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Huang HT. Parallel explorations in LA-NSCLC: Chemoradiation dose-response optimisation considering immunotherapy and cardiac toxicity sparing. Radiother Oncol 2024; 200:110477. [PMID: 39153508 DOI: 10.1016/j.radonc.2024.110477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND AND PURPOSE Chemoradiotherapy (CRT) for locally-advanced non-small cell lung cancer (LA-NSCLC) has undergone advances, including increased overall survival (OS) when combined with immune checkpoint blockade (ICB), and using cardiac-sparing techniques to reduce the radiotoxicity. This research investigated 1) how radiotherapy schedules can be optimised with CRT-ICB schemes, and 2) how cardiac-sparing might change the OS for concurrent CRT (cCRT). METHODS AND MATERIALS Survival data and dosimetric indices were sourced from published studies, with 2-year OS standardised and the hazard ratio of mean heart dose (MHD) against radiotoxicity tabulated in purpose. A published CRT dose-response model was selected, then modified with ICB and cardiac-sparing hypotheses. Models were maximum likelihood fitted, then visualised the prediction outcomes after bootstrapping. RESULTS The modelled 2-year OS rate of cCRT-ICB reached 71 % (95 % confidence intervals, CI 62 %, 84 %) and 66 % (95 % CI: 53 %, 81 %) for stage IIIA and IIIB/C, respectively, given 60 Gy in 2 Gy-per-fraction. 60 Gy in 30 fractions remained the best schedule for cCRT-ICB, whereas modest dose de-escalation to 55 Gy only reduced the OS in 2 %. Sequential CRT (sCRT)-ICB provided 6 % OS increases versus the best OS rate achieved by sCRT alone. Photon MHD-sparing achieved a 5-10 % increase in modelled 2-year OS, with protons providing a further roughly 5-10 % increase. CONCLUSION Neither dose-escalation nor de-escalation relative to 60 Gy in 30 fractions influenced the survival with cCRT-ICB, while 5 Gy dose de-escalation might benefit patients with heavily irradiated organs at risk. Cardiac-sparing improved OS, and protons provided advantages for tumours anatomically overlapped or lay below the heart.
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Affiliation(s)
- Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.
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2
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Simone CB. Enhancing Outcomes in Locally Advanced Non-Small Cell Lung Cancer Through Stereotactic Dose Escalation. Int J Radiat Oncol Biol Phys 2024; 120:695-697. [PMID: 39326955 DOI: 10.1016/j.ijrobp.2024.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Accepted: 06/29/2024] [Indexed: 09/28/2024]
Affiliation(s)
- Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York; Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, New York.
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3
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Gkika E, Dejonckheere CS, Sahlmann J, Barth SA, Schimek-Jasch T, Adebahr S, Hecht M, Miederer M, Brose A, Binder H, König J, Grosu AL, Nestle U, Rimner A. Impact of mediastinal tumor burden and lymphatic spread in locally advanced non-small-cell lung cancer: A secondary analysis of the multicenter randomized PET-Plan trial. Radiother Oncol 2024; 200:110521. [PMID: 39236984 DOI: 10.1016/j.radonc.2024.110521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/30/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE The aim of this secondary analysis of the prospective randomized phase 2 PET-Plan trial (ARO-2009-09; NCT00697333) was to evaluate the impact of mediastinal tumor burden and lymphatic spread in patients with locally advanced non-small-cell lung cancer (NSCLC). METHODS All patients treated per protocol (n = 172) were included. Patients received isotoxically dose-escalated chemoradiotherapy up to a total dose of 60-74 Gy in 30-37 fractions, aiming as high as possible while adhering to normal tissue constraints. Radiation treatment (RT) planning was based on an 18F-FDG PET/CT targeting all lymph node (LN) stations containing CT positive LNs (i.e. short axis diameter > 10 mm), even if PET-negative (arm A) or targeting only LN stations containing PET-positive nodes (arm B). LN stations were classified into echelon 1 (ipsilateral hilum), 2 (ipsilateral station 4 and 7), and 3 (rest of the mediastinum, contralateral hilum). The endpoints were overall survival (OS), progression-free survival (PFS), and freedom from local progression (FFLP). RESULTS The median follow-up time (95 % confidence interval [CI]) was 41.1 (33.8 - 50.4) months. Patients with a high absolute number of PET-positive LN stations had worse OS (hazard ratio [HR] = 1.09; 95 % CI 0.99 - 1.18; p = 0.05) and PFS (HR = 1.12; 95 % CI 1.04 - 1.20; p = 0.003), irrespective of treatment arm allocation. The prescribed RT dose to the LNs did not correlate with any of the endpoints when considering all patients. However, in patients in arm B (i.e., PET-based selective nodal irradiation), prescribed RT dose to each LN station correlated significantly with FFLP (HR=0.45; 95 % CI 0.24-0.85; p = 0.01). Furthermore, patients with involvement of echelon 3 LN stations had worse PFS (HR = 2.22; 95 % CI 1.16-4.28; p = 0.02), also irrespective of allocation. CONCLUSION Mediastinal tumor burden and lymphatic involvement patterns influence outcome in patients treated with definitive chemoradiotherapy for locally advanced NSCLC. Higher dose to LNs did not improve OS, but did improve FFLP in patients treated with PET-based dose-escalated RT.
