B, Provencio M, Huang CY, Mayo de las Casas C, Garzon M, Cardona AF, Arrieta O, Meyerhans A, Molina-Vila MA, Martinez-Picado J, Rosell R. Abstract 929: Transcriptomic analysis of pre-treatment tissue samples to predict clinical benefit to durvalumab in HIV-infected cancer patients. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-929] [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
Introduction: Treatment with anti PD-1/PD-L1 antibodies has demonstrated clinical activity in different types of solid tumors, but only 20 to 30% of patients (pts) respond to these immune checkpoint inhibitors (ICIs). Therefore, predictive biomarkers of response that can assist in pt selection are urgently needed. Single biomarker expression, like PD-L1, may not provide enough information about cancer cells and the tumor microenviroment. Novel technologies, analyzing hundreds of genes at the same time, are needed to yield better predictive gene signatures of ICI response. The DURVAST trial analyzed the feasibility of durvalumab treatment in HIV-infected cancer pts, which are usually excluded from ICI clinical trials. The trial included 20 patients with different tumor types and yielded a disease control rate of 56%.
Methods: Pre-ICI-treatment FFPE tumor tissue samples from 14 HIV-infected cancer pts (including 11 lung, 1 melanoma, 1 anal and 1 bladder cancer) were analyzed using the nCounter NanoString platform with the IO360 panel, including 770 genes involved in tumor biology, microenvironment and immune response. Gene expression results were correlated with clinical benefit (CB) (objective response and stable disease of more than 24 weeks by RECIST1.1 criteria), and compared to other predictive markers.
Results: Exploratory analysis of pre-treatment gene expression profiles (GEPs) revealed differentially expressed genes (DEGs) between the pts with- and without CB. Panel-incorporated biological signatures related to tumor and immune activities were evaluated and some of the most DEGs (based on higher log2FC values and nominal p-values ≤0.05) were shown to be involved in cytokine and chemokine signaling. Although not significant, pts without CB tend to have lower expression of genes involved in cytokine and chemokine signaling (p = 0.097). In contrast, pts without CB tended to have a higher TGF beta signature scores (p = 0.318). When combining both signatures, we obtained an aggregated signature score that was significantly different between pts with- and without CB (p = 0.017). While the positive predictive values were the same for all tests, our signature score outperformed PD-L1 expression positivity by immunohistochemistry and PD-L1 RNA expression as predictors for clinical benefit with a two-fold higher sensitivity and negative predictive value.
Conclusion: Gene expression analysis of pre-treatment tumor samples revealed distinct GEPs between HIV-infected cancer pts with- and without CB, where combined high baseline recruitment and activation of immune cells by cytokine and chemokine signaling pathways and low immunosuppressive TGF beta signaling pathways predict CB from durvalumab treatment. This predictive score outperformed other predictive markers of CB. These findings need further validation in an external and non-HIV infected pt cohort, in addition to a pt cohort treated with other ICIs.
Citation Format: Jillian Wilhelmina Bracht, Maria Gonzalez-Cao, Teresa Moran, Judith Dalmau, Javier Garcia-Corbacho, Reyes Bernabe, Oscar Juan, Javier de Castro, Ana Gimenez-Capitan, Remedios Blanco, Erika Aldeguer, Sonia Rodriguez, Ana Drozdowskyj, Jordi Argilaguet, Julian Blanco, Julia Prado, Christian Brander, Jorge Carrillo, Bonaventura Clotet, Bartomeu Massuti, Mariano Provencio, Chung-Ying Huang, Clara Mayo de las Casas, Monica Garzon, Andres Felipe Cardona, Oscar Arrieta, Andreas Meyerhans, Miguel Angel Molina-Vila, Javier Martinez-Picado, Rafael Rosell. Transcriptomic analysis of pre-treatment tissue samples to predict clinical benefit to durvalumab in HIV-infected cancer patients [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 929.
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Affiliation(s)
| | | | - Teresa Moran
- 3Germans Trias i Pujol Hospital (IGTP), Badalona, Spain
| | | | | | | | - Oscar Juan
- 7Hospital Universitario la Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rafael Rosell
- 3Germans Trias i Pujol Hospital (IGTP), Badalona, Spain
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Moran T, Taus A, Arriola E, Aguado C, Dómine M, Rueda AG, Calles A, Cedrés S, Viñolas N, Isla D, Palmero R, Sereno M, Diaz V, Juan O, Marsé R, Martorell PM, Sánchez Torres JM. Clinical Activity of Afatinib in Patients With Non-Small-Cell Lung Cancer Harboring Uncommon EGFR Mutations: A Spanish Retrospective Multicenter Study. Clin Lung Cancer 2020; 21:428-436.e2. [PMID: 32461037 DOI: 10.1016/j.cllc.2020.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/12/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Uncommon epidermal growth factor receptor (EGFR) mutations (u-EGFRm) are a heterogeneous group of molecular alterations and have also been reported as comutations with other EGFR mutations (complex mutations) in non-small-cell lung cancer (NSCLC). Afatinib has shown activity against some u-EGFRm, and we examined its efficacy in Spanish clinical practice. PATIENTS AND METHODS Data of 67 patients with advanced NSCLC with u-EGFRm treated with afatinib between 2012 and 2017 at 23 Spanish institutions were reviewed. u-EGFRm were analyzed as complex mutations (group A), EGFR exon 20 insertions (ins20; group B), or single mutations (group C). Efficacy was evaluated in terms of overall survival (OS) and tumor response. RESULTS Group A complex u-EGFRm consisted of double mutations of G719X+E709F, G719X+S768I, G719X+L861Q, L858R+T790M, L858R+S768I, L858R+S765I, del19+S768I, del19+L747S, or R776C+L861Q. No differences in clinical characteristics were found between groups A (n = 20), B (n = 23), and C (n = 24). Afatinib was administered as first-line therapy in 80% of patients. Median time of receipt of therapy was 4.2 months (range, 2.0-12.9 months). Median OS for the entire cohort was 19.9 months (95% confidence interval, 9.7, 30.1). Hazard ratios for OS were 0.26 (95% confidence interval, 0.10, 0.71; P = .008) and 0.40 (95% confidence interval, 0.17, 0.95; P = .037) for groups A and C compared to B, respectively. Response was significantly higher in groups A (70%) and C (54%) compared to B (13%; pairwise comparison P < .001 and .008, respectively). CONCLUSION In clinical practice, afatinib was active in patients with u-EGFRm NSCLC, particularly in complex and single mutations. Further strategies are needed for patients with ins20, a subgroup u-EGFRm with a lower clinical benefit with afatinib.
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Affiliation(s)
- Teresa Moran
- Medical Oncology Department, Catalan Institute of Oncology and Applied Research Group in Oncology (B-ARGO), Badalona, Spain; Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona (UAB), Badalona, Spain.