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Affiliation(s)
- Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany; Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | | | - Jörg Sahlmann
- Institute of Medical Biometry and Statistics (IMBI), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simeon Ari Barth
- Department of Pediatrics, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sonja Adebahr
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Hecht
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Matthias Miederer
- Department of Translational Imaging in Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden: Faculty of Medicine and University Hospital Carl Gustav Carus, University of Technology Dresden (TUD), Dresden, Germany; German Cancer Research Center (DKFZ) Heidelberg, Germany; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Alexander Brose
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics (IMBI), University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Hospital Mainz, Mainz, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany
| | - Andreas Rimner
- Department of Radiation Oncology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kim KH, Kang N, Song SY, Kim HJ, Kim YS, Oh MJ, Cho J. Safety and Efficacy of HL301 In Radiation Pneumonitis in Patients With Unresectable Non-Small Cell Lung Cancer Receiving Curative Concurrent Chemoradiotherapy: A Multicenter, Randomized, Double-Blinded, Placebo-Controlled, Phase 2a Clinical Trial. Int J Radiat Oncol Biol Phys 2024; 120:432-438. [PMID: 38565405 DOI: 10.1016/j.ijrobp.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE We aimed to investigate the safety and efficacy of HL301, a standardized combination product of 7 medicinal plants, in radiation pneumonitis in patients with unresectable non-small cell lung cancer undergoing curative concurrent chemoradiotherapy. METHODS AND MATERIALS The target accrual was 87 and a total of 63 patients were enrolled due to poor accrual rate. We randomly assigned the 63 patients to receive a placebo (arm A), or 1200 mg HL301 (arm B), or 1800 mg HL301 (arm C). Patients received weekly paclitaxel and carboplatin concurrently with intensity-modulated radiation therapy at 60 to 66 Gy in conventional fractionation. Durvalumab was administered as a maintenance treatment according to standard clinical practice. HL301 was administered orally, daily for 12 weeks. The primary endpoint was incidence of grade ≥2 radiation pneumonitis at 24 weeks postchemoradiotherapy. RESULTS The baseline characteristics of the patients were well balanced. The drug was tolerable with a compliance rate of 86.6%, 86.2%, and 88.8% in arms A, B, and C, respectively (P = .874). None of the patients experienced severe drug-related adverse events. No significant difference in the rate of adverse events were observed between the treatment arms. The incidence of grade ≥2 radiation pneumonitis at 24 weeks postchemoradiotherapy was 37.5% (95% CI, 18.5%-61.4%), 55.6% (95% CI, 33.7%-75.4%), and 52.4% (95% CI, 32.4%-71.7%) in arms A, B, and C, respectively (P = .535). CONCLUSIONS This is the first exploratory clinical trial to test the safety and efficacy of HL301 in patients with non-small cell lung cancer. Safety and feasibility of HL301 were established but no signals of efficacy in reducing radiation pneumonitis was observed in this dose level.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nahyun Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea; R&D Center, Hanlim Pharm. Co, Ltd, Seoul, Republic of Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Jin Oh
- R&D Center, Hanlim Pharm. Co, Ltd, Seoul, Republic of Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Huang HT, Brand DH, Fenwick JD, Hawkins MA. ImmunoChemoradiation for Non-Small Cell Lung Cancer: A Meta-Analysis of Factors Influencing Survival Benefit in Combination Trials. Int J Radiat Oncol Biol Phys 2024; 120:409-421. [PMID: 38570169 DOI: 10.1016/j.ijrobp.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Adding immune checkpoint blockade (ICB) to concurrent chemoradiotherapy (cCRT) has improved overall survival (OS) for inoperable locally advanced non-small cell lung cancer. Trials of cCRT-ICB are heterogeneous for factors such as tumor stage and histology, programmed cell death ligand-1 (PDL-1) status, and cCRT-ICB schedules. We therefore aimed to determine the ICB contribution to survival across studies and identify factors associated with survival gain. METHODS AND MATERIALS Data were collated from cCRT-ICB clinical studies published 2018 to 2022 that treated 2196 patients with non-small cell lung cancer (99% stage 3). Associations between 2-year OS and ICB, CRT, patient and tumor factors were investigated using metaregression. A published model of survival after radiation therapy (RT) or CRT was extended to include ICB effects. The model was fitted simultaneously to the cCRT-ICB data and data previously compiled for RT/CRT treatments alone. The net ICB contribution (OS gain) and its associations with factors were described by fitted values of ICB terms added to the model. Statistical significance was determined by likelihood-ratio testing. RESULTS The gain in 2-year OS from ICB was 9.9% overall (95% CI, 7.6%, 12.2%; P = .018). Both OS gain and 2-year OS itself rose with increasing planned ICB duration (P = .008, .002, respectively) and with tumor PDL-1 ≥ 1% (P = .034, .023). Fitted OS gains were also greater for patients with stage 3B/C disease (P = .021). OS gain was not associated with tumor histology, patient performance status, radiation therapy dose, ICB drug type (anti-PDL-1 vs anti-programmed cell death-1), or whether ICB began concurrently with or after cCRT. CONCLUSIONS Fitted gains in 2-year OS due to ICB were higher in cohorts with greater fractions of stage 3B/C patients and patients with tumor PDL-1 ≥ 1%. OS gain was also significantly higher in a single cohort with a planned ICB duration of 2 years rather than 1, but was not associated with whether ICB treatment began during versus after CRT.
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Affiliation(s)
- Huei-Tyng Huang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Douglas H Brand
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - John D Fenwick
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.
| | - Maria A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; University College London Hospital NHS Foundation Trust, London, United Kingdom.
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Claude L, Schiffler C, Isnardi V, Metzger S, Darnis S, Martel-Lafay I, Baudier T, Rit S, Sarrut D, Ayadi M. "Mid-P strategy" versus "internal target volume strategy in locally advanced non small cell lung cancer: Clinical results from the randomized non-comparative phase II study Mid-P. Radiother Oncol 2024; 199:110435. [PMID: 39004227 DOI: 10.1016/j.radonc.2024.110435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/03/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Locally advanced non-small cell lung cancer (LA-NSCLC) reported poor 5-year survival rates with frequent local or regional recurrences. Personalized RT may contribute to improve control and clinical outcome. We investigated efficacy and tolerance of "Mid-position" (Mid-P) strategy versus the conventional Internal Target Volume (ITV) strategy in LA-NSCLC patients treated by definitive conformal radiotherapy. METHODS This prospective non-comparative randomized monocentric phase II trial included adult patients with non-resected, non-metastatic, non-previously irradiated proven LA-NSCLC treated with definitive normo-fractionated conformal radiotherapy (+/- chemotherapy). Allocated patients (randomisation 2:1) were treated using Mid-P or ITV strategy. A Fleming single-stage design (1-sided α = 0.1, 80 % power, P0 = 30 %, P1 = 50 %) planned enrolment of 36 patients in the Mid-P group. The ITV group ensured the absence of selection bias. The primary outcome was 1-year progression-free- survival (1y-PFS) rate. RESULTS Among 54 eligible patients included from September 2012 to May 2018, 51 patients were analyzed (Mid-P: N = 34; ITV: 17). The 1y-PFS was 38 % (1-sided 95 %CI 25 %-not reached) with Mid-P strategy, and 47 % (95 %CI [27 %-not reached[) with ITV. Loco-regional failure as first event mainly occurred within radiation-field regardless the strategy. Acute and middle-term radiation toxicities were observed with both strategies. CONCLUSION Local control and survival remain poor using the Mid-P strategy in this prospective randomized non-comparative monocentric study investigating Mid-P strategy versus ITV strategy in LA-NSCLC. Since the Mid-P strategy is not integrated into routine software, and perceived as a time-consuming method, Mid-P strategy cannot be recommended in LA-NSCLCC treated by definitive normo-fractionated conformal radiotherapy outside clinical trials.