| | - Alvaro Taus
- Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain; Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Edurne Arriola
- Medical Oncology Department, Hospital del Mar-CIBERONC, Barcelona, Spain; Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carlos Aguado
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Dómine
- Medical Oncology Department, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | - Ana Gómez Rueda
- Medical Oncology Department, IRYCIS, Ramón y Cajal University Hospital, Madrid, Spain
| | - Antonio Calles
- Early Drug Development and Phase I Unit, Medical Oncology Department, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Susana Cedrés
- Medical Oncology Department, Vall d'Hebron Hospital and Institute of Oncology, Barcelona, Spain
| | - Nuria Viñolas
- Medical Oncology Department, Hospital Clinic i Provincial, Barcelona, Spain
| | - Dolores Isla
- Medical Oncology Department, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Ramón Palmero
- Medical Oncology Department, ICO-Duran i Reynalds, L'Hospitalet de Llobregat, Spain
| | - María Sereno
- Medical Oncology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain
| | - Victor Diaz
- Medical Oncology Department, Hospital Sureste, Madrid, Spain
| | - Oscar Juan
- Medical Oncology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Raquel Marsé
- Medical Oncology Department, Son Espases, Palma de Mallorca, Spain
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Garrido P, Campelo RG, Majem M, Carcereny E, Isla D, Larriba JG, Coves J, De Castro Carpeno J, Domine M, Lianes P, Juan O, Terrassa J, Provencio M, Blasco A, Garcia J, De Las Peñas RG, Artal A, Remon J, Catot S, Felip E, Viñolas N. MA22.05 Assessment of Gender Differences in the Psychosocial and Economic Impact on Patients with Stage IV Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.685] [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: 10/25/2022]
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19
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Paz-Ares Rodríguez L, Spigel D, Chen Y, Jove M, Juan O, Rich P, Hayes T, Calderón VG, Bernabe R, Navarro A, Dowlati A, Zhang B, Moore Y, Wang T, Nazarenko N, Ponce S, Bunn P. OA03.03 Initial Efficacy and Safety Results of Irinotecan Liposome Injection (nal-IRI) in Patients with Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.419] [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: 11/27/2022]
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20
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Nadal E, Castro RL, Juan O, Huidobro G, De Castro Carpeno J, Sullivan I, Bosch-Barrera J, Campelo RG, Estival A, Blasco A, Felip E, Massuti B, Guirado M, Rodriguez-Abreu D, Domine M, Simo M, Navarro V, Bruna J. P1.01-111 ATEZO-BRAIN, A Single-Arm Phase II Study of Atezolizumab Combined with Chemotherapy in Stage IV NSCLC Patients with Untreated Brain Metastases. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.826] [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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21
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Angelats L, Campelo RG, Bernabe R, Arriola E, Rocha P, De Juan VC, Sais E, Barba A, Viñolas N, Moreno MG, Vilà L, Juan O, Vilariño N, Cobo M, Domine M, Vazquez S, Coves J, Marse-Fabregat R, Gomez AE, Carcereny E. P1.01-93 Metastases Sites as a Prognostic Factor in a Real-World Multicenter Cohort Study of Spanish ALK-Positive NSCLC Patients (p). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.808] [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: 10/25/2022]
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22
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De Castro Carpeno J, Felip E, Juan O, Campelo RG, Aguiar D, Terrassa J, Castro RL, Blanco AC, Paredes A, Bernabe R, Barneto I, Campillo J, García-Palacios L, Rojo F. P2.01-10 Real Clinical Practice Study to Evaluate 2 Line Treatment Based on Comprenhensive Genomic Profiling in NSCLC. LungONE Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1354] [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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23
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Becker JH, Gao Y, Soucheray M, Pulido I, Kikuchi E, Rodríguez ML, Gandhi R, Lafuente-Sanchis A, Aupí M, Alcácer Fernández-Coronado J, Martín-Martorell P, Cremades A, Galbis-Caravajal JM, Alcácer J, Christensen CL, Simms P, Hess A, Asahina H, Kahle MP, Al-Shahrour F, Borgia JA, Lahoz A, Insa A, Juan O, Jänne PA, Wong KK, Carretero J, Shimamura T. CXCR7 Reactivates ERK Signaling to Promote Resistance to EGFR Kinase Inhibitors in NSCLC. Cancer Res 2019; 79:4439-4452. [PMID: 31273063 DOI: 10.1158/0008-5472.can-19-0024] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/10/2019] [Accepted: 06/27/2019] [Indexed: 12/16/2022]
Abstract
Although EGFR mutant-selective tyrosine kinase inhibitors (TKI) are clinically effective, acquired resistance can occur by reactivating ERK. We show using in vitro models of acquired EGFR TKI resistance with a mesenchymal phenotype that CXCR7, an atypical G protein-coupled receptor, activates the MAPK-ERK pathway via β-arrestin. Depletion of CXCR7 inhibited the MAPK pathway, significantly attenuated EGFR TKI resistance, and resulted in mesenchymal-to-epithelial transition. CXCR7 overexpression was essential in reactivation of ERK1/2 for the generation of EGFR TKI-resistant persister cells. Many patients with non-small cell lung cancer (NSCLC) harboring an EGFR kinase domain mutation, who progressed on EGFR inhibitors, demonstrated increased CXCR7 expression. These data suggest that CXCR7 inhibition could considerably delay and prevent the emergence of acquired EGFR TKI resistance in EGFR-mutant NSCLC. SIGNIFICANCE: Increased expression of the chemokine receptor CXCR7 constitutes a mechanism of resistance to EGFR TKI in patients with non-small cell lung cancer through reactivation of ERK signaling.
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Affiliation(s)
- Jeffrey H Becker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois.,University of Illinois Hospital & Health Sciences System Cancer Center, University of Illinois at Chicago, Chicago, Illinois.,Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Yandi Gao
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Margaret Soucheray
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Ines Pulido
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain
| | - Eiki Kikuchi
- First department of Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - María L Rodríguez
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain
| | - Rutu Gandhi
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | | | - Miguel Aupí
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain
| | | | | | - Antonio Cremades
- Department of Pathology, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - José M Galbis-Caravajal
- Department of Thoracic Surgery, Hospital Universitario de la Ribera, Alzira, Valencia, Spain
| | - Javier Alcácer
- Department of Pathology, Hospital Quirónsalud Valencia, Valencia, Spain
| | - Camilla L Christensen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts.,Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Ludwig Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patricia Simms
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Ashley Hess
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Hajime Asahina
- First department of Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Michael P Kahle
- Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Fatima Al-Shahrour
- Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Jeffrey A Borgia
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Agustín Lahoz
- Biomarkers and Precision Medicine Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Amelia Insa
- Department of Medical Oncology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Oscar Juan
- Biomarkers and Precision Medicine Unit, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Department of Medical Oncology, Hospital Universitari I Politècnic La Fe, Valencia, Spain
| | - Pasi A Jänne
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, Massachusetts.,Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Bioinformatics Unit, Spanish National Cancer Research Centre, Madrid, Spain
| | - Kwok-Kin Wong
- Laura and Isaac Perlmutter Cancer Center, Division of Hematology and Medical Oncology, New York University, New York, New York
| | - Julian Carretero
- Departament de Fisiologia, Facultat de Farmacia, Universitat de València, Burjassot, Spain.
| | - Takeshi Shimamura
- Department of Surgery, Division of Cardiothoracic Surgery, University of Illinois at Chicago, Chicago, Illinois. .,University of Illinois Hospital & Health Sciences System Cancer Center, University of Illinois at Chicago, Chicago, Illinois.,Department of Molecular Pharmacology and Therapeutics, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
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24
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González-Cao M, Moran T, Dalmau J, Garcia-Corbacho J, Bernabé R, Juan O, De Castro J, Blanco R, Meyerhans A, Blanco J, Karachaliou N, Brander C, Garcia-Prado J, Carrillo J, Provencio M, Molina Vila MA, Massuti B, Clotet B, Martinez-Picado J, Rosell R. Phase II study of durvalumab (MEDI4736) in cancer patients HIV-1-infected. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2501] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2501 Background: Durvalumab (MEDI4736), a programmed cell death-ligand 1 (PD-L1) blocking antibody, is currently approved for treatment of several cancer types. As HIV-1-infected (HIV+) patients have been excluded from cancer clinical trials, there are no data on the safety of durvalumab in this population. Methods: DURVAST (NCT03094286) is a multicenter, open-label, phase 2 clinical trial evaluating the safety and feasibility of durvalumab treatment at the recommended dose of 1500 mg Q4W in HIV+ cancer patients with solid tumors. Secondary endpoints include analyses of antitumoral activity in terms of objective response rate and duration of response (DOR). An associated translational sub-study includes the assessment of antiviral activity and the interaction of chronic viral infection with anti-cancer response and drug tolerance. Results: Twenty HIV+ individuals with advanced solid tumors were enrolled (Table). All participants maintained their standard-of-care antiretroviral therapy. Basal plasma viremia was undetectable and CD4+ T-cell count was over 200/mm3. There were no durvalumab-related serious adverse events. Only 8 patients (40%) presented drug-related adverse events (all grade 1-2) including diarrhea (15%), rash (15%), nausea (15%) and asthenia (10%). Best response includes: partial response in 5 (25%) (4 NSCLC and 1 anal cancer), stable disease in 4 (20%) (3 NSCLC and 1 melanoma) and progression disease in 11 (55%) patients. At data cut-off, 8 patients (40%) remained on therapy for a median of 10.5 months (range: 6-19 m). Median DOR has not been reached (range 1m to 19 m+). Plasma viremia remained suppressed during the study suggesting no viral reactivation upon durvalumab treatment. Conclusions: DURVAST study demonstrates durvalumab safety in HIV+ cancer patients and suggests an excellent tolerance profile. Understanding how chronic viral infection could contribute to a better tolerance towards immune checkpoint inhibitors will open a new way for the development of safer anti-cancer immunotherapy strategies. Clinical trial information: NCT03094286. [Table: see text]
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Affiliation(s)
| | - Teresa Moran
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | - Oscar Juan
- Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Javier De Castro
- Translational Oncology Unit at Medical Oncology Division, Hospital Universitario La Paz, IdipAZ, Madrid, Spain
| | | | - Andreas Meyerhans
- Infection Biology Laboratory, University Pompeu Fabra, Barcelona, Spain
| | - Julia Blanco
- AIDS Research Institute, IrsiCaixa, Badalona, Spain, Barcelona, Spain
| | - Niki Karachaliou
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | | | | | | | - Mariano Provencio
- Medical Oncology Service. Hospital Universitario Puerta de Hierro, Madrid, Spain, Madrid, Spain
| | | | | | | | | | - Rafael Rosell
- Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain and Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain and Institute of Oncology Rosell (IOR), University Hospital Sagrat Cor, Badalona, Barcelona, Spain
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Ponce S, Bruna J, Juan O, López R, Navarro A, Ortega AL, Puente J, Verger E, Bartolomé A, Nadal E. Multidisciplinary expert opinion on the treatment consensus for patients with EGFR mutated NSCLC with brain metastases. Crit Rev Oncol Hematol 2019; 138:190-206. [PMID: 31092376 DOI: 10.1016/j.critrevonc.2019.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/09/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022] Open
Abstract
The presence of an epidermal growth factor receptor (EGFR) mutation is associated with higher incidence of brain metastases in patients with non-small cell lung cancer (NSCLC); however, patients with synchronous brain metastases at diagnosis have generally been excluded from clinical trials. As there is limited clinical evidence for managing this patient population, a multidisciplinary group of Spanish medical and radiation oncologists, and neuro-oncologist with expertise treating brain metastases in lung cancer patients met with the aim of reaching and developing an expert opinion consensus on the management of patients with EGFR mutated NSCLC with brain metastases. This consensus contains 26 recommendations and 20 conclusion statements across 21 questions in 7 areas, as well as a first-line treatment algorithm.
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Affiliation(s)
- Santiago Ponce
- Lung Cancer Clinical Research Unit, Hospital Universitario 12 de Octubre, Av. Cordoba, s/n, 28041 Madrid, Spain.
| | - Jordi Bruna
- Neuro-Oncology Unit, Bellvitge University Hospital-ICO, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; Clinical Research in Solid Tumors (CReST) and Neuro-Oncology Group. Oncobell, IDIBELL, Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Oscar Juan
- Medical Oncology Service, Hospital Universitario y Politécnico La Fe, Valencia, Avda. de Fernando Abril Martorell, nº 106, 46026, Valencia, Spain.
| | - Rafael López
- Medical Oncology Unit. Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.
| | - Alejandro Navarro
- Medical Oncology. Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Ana Laura Ortega
- Oncology Research Unit, Complejo Hospitalario de Jaén, Av. del Ejército Español, 10, 23007, Jaén, Spain.
| | - Javier Puente
- GU, Thoracic and Melanoma Cancer Unit, Medical Oncology Department, Assistant Professor of Medicine, Complutense University. Hospital Clinico Universitario San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Eugènia Verger
- Radiation Oncology Department, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - Adela Bartolomé
- Radiotherapy Oncology Department. Hospital Universitario 12 de Octubre, Av. Cordoba, s/n, 28041, Madrid, Spain.
| | - Ernest Nadal
- Clinical Research in Solid Tumors (CReST) and Neuro-Oncology Group. Oncobell, IDIBELL, Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology. Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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Majem M, Juan O, Insa A, Reguart N, Trigo JM, Carcereny E, García-Campelo R, García Y, Guirado M, Provencio M. SEOM clinical guidelines for the treatment of non-small cell lung cancer (2018). Clin Transl Oncol 2019; 21:3-17. [PMID: 30446985 PMCID: PMC6339680 DOI: 10.1007/s12094-018-1978-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
Abstract
Non-small cell lung cancer (NSCLC) accounts for up to 85% of all lung cancers. The last few years have seen the development of a new staging system, diagnostic procedures such as liquid biopsy, treatments like immunotherapy, as well as deeper molecular knowledge; so, more options can be offered to patients with driver mutations. Groups with specific treatments account for around 25% and demonstrate significant increases in overall survival, and in some subgroups, it is important to evaluate each treatment alternative in accordance with scientific evidence, and even more so with immunotherapy. New treatments similarly mean that we must reconsider what should be done in oligometastatic disease where local treatment attains greater value.
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Affiliation(s)
- M. Majem
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain
| | - O. Juan
- Medical Oncology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - A. Insa
- Medical Oncology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - N. Reguart
- Medical Oncology Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J. M. Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - E. Carcereny
- Medical Oncology Department, Institut Català d’Oncologia Badalona-Hospital Germans Trias i Pujol, Badalona, Spain
| | - R. García-Campelo
- Medical Oncology Department, Complexo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Y. García
- Medical Oncology Department, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - M. Guirado
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
| | - M. Provencio
- Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
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Alcoriza-Balaguer MI, García-Cañaveras JC, López A, Conde I, Juan O, Carretero J, Lahoz A. LipidMS: An R Package for Lipid Annotation in Untargeted Liquid Chromatography-Data Independent Acquisition-Mass Spectrometry Lipidomics. Anal Chem 2018; 91:836-845. [PMID: 30500173 DOI: 10.1021/acs.analchem.8b03409] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
High resolution LC-MS untargeted lipidomics using data independent acquisition (DIA) has the potential to increase lipidome coverage, as it enables the continuous and unbiased acquisition of all eluting ions. However, the loss of the link between the precursor and the product ions combined with the high dimensionality of DIA data sets hinder accurate feature annotation. Here, we present LipidMS, an R package aimed to confidently identify lipid species in untargeted LC-DIA-MS. To this end, LipidMS combines a coelution score, which links precursor and fragment ions with fragmentation and intensity rules. Depending on the MS evidence reached by the identification function survey, LipidMS provides three levels of structural annotations: (i) "subclass level", e.g., PG(34:1); (ii) "fatty acyl level", e.g., PG(16:0_18:1); and (iii) "fatty acyl position level", e.g., PG(16:0/18:1). The comparison of LipidMS with freely available data dependent acquisition (DDA) and DIA identification tools showed that LipidMS provides significantly more accurate and structural informative lipid identifications. Finally, to exemplify the utility of LipidMS, we investigated the lipidomic serum profile of patients diagnosed with nonalcoholic steatohepatitis (NASH), which is the progressive form of nonalcoholic fatty liver disease, a disorder underlying a strong lipid dysregulation. As previously published, a significant decrease in lysophosphatidylcholines, phosphatidylcholines and cholesterol esters and an increase in phosphatidylethanolamines were observed in NASH patients. Remarkably, LipidMS allowed the identification of a new set of lipids that may be used for NASH diagnosis. Altogether, LipidMS has been validated as a tool to assist lipid identification in the LC-DIA-MS untargeted analysis of complex biological samples.