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Affiliation(s)
- Line Claude
- Radiotherapy Oncology Department, Léon Bérard Cancer Center, Lyon, France.
| | - Camille Schiffler
- Clinical Research and Innovation Department, Léon Bérard Cancer Center, Lyon, France
| | - Vanina Isnardi
- Nuclear Medicine Department, Léon Bérard Cancer Center, Lyon, France
| | - Séverine Metzger
- Clinical Research and Innovation Department, Léon Bérard Cancer Center, Lyon, France
| | - Sophie Darnis
- Clinical Research and Innovation Department, Léon Bérard Cancer Center, Lyon, France
| | | | - Thomas Baudier
- INSA-Lyon, Université Lyon 1; Centre Léon Bérard; CREATIS CNRS UMR 5220, Inserm U1206, F-69373, Lyon, France
| | - Simon Rit
- INSA-Lyon, Université Lyon 1; Centre Léon Bérard; CREATIS CNRS UMR 5220, Inserm U1206, F-69373, Lyon, France
| | - David Sarrut
- INSA-Lyon, Université Lyon 1; Centre Léon Bérard; CREATIS CNRS UMR 5220, Inserm U1206, F-69373, Lyon, France
| | - Myriam Ayadi
- Radiotherapy Oncology Department, Léon Bérard Cancer Center, Lyon, France
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7
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Hendriks LEL, Remon J, Faivre-Finn C, Garassino MC, Heymach JV, Kerr KM, Tan DSW, Veronesi G, Reck M. Non-small-cell lung cancer. Nat Rev Dis Primers 2024; 10:71. [PMID: 39327441 DOI: 10.1038/s41572-024-00551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/28/2024]
Abstract
Non-small-cell lung cancer (NSCLC) is one of the most frequent cancer types and is responsible for the majority of cancer-related deaths worldwide. The management of NSCLC has improved considerably, especially in the past 10 years. The systematic screening of populations at risk with low-dose CT, the implementation of novel surgical and radiotherapeutic techniques and a deeper biological understanding of NSCLC that has led to innovative systemic treatment options have improved the prognosis of patients with NSCLC. In non-metastatic NSCLC, the combination of various perioperative strategies and adjuvant immunotherapy in locally advanced disease seem to enhance cure rates. In metastatic NSCLC, the implementation of novel drugs might prolong disease control together with preserving quality of life. The further development of predictive clinical and genetic markers will be essential for the next steps in individualized treatment concepts.
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Affiliation(s)
- Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW-School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, University of Manchester and The Christie NHS Foundation, Manchester, UK
| | - Marina C Garassino
- Thoracic Oncology Program, Section of Hematology Oncology, Department of Medicine, the University of Chicago, Chicago, IL, USA
| | - John V Heymach
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA
| | - Keith M Kerr
- Department of Pathology, Aberdeen Royal Infirmary and Aberdeen University Medical School, Aberdeen, UK
| | - Daniel S W Tan
- National Cancer Centre Singapore, Duke-NUS Medical School, Singapore, Singapore
| | - Giulia Veronesi
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Martin Reck
- Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany.
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8
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Mao Q, Wu Z, Lai Y, Wang L, Zhao Q, Xu X, Lu X, Qiu W, Zhang Z, Wu J, Wang G, Zhou R, Wu J, Sun H, Huang N, Huang X, Jiang L, Fang Y, Kong Y, Liang L, Bin J, Liao Y, Shi M, Liao W, Zeng D. Dynamic single-cell sequencing unveils the tumor microenvironment evolution of gastric cancer abdominal wall metastases during radiotherapy. Cancer Sci 2024. [PMID: 39327670 DOI: 10.1111/cas.16308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 09/28/2024] Open
Abstract
Although the combination of immunotherapy and radiotherapy (RT) for the treatment of malignant tumors has shown rapid development, the insight of how RT remodels the tumor microenvironment to prime antitumor immunity involves a complex interplay of cell types and signaling pathways, much of which remains to be elucidated. Four tumor samples were collected from the same abdominal wall metastasis site of the patient with gastric cancer at baseline and during fractionated RT for single-cell RNA and T-cell receptor sequencing. The Seurat analysis pipeline and immune receptor analysis were used to characterize the gastric cancer metastasis ecosystem and investigated its dynamic changes of cell proportion, cell functional profiles and cell-to-cell communication during RT. Immunohistochemical and immunofluorescent staining and bulk RNA sequencing were applied to validate the key results. We found tumor cells upregulated immune checkpoint genes in response to RT. The infiltration and clonal expansion of T lymphocytes declined within tumors undergoing irradiation. Moreover, RT led to the accumulation of proinflammatory macrophages and natural killer T cells with enhanced cytotoxic gene expression signature. In addition, subclusters of dendritic cells and endothelial cells showed decrease in the expression of antigen present features in post-RT samples. More ECM component secreted by myofibroblasts during RT. These findings indicate that RT induced the dynamics of the immune response that should be taken into consideration when designing and clinically implementing innovative multimodal cancer treatment regimens of different RT and immunotherapy approaches.