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Affiliation(s)
- María Isabel Alcoriza-Balaguer
- Biomarkers and Precision Medicine Unit and Analytical Unit , Instituto de Investigación Sanitaria Fundación Hospital La Fe , Valencia 46026 , Spain
| | - Juan Carlos García-Cañaveras
- Biomarkers and Precision Medicine Unit and Analytical Unit , Instituto de Investigación Sanitaria Fundación Hospital La Fe , Valencia 46026 , Spain
| | - Adrián López
- Biomarkers and Precision Medicine Unit and Analytical Unit , Instituto de Investigación Sanitaria Fundación Hospital La Fe , Valencia 46026 , Spain
| | | | - Oscar Juan
- Biomarkers and Precision Medicine Unit and Analytical Unit , Instituto de Investigación Sanitaria Fundación Hospital La Fe , Valencia 46026 , Spain
| | - Julián Carretero
- Department of Physiology , University of Valencia , Burjassot 4100 , Spain
| | - Agustín Lahoz
- Biomarkers and Precision Medicine Unit and Analytical Unit , Instituto de Investigación Sanitaria Fundación Hospital La Fe , Valencia 46026 , Spain
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Melian M, Lorente D, Aparici F, Juan O. Lung brain metastasis pseudoprogression after nivolumab and ipilimumab combination treatment. Thorac Cancer 2018; 9:1770-1773. [PMID: 30276979 PMCID: PMC6275812 DOI: 10.1111/1759-7714.12873] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022] Open
Abstract
Immunotherapy has revolutionized the treatment of non-small cell lung cancer; however, its role in the treatment response of lung brain metastasis is unknown. Understanding immunotherapy activity in the central nervous system is important in order to avoid additional toxicity, such as that associated with the use of cerebral radiotherapy. We present two cases with clinical and radiological progression with increases in size and perilesional edema of brain lesions after treatment with a combination of ipilimumab and nivolumab. The increasing use of immunotherapy in lung cancer requires increased knowledge of new patterns of radiological response, such as pseudoprogression.
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Affiliation(s)
- Marcos Melian
- Department of Medical OncologyHospital Universitari i Politecnic La FeValenciaSpain
| | - David Lorente
- Department of Medical OncologyHospital Universitari i Politecnic La FeValenciaSpain
| | | | - Oscar Juan
- Department of Medical OncologyHospital Universitari i Politecnic La FeValenciaSpain
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Pulido I, Becker J, Aupi M, Cañaveras JCG, Alcacer J, Rodríguez M, Martín P, Perales J, Aparisi S, Chulia L, Lafuente A, Alcoriza M, Mena S, Pereda J, Galbis-Carabajal J, Insa A, Juan O, Al-Shahrour F, Pino MSD, Lahoz A, Shimamura T, Carretero J. Abstract LB-099: Metabolic vulnerabilities of mesenchymal-like EGFR-mutant NSCLC cells with acquired resistance to tyrosine kinase inhibitors. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-099] [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
Despite the availability of the effective targeted therapies in lung cancer, such as EGFR tyrosine kinase inhibitors (TKIs), drug tolerance and acquired resistance are two common problems that negatively impact lung cancer patient survival. Consequently it is important to understand the molecular basis of the drug tolerance and resistance so that we could formulate effective strategies to ameliorate the efficacy of existing drug and to suppress the emergence of drug resistance. A burgeoning body of literature demonstrated that epigenetic changes by the methylation of DNA and histones are critical in acquired drug resistance, especially in those cancer cells with stem cell-like properties and epithelial to mesenchymal (EMT)-like features. EMT involves multiple and complex changes in the epigenome and therefore in the transcriptome, the proteome and the metabolome. However, in the context of NSCLC, there are no comprehensive studies linking epigenomic and metabolic reprogramming during EMT and the acquisition of drug resistance.
One-carbon metabolic pathway is composed of the folate and methionine cycle, generating S-adenosylmethionine (SAM), which is the universal methyl donor for methylation reactions, including histone and DNA methylation. Interestingly, it has been demonstrated that the overexpression of specific methyl-transferases, such as NNMT, which catalyzes the transfer of the methyl group from SAM to nicotinamide, can impact the methylation potential of cancer cells, draining methyl groups from the methionine cycle and thereby decreasing protein and DNA methylation. Strikingly, NNMT depletion has been shown to restore methylation potential and attenuate the aggressive nature of several cancer cell lines with NNMT overexpression. However, its contribution to lung cancer progression and the drug resistance is still unknown.
In this work we have discovered that NNMT is a poor prognosis factor and is significantly correlated with mesenchymal-like phenotypes in publicly available NSCLC clinical databases. We have generated multiple EGFR-TKI acquired resistant NSCLC models with EMT phenotype and utilized a multi-omic approach on the clinically-relevant resistant cell lines to identified that NNMT overexpression affects the nicotinamide pathway leading to deficient nicotinamide adenine dinucleotide (NAD) synthesis. This new cancer vulnerability of TKI-resistant, mesenchymal-like NSCLC cells is druggable using NAD depleting agents such as daporinad, a NAMPT inhibitor in phase II clinical trials for the treatment of B-cell chronic lymphocytic leukemia, cutaneous T-cell lymphoma and melanoma. Additionally, the quantitative measurement of the metabolite signature of the nicotinamide pathway in liquid biopsies may correlate with poor prognosis of TKI-treated patients, and emerges as a potential biomarker of TKI response and tumor progression in NSCLC patients. Based on these evidences and tools, we propose that targeting nicotinamide pathway may serve as a therapeutic tool for sensitizing drug-resistant NSCLC cells with an EMT phenotype to currently available treatments.
Citation Format: Ines Pulido, Jeff Becker, Miguel Aupi, Juan Carlos García Cañaveras, Javier Alcacer, María Rodríguez, Paloma Martín, Javier Perales, Salvador Aparisi, Lourdes Chulia, Arantxa Lafuente, Maribel Alcoriza, Salvador Mena, Javier Pereda, José Galbis-Carabajal, Amelia Insa, Oscar Juan, Fatima Al-Shahrour, Manuel Sanchez del Pino, Agustín Lahoz, Takeshi Shimamura, Julian Carretero. Metabolic vulnerabilities of mesenchymal-like EGFR-mutant NSCLC cells with acquired resistance to tyrosine kinase inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-099.
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Affiliation(s)
- Ines Pulido
- 1University of Valencia, School Of Pharmacy, Burjassot, Spain
| | - Jeff Becker
- 2Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Miguel Aupi
- 1University of Valencia, School Of Pharmacy, Burjassot, Spain
| | | | | | - María Rodríguez
- 1University of Valencia, School Of Pharmacy, Burjassot, Spain
| | | | | | | | - Lourdes Chulia
- 1University of Valencia, School Of Pharmacy, Burjassot, Spain
| | | | - Maribel Alcoriza
- 3Biomarkers and Precision Medicine Unit, IIS La Fe, Valencia, Spain
| | - Salvador Mena
- 1University of Valencia, School Of Pharmacy, Burjassot, Spain
| | - Javier Pereda
- 1University of Valencia, School Of Pharmacy, Burjassot, Spain
| | | | - Amelia Insa
- 5Hospital Clínico Universitario, Valencia, Spain
| | - Oscar Juan
- 3Biomarkers and Precision Medicine Unit, IIS La Fe, Valencia, Spain
| | | | | | - Agustín Lahoz
- 3Biomarkers and Precision Medicine Unit, IIS La Fe, Valencia, Spain
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Edelman MJ, Juan O, Navarro A, Golden G, Borg E, Saunders AV. A two-part, open-label, randomized, phase 2/3 study of dinutuximab and irinotecan versus irinotecan for second-line treatment of subjects with relapsed or refractory small cell lung cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps8588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Oscar Juan
- Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | | | - Gil Golden
- United Therapeutics Corporation, Research Triangle Park, NC
| | - Erick Borg
- United Therapeutics Corporation, Research Triangle Park, NC
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Reck M, Garon EB, Paz-Ares L, Ponce S, Jaime JC, Juan O, Nadal E, Kiura K, Widau RC, He S, Dalal R, Lee P, Nakagawa K. Randomized, Double-Blind Phase Ib/III Study of Erlotinib With Ramucirumab or Placebo in Previously Untreated EGFR-Mutant Metastatic Non-Small-Cell Lung Cancer (RELAY): Phase Ib Results. Clin Lung Cancer 2018; 19:213-220.e4. [PMID: 29317191 DOI: 10.1016/j.cllc.2017.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/17/2017] [Accepted: 11/10/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite the likelihood of an initial response to an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), EGFR-mutant non-small-cell lung cancer (NSCLC) patients develop disease progression. Antiangiogenic agents in combination with an EGFR TKI might provide additional benefit in patients with EGFR-mutant NSCLC. In this article we report safety, exposure, and progression-free survival (PFS) results for part A (phase Ib) of RELAY, a randomized, double-blind, phase Ib/III study investigating safety and efficacy of erlotinib (EGFR TKI) with ramucirumab (anti-vascular endothelial growth factor receptor-2 antibody) or placebo in first-line EGFR-mutant stage IV NSCLC. PATIENTS AND METHODS Eligible patients had untreated stage IV NSCLC, Eastern Cooperative Oncology Group performance status of 0 to 1, and activating EGFR mutation (exon 19 deletion or exon 21 L858R substitution). Patients received ramucirumab 10 mg/kg on day 1 of a repeating 14-day cycle and erlotinib 150 mg/d. Treatment continued until disease progression or unacceptable toxicity. The primary objective was to assess safety and tolerability, in terms of dose-limiting toxicities (DLTs), during the first 2 cycles. RESULTS Fourteen patients were treated and 12 were evaluable for DLTs. One patient experienced a DLT of Grade 3 elevated alanine aminotransferase during the DLT assessment period. Adverse events were reported in all patients, but were generally mild and manageable. The most common Grade 3 adverse events were hypertension, rash, and diarrhea. No serious or Grade 4 to 5 events occurred. Median PFS was 17.1 months (95% confidence interval, 8.8-not reached). Five patients continue receiving study treatment. CONCLUSION Ramucirumab with erlotinib showed no unexpected toxicities and encouraging clinical activity in part A. Phase III enrollment has been initiated, maintaining ramucirumab 10 mg/kg every 2 weeks with erlotinib 150 mg/d.
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Affiliation(s)
- Martin Reck
- Lungen Clinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | | | - Luis Paz-Ares
- Hospital Universitario Doce de Octubre and IIS i+12, CNIO, Universidad Complutense and Ciberonc, Madrid, Spain
| | - Santiago Ponce
- Hospital Universitario Doce de Octubre and IIS i+12, CNIO, Universidad Complutense and Ciberonc, Madrid, Spain
| | | | - Oscar Juan
- Hospital Universitario La Fe, Valencia, Spain
| | - Ernest Nadal
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | | | | | - Shuang He
- Eli Lilly and Company, Indianapolis, IN
| | | | - Pablo Lee
- Eli Lilly and Company, Bridgewater, NJ
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32
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Edelman M, Juan O, Navarro A, Golden G, Saunders A. 88P Feasibility of outpatient dinutuximab (D) and irinotecan (I) for second-line treatment of relapsed or refractory small cell lung cancer (RR SCLC): Part 1 of an open-label, randomized, phase 2/3 study. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30363-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Juan O, Méndez J, Domingo-Arrué B, Estelles DL, Escoín C, Coloma CS, Navarro E, Sosa MM, Mancheño N, Codina JG. 137PD Prognostic factors in oligometastatic non-small-cell lung cancer (OM-NSCLC). J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30411-8] [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: 10/17/2022]
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34
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Baz DV, Lario AP, Bueno MM, Sureda BM, Reguard N, Álvarez R, Molla AI, Juan O, Marquez G, Pulla MP. 156P ASTRIS, a real-world study with osimertinib in patients with non-small cell lung cancer (NSCLC) EGFR T790M mutated: Characteristics and diagnostic methods used for patients included in Spain. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30430-1] [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: 10/17/2022]
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35
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Thomas M, Spigel DR, Jotte RM, McCleod M, Socinski MA, Page RD, Gressot L, Knoble J, Juan O, Morgensztern D, Isla D, Kim ES, West H, Ko A, Ong TJ, Trunova N, Gridelli C. nab-paclitaxel/carboplatin induction in squamous NSCLC: longitudinal quality of life while on chemotherapy. Lung Cancer (Auckl) 2017; 8:207-216. [PMID: 29138610 PMCID: PMC5679693 DOI: 10.2147/lctt.s138570] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Longitudinal data on the impact of treatment on quality of life (QoL) in advanced non-small cell lung cancer (NSCLC) are limited. In this palliative setting, treatment that does not deteriorate QoL is key. Here we report longitudinal QoL in patients with squamous NSCLC, receiving ≤4 cycles of nab-paclitaxel/carboplatin combination chemotherapy. Methods Patients received nab-paclitaxel 100 mg/m2 days 1, 8, 15 + carboplatin area under the curve 6 mg•min/mL day 1 (q3w) for four cycles. QoL was assessed by the Lung Cancer Symptom Scale (LCSS) and Euro-QoL-5 Dimensions-5 Levels (EQ-5D-5L) at baseline and each cycle (day 1). Results Two-hundred and six lesion-response-evaluable patients completed baseline + ≥1 postbaseline QoL assessment and were QoL evaluable. LCSS average total score and symptom burden index improved from baseline throughout four cycles. In the LCSS pulmonary symptoms score, 46% of patients reported clinically meaningful improvement (≥10 mm visual analog scale) from baseline. Individual EQ-5D-5L dimensions remained stable/improved in ≥83% of patients; ≈33% reported complete resolution of baseline problems at least once during four cycles. Generally, responders (unconfirmed complete/partial response) had higher scores vs nonresponders. Conclusion In patients with squamous NSCLC, four cycles of nab-paclitaxel/carboplatin demonstrated clinically meaningful QoL improvements, with greater benefits in responders vs nonresponders.
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Affiliation(s)
- Michael Thomas
- Department of Thoracic Oncology/Internal Medicine, Thoraxklinik im Universitätsklinikum Heidelberg.,Translational Lung Research Center Heidelberg, Heidelberg, Germany
| | | | - Robert M Jotte
- Department of Medical Oncology/Hematology, Rocky Mountain Cancer Centers, Denver, CO
| | | | | | - Ray D Page
- The Center for Cancer and Blood Disorders, Fort Worth
| | | | | | - Oscar Juan
- Department of Medical Oncology, Hospital Universitari i Politécnic La Fe, Valencia, Spain
| | - Daniel Morgensztern
- Department of Medical Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Dolores Isla
- Department of Medical Oncology, University Hospital Lozano Blesa, Zaragoza, Spain
| | - Edward S Kim
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC
| | - Howard West
- Thoracic Oncology Program, Swedish Cancer Institute, Seattle, WA
| | - Amy Ko
- Celgene Corporation, Summit, NJ, USA
| | | | | | - Cesare Gridelli
- Department of Oncology/Hematology, S.G. Moscati Hospital, Avellino, Italy
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Abstract
Epigenetic deregulation is increasingly being recognized as a hallmark of cancer. Recent studies have identified many new epigenetic biomarkers, some of which are being introduced into clinical practice for diagnosis, molecular classification, prognosis or prediction of response to therapies. O-6-methylguanine-DNA methyltransferase gene is the most clinically advanced epigenetic biomarker as it predicts the response to temozolomide and carmustine in gliomas. Therefore, epigenomics may represent a novel and promising tool for precision medicine, and in particular, the detection of epigenomic biomarkers in liquid biopsies will be of great interest for monitoring diseases in patients. Of particular relevance is the identification of epigenetic biomarkers in lung cancer, one of the most prevalent and deadly types of cancer. DNA methylation of SHOX2 and RASSF1A could be used as diagnostic markers to differentiate between normal and tumor samples. MicroRNA and long noncoding RNA signatures associated with lung cancer development or tobacco smoke have also been identified. In addition to the field of biomarkers, therapeutic approaches using DNA methylation and histone deacetylation inhibitors are being tested in clinical trials for several cancer types. Moreover, new DNA editing techniques based on zinc finger and CRISPR/Cas9 technologies allow specific modification of aberrant methylation found in oncogenes or tumor suppressor genes. We envision that epigenomics will translate into the clinical field and will have an impact on lung cancer diagnosis/prognosis and treatment.