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Affiliation(s)
- Qianqian Mao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Cancer Center, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
- Foshan Key Laboratory of Translational Medicine in Oncology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
| | - Zhenzhen Wu
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yonghong Lai
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ling Wang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiongzhi Zhao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xi Xu
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiansheng Lu
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenjun Qiu
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhihua Zhang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiani Wu
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Gaofeng Wang
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rui Zhou
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianhua Wu
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Huiying Sun
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Na Huang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiatong Huang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Luyang Jiang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yiran Fang
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuyun Kong
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Liang
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianping Bin
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yulin Liao
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Min Shi
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Cancer Center, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
- Foshan Key Laboratory of Translational Medicine in Oncology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
| | - Dongqiang Zeng
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Cancer Center, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
- Foshan Key Laboratory of Translational Medicine in Oncology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
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9
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Shirai K, Aoki S, Endo M, Takahashi Y, Fukuda Y, Akahane K, Musha A, Sato H, Wakatsuki M, Ishikawa H, Sasaki R. Recent developments in the field of radiotherapy for the management of lung cancer. Jpn J Radiol 2024:10.1007/s11604-024-01663-8. [PMID: 39316285 DOI: 10.1007/s11604-024-01663-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024]
Abstract
Lung cancer has a poor prognosis, and further improvements in outcomes are needed. Radiotherapy plays an important role in the treatment of unresectable lung cancer, and there have been recent developments in the field of radiotherapy for the management of lung cancer. However, to date, there have been few reviews on the improvement in treatment outcomes associated with high precision radiotherapy for lung cancer. Thus, this review aimed to summarize the recent developments in radiotherapy techniques and indicate the future directions in the use of radiotherapy for lung cancer. Stereotactic body radiotherapy (SBRT) for unresectable stage I lung cancer has been reported to improve local control rates without severe adverse events, such as radiation pneumonitis. For locally advanced lung cancer, a combination of chemoradiotherapy and adjuvant immune checkpoint inhibitors dramatically improves treatment outcomes, and intensity-modulated radiotherapy (IMRT) enables safer radiation therapy with less frequent pneumonitis. Particle beam therapy, such as carbon-ion radiotherapy and proton beam therapy, has been administered as advanced medical care for patients with lung cancer. Since 2024, it has been covered under insurance for early stage lung cancer with tumors ≤ 5 cm in size in Japan. In addition to chemotherapy, local ablative radiotherapy improves treatment outcomes in patients with oligometastatic stage IV lung cancer. A particular problem with radiotherapy for lung cancer is that the target location changes with respiratory motion, and various physical methods have been used to control respiratory motion. Recently, coronavirus disease has had a major impact on lung cancer treatment, and cancer treatment during situations, such as the coronavirus pandemic, must be performed carefully. To improve treatment outcomes for lung cancer, it is necessary to fully utilize evolving radiotherapy modalities, and the role of radiotherapy in lung cancer treatment is expected to increase.
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Affiliation(s)
- Katsuyuki Shirai
- Department of Radiology, Jichi Medical University Hospital, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan.
| | - Shuri Aoki
- QST Hospital, National Institutes for Quantum Science and Technology, Anagawa, Chiba, Japan
| | - Masashi Endo
- Department of Radiology, Jichi Medical University Hospital, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Yuta Takahashi
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Yukiko Fukuda
- Department of Radiology, Jichi Medical University Hospital, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Keiko Akahane
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Atsushi Musha
- Gunma University Heavy Ion Medical Center, Maebashi, Gunma, Japan
| | - Harutoshi Sato
- Department of Radiology, Jichi Medical University Hospital, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Masaru Wakatsuki
- QST Hospital, National Institutes for Quantum Science and Technology, Anagawa, Chiba, Japan
| | - Hitoshi Ishikawa
- QST Hospital, National Institutes for Quantum Science and Technology, Anagawa, Chiba, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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10
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Chin V, Finnegan RN, Keall P, Otton J, Delaney GP, Vinod SK. Overview of cardiac toxicity from radiation therapy. J Med Imaging Radiat Oncol 2024. [PMID: 39301913 DOI: 10.1111/1754-9485.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024]
Abstract
Radiotherapy is an essential part of treatment for many patients with thoracic cancers. However, proximity of the heart to tumour targets can lead to cardiac side effects, with studies demonstrating link between cardiac radiation dose and adverse outcomes. Although reducing cardiac dose can reduce associated risks, most cardiac constraint recommendations in clinical use are generally based on dose to the whole heart, as dose assessment at cardiac substructure levels on individual patients has been limited historically. Furthermore, estimation of an individual's cardiac risk is complex and multifactorial, which includes radiation dose alongside baseline risk factors, and the impact of systemic therapies. This review gives an overview of the epidemiological impact of cancer and cardiac disease, risk factors contributing to radiation-related cardiotoxicity, the evidence for cardiac side effects and future directions in cardiotoxicity research. A better understanding of the interactions between risk factors, balancing treatment benefit versus toxicity and the ongoing management of cardiac risk is essential for optimal clinical care. The emerging field of cardio-oncology is thus a multidisciplinary collaborative effort to enable better understanding of cardiac risks and outcomes for better-informed patient management decisions.
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Affiliation(s)
- Vicky Chin
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia
- Image X Institute, University of Sydney, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Robert N Finnegan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Medical Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Paul Keall
- Image X Institute, University of Sydney, Sydney, New South Wales, Australia
| | - James Otton
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Geoff P Delaney
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
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11
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Furuta M, Horinouchi H, Yokota I, Yamaguchi T, Itoh S, Fukui T, Iwashima A, Sugisaka J, Miura Y, Tanaka H, Miyawaki T, Yokouchi H, Miura K, Saito R, Saito G, Kamoshida T, Uchinami Y, Kato T, Kobayashi K, Asahina H. Durvalumab after chemoradiotherapy for locoregional recurrence of completely resected non-small-cell lung cancer (NEJ056). Cancer Sci 2024. [PMID: 39278260 DOI: 10.1111/cas.16340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/13/2024] [Accepted: 08/30/2024] [Indexed: 09/18/2024] Open
Abstract
Locoregional recurrence of non-small-cell lung cancer (NSCLC) after complete resection lacks standard treatment. Durvalumab after chemoradiotherapy (CRT) or CRT alone is often selected in daily clinical practice for patients with locoregional recurrence; however, the therapeutic efficacy of these treatments remains unclear, and we aimed to assess this. This retrospective observational study used data from patients with NSCLC diagnosed with locoregional recurrence after complete resection who subsequently underwent concurrent CRT followed by durvalumab (CRT-D group) or CRT alone (CRT group). We employed propensity score analysis with inverse probability treatment weighting (IPTW) to adjust for various confounders and evaluate efficacy in the CRT-D group. After IPTW adjustment, the CRT-D group contained 119 patients (64.7% male; 69.7% adenocarcinoma), and the CRT group contained 111 patients (60.5% male; 73.4% adenocarcinoma). Their mean ages were 66 and 65 years, respectively. The IPTW-adjusted median progression-free survival was 25.4 and 11.5 months for the CRT-D and CRT groups, respectively (hazard ratio, 0.44; 95% confidence interval, 0.30-0.64); the median overall survival was not reached in either group favoring CRT-D (hazard ratio, 0.49; 95% confidence interval, 0.24-0.99). Grade 3 or 4 adverse events were observed in 48.8% of patients during CRT, 10.7% after initiating durvalumab maintenance therapy in the CRT-D group, and 57.3% in the CRT group. Overall, the sequential approach of CRT followed by durvalumab is a promising treatment strategy for locoregional recurrence of NSCLC after complete resection.