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Affiliation(s)
- Josep Mari-Alexandre
- Unit of Inherited Cardiovascular Diseases, Sudden Death and Mechanisms of Disease, Health Research Institute La Fe, Valencia, Spain
| | - Angel Diaz-Lagares
- Translational Medical Oncology (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago (CHUS), CIBERONC, Santiago de Compostela, Spain
| | - Maria Villalba
- Department of Histology and Pathology, School of Medicine, University of Navarra, Pamplona, Navarra, Spain; CIBERONC, IDISNA and Program in Solid Tumors and Biomarkers, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Navarra, Spain
| | - Oscar Juan
- Biomarkers and Precision Medicine Unit. Health Research Institute La Fe, Valencia, Spain
| | - Ana B Crujeiras
- Laboratory of Molecular and Cellular Endocrinology, Health Research Institute of Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS) and Santiago de Compostela University (USC), Santiago de Compostela, Spain; CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Madrid, Spain.
| | - Alfonso Calvo
- Department of Histology and Pathology, School of Medicine, University of Navarra, Pamplona, Navarra, Spain; CIBERONC, IDISNA and Program in Solid Tumors and Biomarkers, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Navarra, Spain.
| | - Juan Sandoval
- Biomarkers and Precision Medicine Unit. Health Research Institute La Fe, Valencia, Spain.
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Gridelli C, McCleod M, Morgensztern D, Daniel D, Page R, Wehler T, Juan O, Levy B, Ardizzoni A, Berry T, Chen T, Trunova N, Jotte R. nab-paclitaxel/carboplatin (nab-P/C) induction therapy in squamous (SCC) non-small cell lung cancer (NSCLC): Interim safety results from ABOUND.sqm. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.070] [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: 11/14/2022] Open
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Juan O, Popat S. Ablative Therapy for Oligometastatic Non-Small Cell Lung Cancer. Clin Lung Cancer 2017; 18:595-606. [PMID: 28377206 DOI: 10.1016/j.cllc.2017.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 12/25/2016] [Revised: 02/22/2017] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Abstract
The oligometastatic state represents a distinct entity among those with metastatic disease and consists of patients with metastases limited in number and location, representing an intermediate state between locally confined and widely metastatic cancer. Although similar, "oligorecurrence" (limited number of metachronous metastases under conditions of a controlled primary lesion) and "oligoprogressive" (disease progression at a limited number of sites with disease controlled at other disease sites) states are distinct entities. In non-small cell lung cancer (NSCLC), the oligometastatic state is relatively common, with 20% to 50% of patients having oligometastatic disease at diagnosis. This subgroup of patients when receiving ablative therapy, such as surgery or stereotactic body radiation radiotherapy, can obtain markedly long progression-free and overall survival. The role of radical treatment for intracranial oligometastases is well established. Fewer data exist regarding radical treatment of extracranial metastases in lung cancer; however, retrospective series using surgery or stereotactic body radiotherapy for extracranial oligometastatic disease in NSCLC have shown excellent local control, with a suggestion of improvement in progression-free survival. In the present report, we have reviewed the data on the treatment of brain metastases in oligometastatic NSCLC and the results of ablative treatment of extracranial sites. Recently, the first randomized trial comparing ablative treatment versus control in oligometastatic disease was reported, and those data are reviewed in the context of smaller series. Finally, areas of controversy are discussed and a therapeutic approach for patients with oligometastatic disease is proposed.
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Affiliation(s)
- Oscar Juan
- Department of Medical Oncology, University Hospital La Fe, Valencia, Spain.
| | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital, London, United Kingdom; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom; and the Institute of Cancer Research, London, United Kingdom
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Reck M, Garon EB, Juan O, Nadal E, Lee P, Dalal R, Liu J, He S, Treat JA, Nakagawa K. Multizentrische, randomisierte Doppelblindstudie mit Erlotinib plus Ramucirumab oder plus Plazebo bei metastasiertem nichtkleinzelligen Lungenkarzinom (NCSLC) mit EGFR-Mutation. Pneumologie 2017. [DOI: 10.1055/s-0037-1598342] [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: 10/20/2022]
Affiliation(s)
- M Reck
- Lungenclinic Großhansdorf, Airway Research Center North (Arcn), Member of the German Center for Lung Research (Dzl)
| | - EB Garon
- Ucla Medical Center, Santa Monica, Ca
| | - O Juan
- Hospital Universitario La Fe, Valencia
| | - E Nadal
- Institut Catala D'oncologia, L'hospitalet, Barcelona
| | - P Lee
- Eli Lilly and Company, Bridgewater
| | - R Dalal
- Ex-Employee, Eli Lilly and Company, Bridgewater
| | - J Liu
- Eli Lilly and Company, Indianapolis
| | - S He
- Eli Lilly and Company, Indianapolis
| | - JA Treat
- Eli Lilly and Company, Indianapolis
| | - K Nakagawa
- Kinki University School of Medicine, Osaka
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Juan O, Popat S. Treatment choice in epidermal growth factor receptor mutation-positive non-small cell lung carcinoma: latest evidence and clinical implications. Ther Adv Med Oncol 2017; 9:201-216. [PMID: 28344665 DOI: 10.1177/1758834016687262] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022] Open
Abstract
Discovery of sensitizing mutations in epidermal growth factor receptor (EGFR) and the subsequent development of EGFR tyrosine kinase inhibitors (TKIs) have substantially changed the treatment of lung cancer. First-line treatment with EGFR TKIs (gefitinib, erlotinib and afatinib) has demonstrated a superior response rate and progression-free survival (PFS) compared with chemotherapy in EGFR-mutation positive patients. However, a number of open questions remain, such as choice between the three EGFR TKIs licensed, treatment of patients unsuitable for chemotherapy due to morbidity or advanced age, management of acquired resistance and optimal biological sample to determine EGFR status. Recently the first head-to-head trial comparing gefitinib and afatinib (LUX-Lung 7) has been reported. Moreover, third-generation EGFR TKIs such as osimertinib, rociletinib, olmutinib and ASP8273, with preferential activity against T790M mutant tumours, the commonest resistance mechanism to EGFR TKIs, have shown promising results in early clinical trials, with osimertinib now licensed. In this review, we summarize latest advances in the treatment of EGFR-mutation positive patients focusing on controversial areas and emerging challenges to optimally treat these patients in the future.
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Affiliation(s)
- Oscar Juan
- Department of Medical Oncology, University Hospital La Fe, Valencia, Spain
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Isla D, Felip E, Viñolas N, Provencio M, Majem M, Artal A, Bover I, Lianes P, DE Las Peñas R, Catot S, DE Castro J, Blasco A, Terrasa J, Gonzalez-Larriba JL, Juan O, Dómine M, Bernabe R, Garrido P. Lung Cancer in Women with a Family History of Cancer: The Spanish Female-specific Database WORLD07. Anticancer Res 2017; 36:6647-6653. [PMID: 27919997 DOI: 10.21873/anticanres.11273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The WORLD07 project is a female-specific database to prospectively analyze the characteristics of Spanish women with lung cancer. PATIENTS AND METHODS We analyzed and compared lung cancer features in women with and without a family history of cancer/lung cancer. RESULTS Two thousand and sixty women were included: 876 had a family history of cancer (lung cancer, 34%) and 886 did not, with no significant differences between groups, except for smoking status (p=0.036). We found statistically significant correlations between epidermal growth factor receptor (EGFR) mutation and smoking status in patients with a family history of cancer (r=-0.211; p<0.001) and lung cancer (r=-0.176; p<0.001). Longer median overall survival was observed in women with a family history of cancer and lung cancer. CONCLUSION Among Spanish women with lung cancer, a greater proportion were current smokers in those with a family history of cancer/lung cancer. There was a significant correlation between the presence of EGFR mutation and smoking.