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Affiliation(s)
- Megumi Furuta
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Isao Yokota
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Teppei Yamaguchi
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shoichi Itoh
- Department of Thoracic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Takafumi Fukui
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Iwashima
- Department of Respiratory Medicine, Nagaoka Chuo General Hospital, Niigata, Japan
| | - Jun Sugisaka
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yu Miura
- Department of Respiratory Medicine, Saitama International Medical Center, Hidaka, Japan
| | - Hisashi Tanaka
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Taichi Miyawaki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Yokouchi
- Department of Respiratory Medicine, NHO Hokkaido Cancer Center, Sapporo, Japan
| | - Keita Miura
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Go Saito
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuhiko Kamoshida
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Kato
- Department of Thoracic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hajime Asahina
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Department of Respiratory Medicine, NHO Hokkaido Cancer Center, Sapporo, Japan
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12
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Cheng Y, Spigel DR, Cho BC, Laktionov KK, Fang J, Chen Y, Zenke Y, Lee KH, Wang Q, Navarro A, Bernabe R, Buchmeier EL, Chang JWC, Shiraishi Y, Goksu SS, Badzio A, Shi A, Daniel DB, Hoa NTT, Zemanova M, Mann H, Gowda H, Jiang H, Senan S. Durvalumab after Chemoradiotherapy in Limited-Stage Small-Cell Lung Cancer. N Engl J Med 2024. [PMID: 39268857 DOI: 10.1056/nejmoa2404873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Adjuvant therapy with durvalumab, with or without tremelimumab, may have efficacy in patients with limited-stage small-cell lung cancer who do not have disease progression after standard concurrent platinum-based chemoradiotherapy. METHODS In a phase 3, double-blind, randomized, placebo-controlled trial, we assigned patients to receive durvalumab at a dose of 1500 mg, durvalumab (1500 mg) plus tremelimumab at a dose of 75 mg (four doses only), or placebo every 4 weeks for up to 24 months. Randomization was stratified according to disease stage (I or II vs. III) and receipt of prophylactic cranial irradiation (yes vs. no). Results of the first planned interim analysis of the two primary end points of overall survival and progression-free survival (assessed on the basis of blinded independent central review according to the Response Evaluation Criteria in Solid Tumors, version 1.1) with durvalumab as compared with placebo (data cutoff date, January 15, 2024) are reported; results in the durvalumab-tremelimumab group remain blinded. RESULTS A total of 264 patients were assigned to the durvalumab group, 200 to the durvalumab-tremelimumab group, and 266 to the placebo group. Durvalumab therapy led to significantly longer overall survival than placebo (median, 55.9 months [95% confidence interval {CI}, 37.3 to not reached] vs. 33.4 months [95% CI, 25.5 to 39.9]; hazard ratio for death, 0.73; 98.321% CI, 0.54 to 0.98; P = 0.01), as well as to significantly longer progression-free survival (median 16.6 months [95% CI, 10.2 to 28.2] vs. 9.2 months [95% CI, 7.4 to 12.9]; hazard ratio for progression or death, 0.76; 97.195% CI, 0.59 to 0.98; P = 0.02). The incidence of adverse events with a maximum grade of 3 or 4 was 24.4% among patients receiving durvalumab and 24.2% among patients receiving placebo; adverse events led to discontinuation in 16.4% and 10.6% of the patients, respectively, and led to death in 2.7% and 1.9%. Pneumonitis or radiation pneumonitis with a maximum grade of 3 or 4 occurred in 3.1% of the patients in the durvalumab group and in 2.6% of those in the placebo group. CONCLUSIONS Adjuvant therapy with durvalumab led to significantly longer overall survival and progression-free survival than placebo among patients with limited-stage small-cell lung cancer. (Funded by AstraZeneca; ADRIATIC ClinicalTrials.gov number, NCT03703297.).
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Affiliation(s)
- Ying Cheng
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - David R Spigel
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Byoung Chul Cho
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Konstantin K Laktionov
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Jian Fang
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Yuanbin Chen
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Yoshitaka Zenke
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Ki Hyeong Lee
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Qiming Wang
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Alejandro Navarro
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Reyes Bernabe
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Eva Lotte Buchmeier
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - John Wen-Cheng Chang
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Yoshimasa Shiraishi
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Sema Sezgin Goksu
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Andrzej Badzio
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Anhui Shi
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Davey B Daniel
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Nguyen Thi Thai Hoa
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Milada Zemanova
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Helen Mann
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Hema Gowda
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Haiyi Jiang
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
| | - Suresh Senan
- From Jilin Cancer Hospital, Changchun (Y. Cheng), Department II of Thoracic Oncology (J.F.) and the Department of Radiation Oncology (A.S.), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, and the Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou (Q.W.) - all in China; Sarah Cannon Research Institute (D.R.S.) and Tennessee Oncology (D.B.D.) - both in Nashville; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (B.C.C.), and Chungbuk National University Hospital, Cheongju (K.H.L.) - both in South Korea; Federal State Budgetary Institution "N.N. Blokhin National Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, Moscow (K.K.L.); Cancer and Hematology Centers of Western Michigan, Grand Rapids (Y. Chen); National Cancer Center Hospital East, Kashiwa (Y.Z.), and Kyushu University Hospital, Fukuoka (Y.S.) - both in Japan; Hospital Vall d'Hebron and Vall d'Hebron Institute of Oncology, Barcelona (A.N.), and Hospital Universitario Virgen del Rocio, Seville (R.B.) - both in Spain; Hospitals of the City of Cologne, Cologne, Germany (E.L.B.); Chang Gung Medical Foundation-LinKou Branch, Taoyuan, Taiwan (J.W.-C.C.); Akdeniz University Medical Faculty, Antalya, Turkey (S.S.G.); Medical University of Gdansk, Gdansk, Poland (A.B.); National Cancer Hospital, Hanoi, Vietnam (N.T.T.H.); First Faculty of Medicine, Charles University, and General University Hospital, Prague, Czech Republic (M.Z.); AstraZeneca, Cambridge, United Kingdom (H.M.); AstraZeneca, Gaithersburg, MD (H.G., H.J.); and the Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam (S.S.)
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Yamanaka Y, Ota T, Masuoka Y, Takeyasu Y, Nakamura S, Terashima M, Yoshioka H, Fukuoka M, Kurata T. Feasibility Study of Nivolumab in Combination with Carboplatin Plus Paclitaxel and Concurrent Thoracic Radiation in Patients with Untreated Unresectable Locally Advanced Non-Small Cell Lung Cancer. Cancers (Basel) 2024; 16:3127. [PMID: 39335099 DOI: 10.3390/cancers16183127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
Despite advancements in diagnosing and treating non-small cell lung cancer (NSCLC), the prognosis remains poor. Immune checkpoint inhibitors have shown promise in enhancing survival rates. Therefore, this study aimed to investigate the safety of nivolumab administration with concurrent chemoradiation therapy (CCRT) in patients with unresectable locally advanced NSCLC. Twelve patients with unresectable locally advanced NSCLC at Kansai Medical University Hospital and Izumi City General Medical Center were enrolled from May 2018 to September 2020. They received nivolumab (360 mg) tri-weekly twice, weekly carboplatin (AUC 2 min × mg/mL) and paclitaxel (40 mg/m2) for 6 weeks, and thoracic radiotherapy (60 Gy/30 fractions), followed by maintenance nivolumab therapy (360 mg, tri-weekly) for 6 months. The primary endpoint was incidence of dose-limiting toxicities (DLTs), and the secondary endpoints included safety, response rate, progression-free survival (PFS), overall survival (OS), 2-year survival rate, and treatment completion rate. Three patients completed the protocol. Nine discontinued due directly to interstitial pneumonia (three) and pneumonia (one). Ten patients (83.3%) experienced a grade 3 or higher event, of which three (25%) experienced a grade 4 or higher event, and of these, one (8.3%) experienced a grade 5 event. Three patients experienced DLTs. Concurrent nivolumab with CCRT was tolerated in unresectable locally advanced NSCLC, which offers potential treatment benefits.
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Affiliation(s)
- Yuta Yamanaka
- Department of Thoracic Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakatashi 573-1010, Osaka, Japan
| | - Takayo Ota
- Medical Oncology, Izumi City General Medical Center, 4-5-1 Wakechou, Izumishi 594-0073, Osaka, Japan
| | - Yutaka Masuoka
- Department of Radiology, Izumi City General Medical Center, 4-5-1 Wakechou, Izumishi 594-0073, Osaka, Japan
| | - Yuki Takeyasu
- Department of Thoracic Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakatashi 573-1010, Osaka, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakatashi 573-1010, Osaka, Japan
| | - Masaaki Terashima
- Medical Oncology, Izumi City General Medical Center, 4-5-1 Wakechou, Izumishi 594-0073, Osaka, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakatashi 573-1010, Osaka, Japan
| | - Masahiro Fukuoka
- Medical Oncology, Izumi City General Medical Center, 4-5-1 Wakechou, Izumishi 594-0073, Osaka, Japan
| | - Takayasu Kurata
- Department of Thoracic Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakatashi 573-1010, Osaka, Japan
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14
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Nassar AH, Jayakrishnan R, Feng J, Shepherd F, Adib E, Cheung JM, Lin JJ, Liu Y, Lin SH, Parikh K, Sridhar A, Shakya P, Dilling TJ, Kaldas D, Gray JE, Lobachov A, Bar J, Luders H, Grohe C, Gupta S, Leal T, Fitzgerald B, Crowley F, Fujiwara Y, Marron TU, Wilgucki M, Reuss J, Chen L, Sankar K, Aredo JV, Neal JW, Wakelee HA, Thummalapalli R, Yu H, Whitaker R, Velazquez A, Ragavan M, Cortellini A, Kwiatkowski DJ, Naqash AR, Goldberg SB, Kim SY. Consolidation ALK Tyrosine Kinase Inhibitors Versus Durvalumab or Observation After Chemoradiation in Unresectable Stage III ALK-Positive NSCLC. J Thorac Oncol 2024:S1556-0864(24)02265-2. [PMID: 39260522 DOI: 10.1016/j.jtho.2024.09.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/19/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Patients with advanced ALK-positive NSCLC typically have poor response to immunotherapy; the benefit of consolidation durvalumab in patients with unresectable stage III ALK-positive NSCLC remains unclear. Herein, we compare the efficacy and safety of consolidation ALK tyrosine kinase inhibitor (TKI) versus durvalumab or observation after concurrent chemoradiation. METHODS We conducted a retrospective study using a multicenter study of 17 institutions globally. Patients with unresectable stage III ALK-positive NSCLC treated between 2015 and 2022 were included. Patients received ALK TKI, durvalumab, or observation after concurrent chemoradiation. Real-world progression-free survival (rwPFS) and overall survival (OS) were estimated using Kaplan-Meier method. Treatment-related adverse events (trAEs) were classified by Common Terminology Criteria for Adverse Events version 5.0. Outcomes were assessed by multivariable Cox regression analysis. RESULTS A total of 67 patients were included, of whom 39 (58%) were female. Median age was 57 (interquartile range: 49-67) years. Furthermore, 15 received consolidation ALK TKI, 30 received durvalumab, and 22 underwent observation. Baseline characteristics were similar across the three groups other than differences in race. After adjusting for stage, age, and nodal status, median rwPFS was significantly longer for ALK TKI (rwPFS not reached, 95% confidence interval [CI]: 22.7- not reached) versus durvalumab (11.3 mo, 95% CI: 8.9-18.5, hazard ratio [HR] = 0.12, 95% CI: 0.026-0.5, p-adjusted [p-adj] = 0.006) or observation (7.2 mo, 95% CI: 3.4-10.6, HR = 0.04, 95% CI: 0.009-0.2, p-adj < 0.0001). Durvalumab significantly improved median rwPFS compared with observation (HR = 0.37, 95% CI: 0.19-0.71, p-adj = 0.002). Median OS in the ALK TKI and durvalumab cohorts was significantly improved compared with patients on observation (ALK TKI-observation: p = 0.04; durvalumab-observation: p = 0.03). TrAE of any grade occurred in eight (53%) and 11 (37%) patients treated with ALK TKI and durvalumab, respectively. Grade greater than or equal to three trAEs occurred in 27% (n = 4) of patients treated with ALK TKI and 6.7% of patients treated with durvalumab. CONCLUSIONS Patients with ALK-positive NSCLC experience significantly improved rwPFS when treated with consolidation ALK TKI therapy, surpassing outcomes found with either durvalumab or observation. Although both ALK TKI therapy and durvalumab offer an extension in OS compared with observation alone, it seems that ALK TKI therapy is the superior choice, underscoring its pivotal role in enhancing patient survival.