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Affiliation(s)
- Dolores Isla
- Medical Oncology Department, Instituto de Investigación Sanitaria Aragón, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
| | - Enriqueta Felip
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Nuria Viñolas
- Medical Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Margarita Majem
- Medical Oncology Department, Hospital Puerta de Hierro, Madrid, Spain
| | - Angel Artal
- Medical Oncology Department, Hospital Sant Pau, Barcelona, Spain
| | - Isabel Bover
- Medical Oncology Department, Hospital Son Llátzer, Palma de Mallorca, Spain
| | - Pilar Lianes
- Medical Oncology Department, Hospital de Mararó, Barcelona, Spain
| | - Ramón DE Las Peñas
- Medical Oncology Department, Consorcio Hospital Provincial de Castellón, Castellón De La Plana, Spain
| | - Silvia Catot
- Medical Oncology Department, Althaia Xarxa Assistencial Universitaria de Manresa, Manresa, Spain
| | | | - Ana Blasco
- Medical Oncology Department, Hospital General de Valencia, Valencia, Spain
| | - Josefa Terrasa
- Medical Oncology Department, Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Oscar Juan
- Medical Oncology Department, Hospital La Fe, Valencia, Spain
| | - Manuel Dómine
- Medical Oncology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Reyes Bernabe
- Medical Oncology Department, Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Pilar Garrido
- Medical Oncology Department, Hospital Ramón y Cajal, Madrid, Spain
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Garon EB, Reck M, Paz-Ares L, Ponce S, Jaime JC, Juan O, Nadal E, Lee P, Dalal R, Liu J, He S, Treat J, Nakagawa K. Treatment Rationale and Study Design for the RELAY Study: A Multicenter, Randomized, Double-Blind Study of Erlotinib With Ramucirumab or Placebo in Patients With Epidermal Growth Factor Receptor Mutation-Positive Metastatic Non-Small-Cell Lung Cancer. Clin Lung Cancer 2017; 18:96-99. [PMID: 27894601 DOI: 10.1016/j.cllc.2016.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION We present the treatment rationale and study design for the RELAY study (NCT02411448 ). This phase Ib/III study will assess safety, tolerability, and efficacy of the combination of ramucirumab with erlotinib in previously untreated stage IV non-small-cell lung cancer patients with an activating epidermal growth factor receptor (EGFR) mutation. PATIENTS AND METHODS The study is being conducted in approximately 120 sites in North America, Europe, and Asia and is currently open for enrollment. In part A (phase Ib), approximately 12 patients will receive ramucirumab (10 mg/kg) every 2 weeks with erlotinib (150 mg) every day. Dose-limiting toxicity will be assessed during 2 cycles (4 weeks) of treatment. In part B (phase III), approximately 450 patients will be randomized in a 1:1 ratio to receive ramucirumab or placebo every 2 weeks with erlotinib daily until disease progression, unacceptable toxicity, or other withdrawal criteria are met. The primary end point is progression-free survival, on the basis of investigator assessment. Secondary end points include overall survival, objective response rate, disease control rate, duration of response, safety, and quality of life. CONCLUSION Erlotinib with ramucirumab combination was chosen because the addition of an antiangiogenic agent, such as ramucirumab, would further improve the efficacy of erlotinib, which is a standard of care in the first-line treatment of patients with activating EGFR mutations.
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Affiliation(s)
- Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Martin Reck
- Lungen Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | | | | | - Oscar Juan
- Hospital Universitario La Fe, Valencia, Spain
| | - Ernest Nadal
- Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain
| | - Pablo Lee
- Eli Lilly and Company, Bridgewater, NJ
| | | | | | - Shuang He
- Eli Lilly and Company, Indianapolis, IN
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Isla D, De Castro J, Juan O, Grau S, Orofino J, Gordo R, Rubio-Terrés C, Rubio-Rodríguez D. Costs of adverse events associated with erlotinib or afatinib in first-line treatment of advanced EGFR-positive non-small cell lung cancer. Clinicoecon Outcomes Res 2016; 9:31-38. [PMID: 28115857 PMCID: PMC5221482 DOI: 10.2147/ceor.s121093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are an established treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutation. According to published meta-analyses, no significant efficacy differences have been demonstrated between erlotinib and afatinib. However, the incidence of EGFR-TKI-related adverse events (AEs) was lower with erlotinib. This study compares the cost of management of the AEs associated with these two drugs from the perspective of the Spanish National Health System (NHS). METHODS The frequency of AEs was established from a recently published meta-analysis. In Spain, the daily cost of both drugs can be considered similar; as a result, only the costs of management of the AEs were considered. Costs and resource utilization in the management of the AEs were estimated by a panel of Spanish oncologists and from studies previously carried out in Spain. A probabilistic analysis was performed based on a Monte Carlo simulation. RESULTS The model generated 1,000 simulations. The total cost per patient treated with erlotinib and afatinib was €657.44 and €1,272.15, respectively. With erlotinib, the cost per patient and per AE of grades ≤2 and ≥3 was €550.86 and €106.58, respectively, whereas the cost with afatinib was €980.63 and €291.52, respectively. The reduction in the number of AEs with erlotinib could avoid a mean cost for the NHS of €614.71 (95% CI: €342.57-881.29) per patient. CONCLUSION In advanced EGFR mutation-positive NSCLC patients, first-line treatment with erlotinib could reduce health care costs for the NHS, due to a decrease in the AE rate compared with afatinib. In long-term treatments, the avoidance of complications and the lowering of costs associated with the management of AEs are relevant factors that contribute to the sustainability of the health system.
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Affiliation(s)
- Dolores Isla
- Medical Oncology Department, Clinical Universitary Hospital Lozano Blesa, Zaragoza
| | - Javier De Castro
- Medical Oncology Department, Universitary Hospital La Paz, Madrid
| | - Oscar Juan
- Medical Oncology Department, Universitary and Polytechnic Hospital La Fe, Valencia
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Isla D, Majem M, Viñolas N, Artal A, Blasco A, Felip E, Garrido P, Remón J, Baquedano M, Borrás JM, Die Trill M, García-Campelo R, Juan O, León C, Lianes P, López-Ríos F, Molins L, Planchuelo MÁ, Cobo M, Paz-Ares L, Trigo JM, de Castro J. A consensus statement on the gender perspective in lung cancer. Clin Transl Oncol 2016; 19:527-535. [PMID: 27885542 DOI: 10.1007/s12094-016-1578-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/12/2016] [Indexed: 10/20/2022]
Abstract
Lung cancer is the most common cancer globally and has the highest mortality. Although this disease is not associated with a particular gender, its incidence is rising among women, who are diagnosed at an increasingly younger age compared with men. One of the main reasons for this rise is women taking up smoking. However, many non-smoking women also develop this disease. Other risk factors implicated in the differential development of lung cancer in women are genetic predisposition, tumour histology and molecular profile. Proportionally more women than men with lung cancer have a mutation in the EGFR gene. This consensus statement reviews the available evidence about the epidemiological, biological, diagnostic, therapeutic, social and psychological aspects of lung cancer in women.
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Affiliation(s)
- D Isla
- Medical Oncology Department, Lozano Blesa Clinical University Hospital, Avda. San Juan Bosco 15, 50009, Zaragoza, Spain.
| | - M Majem
- Medical Oncology Department, Sant Pau University Hospital, Barcelona, Spain
| | - N Viñolas
- Medical Oncology Department, Clinic Hospital, Barcelona, Spain
| | - A Artal
- Medical Oncology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - A Blasco
- Medical Oncology Department, Valencia General University Hospital, Valencia, Spain
| | - E Felip
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - P Garrido
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - J Remón
- Medical Oncology Department, Mataró University Hospital, Mataró, Barcelona, Spain
| | - M Baquedano
- Medical Oncology Department, Lozano Blesa Clinical University Hospital, Avda. San Juan Bosco 15, 50009, Zaragoza, Spain
| | - J M Borrás
- Scientific Coordinator of Cancer Strategy of the Spanish National Health System, University of Barcelona, Barcelona, Spain
| | - M Die Trill
- Atrium, Psyco-Oncology and Clinical Psychology, Madrid, Spain
| | - R García-Campelo
- Medical Oncology Department, A Coruña University Hospital, A Coruña, Spain
| | - O Juan
- Medical Oncology Department, La Fé University Hospital, Valencia, Spain
| | - C León
- Psyco-Oncology Unit, Terrassa Hospital and Parc Taulí University Hospital, Sabadell, Spain
| | - P Lianes
- Medical Oncology Department, Mataró University Hospital, Mataró, Barcelona, Spain
| | - F López-Ríos
- Targeted Therapies Laboratory, Department of Pathology, HM Sanchinarro University Hospital, Madrid, Spain
| | - L Molins
- Thoracic Surgery Department, Clinic Hospital, Barcelona, Spain
| | - M Á Planchuelo
- Humanization of Healthcare Department, Consejería de Sanidad, Madrid, Spain
| | - M Cobo
- Medical Oncology Department, Virgen de la Victoria University Hospital, Málaga, Spain
| | - L Paz-Ares
- Medical Oncology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - J M Trigo
- Medical Oncology Department, Virgen de la Victoria University Hospital, Málaga, Spain
| | - J de Castro
- Medical Oncology Department, La Paz University Hospital, Madrid, Spain
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Goss G, Tsai CM, Shepherd FA, Bazhenova L, Lee JS, Chang GC, Crino L, Satouchi M, Chu Q, Hida T, Han JY, Juan O, Dunphy F, Nishio M, Kang JH, Majem M, Mann H, Cantarini M, Ghiorghiu S, Mitsudomi T. Osimertinib for pretreated EGFR Thr790Met-positive advanced non-small-cell lung cancer (AURA2): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol 2016; 17:1643-1652. [PMID: 27751847 DOI: 10.1016/s1470-2045(16)30508-3] [Citation(s) in RCA: 463] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osimertinib (AZD9291) is an oral, potent, irreversible EGFR tyrosine-kinase inhibitor selective for EGFR tyrosine-kinase inhibitor sensitising mutations, and the EGFR Thr790Met resistance mutation. We assessed the efficacy and safety of osimertinib in patients with EGFR Thr790Met-positive non-small-cell lung cancer (NSCLC), who had progressed after previous therapy with an approved EGFR tyrosine-kinase inhibitor. METHODS In this phase 2, open-label, single-arm study (AURA2), patients aged at least 18 years with centrally confirmed EGFR Thr790Met-positive mutations, locally advanced or metastatic (stage IIIB/IV) NSCLC who progressed on previous EGFR tyrosine-kinase inhibitor therapy received osimertinib 80 mg orally once daily; treatment could continue beyond progression if the investigator observed a clinical benefit. Patients with asymptomatic, stable CNS metastases not requiring steroids were allowed to enrol. The primary endpoint was the proportion of patients achieving an objective response by blinded independent central review using Response Evaluation Criteria in Solid Tumors, version 1.1. Response endpoints were assessed in the evaluable for response analysis set (ie, all patients who received at least one dose of osimertinib and had measurable disease at baseline according to blinded independent central review). Other endpoints and safety were assessed in all patients receiving at least one osimertinib dose (full analysis set). The study is ongoing and patients are still receiving treatment. This study is registered with ClinicalTrials.gov, number NCT02094261. FINDINGS Between May 20, 2014, and Sept 12, 2014, 472 patients were screened, of whom 210 started osimertinib treatment between June 13, 2014, and Oct 27, 2014; 11 patients were excluded from the evaluable for response analysis set (n=199) due to absence of measurable disease at baseline by blinded independent central review. At data cutoff (Nov 1, 2015), 122 (58%) patients remained on treatment. The median duration of follow-up was 13·0 months (IQR 7·6-14·2). 140 (70%; 95% CI 64-77) of 199 patients achieved an objective response by blinded independent central review: confirmed complete responses were achieved in six (3%) patients and partial responses were achieved in 134 (67%) patients. The most common all-causality grade 3 and 4 adverse events were pulmonary embolism (seven [3%]), prolonged electrocardiogram QT (five [2%]), decreased neutrophil count (four [2%]), anaemia, dyspnoea, hyponatraemia, increased alanine aminotransferase, and thrombocytopenia (three [1%] each). Serious adverse events were reported in 52 (25%) patients, of which 11 (5%) were investigator assessed as possibly treatment-related to osimertinib. Seven deaths were due to adverse events; these were pneumonia (n=2), pneumonia aspiration (n=1), rectal haemorrhage (n=1), dyspnoea (n=1), failure to thrive (n=1), and interstitial lung disease (n=1). The only fatal event assessed as possibly treatment-related by the investigator was due to interstitial lung disease. INTERPRETATION Osimertinib showed clinical activity with manageable side-effects in patients with EGFR Thr790Met-positive NSCLC. Therefore, osimertinib could be a suitable treatment for patients with EGFR Thr790Met-positive disease who have progressed on an EGFR tyrosine-kinase inhibitor. FUNDING AstraZeneca.
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Affiliation(s)
- Glenwood Goss
- The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada.
| | - Chun-Ming Tsai
- Department of Chest Medicine, Taipei-Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | | | - Jong Seok Lee
- Seoul National University, Bundang Hospital, Seongnam, South Korea
| | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, National Yang-Ming University, Taipei, Taiwan
| | - Lucio Crino
- Perugia University Medical School, Perugia, Italy
| | | | - Quincy Chu
- University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
| | | | - Ji-Youn Han
- National Cancer Center, Goyang-si, Republic of Korea
| | - Oscar Juan
- La Fe University Hospital, Valencia, Spain
| | | | - Makoto Nishio
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Juan O, Yousaf N, Popat S. First-line Epidermal Growth Factor Receptor (EGFR) Kinase Inhibitors for EGFR Mutant Non-small Cell Lung Cancer: And the Winner is…. Clin Oncol (R Coll Radiol) 2016; 29:e1-e4. [PMID: 27686969 DOI: 10.1016/j.clon.2016.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/18/2016] [Accepted: 08/25/2016] [Indexed: 12/09/2022]
Affiliation(s)
- O Juan
- Department of Medical Oncology, University Hospital La Fe, Valencia, Spain; Lung Unit, Royal Marsden Hospital, London, UK
| | - N Yousaf
- Lung Unit, Royal Marsden Hospital, London, UK
| | - S Popat
- Lung Unit, Royal Marsden Hospital, London, UK; National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, UK; The Institute of Cancer Research, London, UK.
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Ou SH, Park K, Han JY, Kim DW, Bazhenova L, Pang YK, Hin HS, Juan O, Son J, Voccia I, Massey D, Kim M, Jänne PA. Abstract CT079: ELUXA 1: Ph II study of BI1482694 (HM61713) in patients (pts) with T790M-positive non-small cell lung (NSCLC) after treatment with an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI). Clin Trials 2016. [DOI: 10.1158/1538-7445.am2016-ct079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Coloma CS, Pérez CE, Niño O, Sanoyan DA, Melián M, Navarro E, Codina JG, Montalar J, Juan O. 145P: Perspectives in oligometastatic brain lesions in non-small cell lung cancer (NSCLC). J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30255-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marin S, Garde J, Coloma CS, Juan O, Arribas L, Sánchez JG, Pérez CE, Coloma JH, Perez RA, Cussac AL. 144P: Oligometastatic non-small-cell lung cancer (NSCLC) and unresectable primary tumor: Updated retrospective analysis of safety and efficacy of the radical treatment for the primary tumor and the metastases. J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30254-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Park K, Han JY, Kim DW, Bazhenova L, Ou SH, Pang YK, Hin H, Juan O, Son J, Jänne P. 190TiP: ELUXA 1: Phase II study of BI 1482694 (HM61713) in patients (pts) with T790M-positive non-small cell lung cancer (NSCLC) after treatment with an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI). J Thorac Oncol 2016. [DOI: 10.1016/s1556-0864(16)30299-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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