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Affiliation(s)
- Amin H Nassar
- Yale University School of Medicine, New Haven, Connecticut.
| | | | - Jamie Feng
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Frances Shepherd
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Elio Adib
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Justin M Cheung
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Jessica J Lin
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Yufei Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Thomas J Dilling
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - David Kaldas
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida; Department of Internal Medicine, University of South Florida, Tampa, Florida; Department of Clinical Oncology, Cairo University, Cairo, Egypt
| | - Jhanelle E Gray
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Anastasiya Lobachov
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Heike Luders
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Christian Grohe
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Shruti Gupta
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ticiana Leal
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Bailey Fitzgerald
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fionnuala Crowley
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yu Fujiwara
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas U Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Molly Wilgucki
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Joshua Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Luxi Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kamya Sankar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jacqueline V Aredo
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Rohit Thummalapalli
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Ryan Whitaker
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ana Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Meera Ragavan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California; Division of Research, Kaiser Permanente Northern California, The Permanente Medical Group, Oakland, California
| | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy; Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom
| | - David J Kwiatkowski
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | - So Yeon Kim
- Yale University School of Medicine, New Haven, Connecticut
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15
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Nguyen NP, Page BR, Giap H, Dahbi Z, Vinh-Hung V, Gorobets O, Mohammadianpanah M, Motta M, Portaluri M, Arenas M, Bonet M, Lara PC, Kim L, Dutheil F, Natoli E, Loganadane G, Lehrman D, Bose S, Kaur S, Blanco SC, Chi A. Immunotherapy and Radiotherapy for Older Patients with Locally Advanced Non-Metastatic Non-Small-Cell Lung Cancer Who Are Not Candidates for or Decline Surgery and Chemotherapy: A Practical Proposal by the International Geriatric Radiotherapy Group. Cancers (Basel) 2024; 16:3112. [PMID: 39272970 PMCID: PMC11394154 DOI: 10.3390/cancers16173112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/02/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024] Open
Abstract
The standard of care for locally advanced non-small-cell lung cancer (NSCLC) is either surgery combined with chemotherapy pre- or postoperatively or concurrent chemotherapy and radiotherapy. However, older and frail patients may not be candidates for surgery and chemotherapy due to the high mortality risk and are frequently referred to radiotherapy alone, which is better tolerated but carries a high risk of disease recurrence. Recently, immunotherapy with immune checkpoint inhibitors (ICIs) may induce a high response rate among cancer patients with positive programmed death ligand 1 (PD-L1) expression. Immunotherapy is also well tolerated among older patients. Laboratory and clinical studies have reported synergy between radiotherapy and ICI. The combination of ICI and radiotherapy may improve local control and survival for NSCLC patients who are not candidates for surgery and chemotherapy or decline these two modalities. The International Geriatric Radiotherapy Group proposes a protocol combining radiotherapy and immunotherapy based on the presence or absence of PD-L1 to optimize the survival of those patients.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Huan Giap
- Radiation Oncology Proton Therapy, OSF HeathCare Cancer Institute, University of Illinois, Peoria, IL 61603, USA
| | - Zineb Dahbi
- Department of Radiation Oncology, Mohammed VI University of Health Sciences, Casablanca 82403, Morocco
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier Public du Cotentin, 50100 Cherbourg-en-Cotentin, France
| | - Olena Gorobets
- Department of Oral Surgery, Cancer Tech Care Association, Perpignan 66000, France
| | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
| | - Micaela Motta
- Department of Radiation Oncology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Maurizio Portaluri
- Department of Radiation Oncology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Meritxell Arenas
- Department of Radiation Oncology, Sant Joan de Reus University Hospital, University of Rovira I Virgili, 43007 Tarragona, Spain
| | - Marta Bonet
- Department of Radiation Oncology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | - Pedro Carlos Lara
- Department of Radiation Oncology, Fernando Pessoria Canarias Las Palmas University, 35002 Las Palmas, Spain
| | - Lyndon Kim
- Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA
| | - Fabien Dutheil
- Department of Radiation Oncology, Clinique Sainte Clotilde, 97400 Saint Denis, France
| | - Elena Natoli
- Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studorium, Bologna University, 40126 Bologna, Italy
| | | | - David Lehrman
- Department of Radiation Oncology, International Geriatric Radiotherapy Group, Washington, DC 20001, USA
| | - Satya Bose
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA
| | - Sarabjot Kaur
- Department of Radiation Oncology, Howard University, Washington, DC 20059, USA
| | - Sergio Calleja Blanco
- Department of Oral Maxillofacial Surgery, Howard University, Washington, DC 20059, USA
| | - Alexander Chi
- Department of Radiation Oncology, Capital University Xuanwu Hospital, Beijing 100053, China
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16
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Xiao WW, Chen G, Gao YH, Lin JZ, Wu XJ, Luo HL, Lu ZH, Wang QX, Sun R, Cai PQ, Zhu CM, Liu M, Li JB, Wang YR, Jin Y, Wang F, Luo HT, Li CL, Pan ZZ, Xu RH. Effect of neoadjuvant chemoradiotherapy with or without PD-1 antibody sintilimab in pMMR locally advanced rectal cancer: A randomized clinical trial. Cancer Cell 2024; 42:1570-1581.e4. [PMID: 39094560 DOI: 10.1016/j.ccell.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 05/26/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024]
Abstract
Neoadjuvant chemoradiotherapy (NACRT) was the standard treatment for patients with locally advanced rectal cancer (LARC) with proficient mismatch repair (pMMR) proteins. In this randomized phase 2 trial (ClinicalTrial.gov: NCT04304209), 134 pMMR LARC patients were randomly (1:1) assigned to receive NACRT or NACRT and the programmed cell death protein 1 (PD-1) antibody sintilimab. As the primary endpoint, the total complete response (CR) rate is 26.9% (18/67, 95% confidence interval [CI] 16.0%-37.8%) and 44.8% (30/67, 95% CI 32.6%-57.0%) in the control and experimental arm, respectively, with significant difference (p = 0.031 for chi-squared test). Response ratio is 1.667 (95% CI 1.035-2.683). Immunohistochemistry shows PD-1 ligand 1 (PD-L1) combined positive score is associated with the synergistic effect. The safety profile is similar between the arms. Adding the PD-1 antibody sintilimab to NACRT significantly increases the CR rate in pMMR LARC, with a manageable safety profile. PD-L1 positivity may help identify patients who might benefit most from the combination therapy.
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Affiliation(s)
- Wei-Wei Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China; United Laboratory of Frontier Radiotherapy Technology of Sun Yat-sen University & Chinese Academy of Sciences Ion Medical Technology Co., Ltd, Guangzhou, China
| | - Gong Chen
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Yuan-Hong Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Jun-Zhong Lin
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Xiao-Jun Wu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Hui-Long Luo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Zhen-Hai Lu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Qiao-Xuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Rui Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Pei-Qiang Cai
- Department of Radiology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Chong-Mei Zhu
- Department of Pathology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Min Liu
- Department of Ultrasound, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ji-Bin Li
- Department of Statistics, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Yi-Rui Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Ying Jin
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China
| | - Feng Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China
| | - Hai-Tao Luo
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Cai-Ling Li
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Zhi-Zhong Pan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, China
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, China.
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17
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Yamano A, Inoue T, Yagihashi T, Yamanaka M, Matsumoto K, Shimo T, Shirata R, Nitta K, Nagata H, Shiraishi S, Minagawa Y, Omura M, Tokuuye K, Chang W. Impact of interplay effects on spot scanning proton therapy with motion mitigation techniques for lung cancer: SFUD versus robustly optimized IMPT plans utilizing a four-dimensional dynamic dose simulation tool. Radiat Oncol 2024; 19:117. [PMID: 39252032 PMCID: PMC11385833 DOI: 10.1186/s13014-024-02518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/04/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND The interaction between breathing motion and scanning beams causes interplay effects in spot-scanning proton therapy for lung cancer, resulting in compromised treatment quality. This study investigated the effects and clinical robustness of two types of spot-scanning proton therapy with motion-mitigation techniques for locally advanced non-small cell lung cancer (NSCLC) using a new simulation tool (4DCT-based dose reconstruction). METHODS Three-field single-field uniform dose (SFUD) and robustly optimized intensity-modulated proton therapy (IMPT) plans combined with gating and re-scanning techniques were created using a VQA treatment planning system for 15 patients with locally advanced NSCLC (70 GyRBE/35 fractions). In addition, gating windows of three or five phases around the end-of-expiration phase and two internal gross tumor volumes (iGTVs) were created, and a re-scanning number of four was used. First, the static dose (SD) was calculated using the end-of-expiration computed tomography (CT) images. The four-dimensional dynamic dose (4DDD) was then calculated using the SD plans, 4D-CT images, and the deformable image registration technique on end-of-expiration CT. The target coverage (V98%, V100%), homogeneity index (HI), and conformation number (CN) for the iGTVs and organ-at-risk (OAR) doses were calculated for the SD and 4DDD groups and statistically compared between the SD, 4DDD, SFUD, and IMPT treatment plans using paired t-test. RESULTS In the 3- and 5-phase SFUD, statistically significant differences between the SD and 4DDD groups were observed for V100%, HI, and CN. In addition, statistically significant differences were observed for V98%, V100%, and HI in phases 3 and 5 of IMPT. The mean V98% and V100% in both 3-phase plans were within clinical limits (> 95%) when interplay effects were considered; however, V100% decreased to 89.3% and 94.0% for the 5-phase SFUD and IMPT, respectively. Regarding the significant differences in the deterioration rates of the dose volume histogram (DVH) indices, the 3-phase SFUD plans had lower V98% and CN values and higher V100% values than the IMPT plans. In the 5-phase plans, SFUD had higher deterioration rates for V100% and HI than IMPT. CONCLUSIONS Interplay effects minimally impacted target coverage and OAR doses in SFUD and robustly optimized IMPT with 3-phase gating and re-scanning for locally advanced NSCLC. However, target coverage significantly declined with an increased gating window. Robustly optimized IMPT showed superior resilience to interplay effects, ensuring better target coverage, prescription dose adherence, and homogeneity than SFUD. TRIAL REGISTRATION None.
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Affiliation(s)
- Akihiro Yamano
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa, Tokyo, 116-8551, Japan
| | - Tatsuya Inoue
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Takayuki Yagihashi
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa, Tokyo, 116-8551, Japan
| | - Masashi Yamanaka
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, 1-7, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuki Matsumoto
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
- Doctoral Program in Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Takahiro Shimo
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ryosuke Shirata
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Kazunori Nitta
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Hironori Nagata
- Department of Medical Physics, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Sachika Shiraishi
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Yumiko Minagawa
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Motoko Omura
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Koichi Tokuuye
- Department of Radiation Oncology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Weishan Chang
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa, Tokyo, 116-8551, Japan
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Dong H, Hu F, Hao B, Jin X, Zheng Q, Su Y. Single-cell analysis reveals the disparities in immune profiles between younger and elder patients. Eur Geriatr Med 2024:10.1007/s41999-024-01032-8. [PMID: 39244673 DOI: 10.1007/s41999-024-01032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 07/26/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE The immune profiles of elder patients with non-small cell lung cancer (NSCLC) differ significantly from those of younger patients. The tumor microenvironment (TME) is a crucial factor in cancer progression and therapeutic responses. The present study aims to decipher the difference in TME between younger and elderly patients with lung cancers. METHODS We downloaded single-cell RNA data from public databases. The algorithm of uniform manifold approximation and projection (UMAP) was applied to cluster and visualize single-cell sequencing data. Gene set variation analysis (GSVA) and gene set enrichment analysis (GSEA) analysis were performed to evaluate the physiological functional characteristics in sub-group cells. CellPhoneDB was used to identify cell-cell interactions between immune cells within TME. RESULTS We conducted single-cell RNA sequencing on 96,491 cells from elderly patients and 169,207 cells from younger patients, respectively. We observed that epithelial cells were the predominant component of the TME in younger patients, whereas T/NK cells were the predominant cell type in the TME of elderly patients. We also found that there was a higher proportion of Tregs and a lower proportion of NK, effector CD8+T and γδT cells in elder patients compared with younger patients. In addition, a comparative GSEA analysis of NK cells between older and younger patients revealed that the pathways of Parkinson's disease, Alzheimer's disease, mismatch repair, and base excision repair were up-regulated in NK cells from elderly patients, while the pathways related to natural killer cell-mediated cytotoxicity and allograft rejection were downregulated. Furthermore, we identified tumor-associated neutrophils (TANs) in elder patients, and GSVA analysis demonstrated that the pathway of angiogenesis was upregulated, and the pathway of interferon_γ_response, inflammatory_response, TNFα_signaling_via_NFκB pathways were downregulated. Importantly, the pro-inflammatory response scores of complement C1q C chain positive (C1QC+) macrophages, tissue-resident macrophages (TRM), non-classical monocytes (NCM), secreted phosphoprotein 1 positive (SPP1+) macrophages, and classical monocytes (CM) in elder patients were significantly lower compared to those in younger patients. Finally, cell-to-cell communication analyses unveiled the disparities in regulatory patterns between elder and younger patients, namely the pairs of CXCL13-ACKR4 and CSF1-SIRPA in elder patients and the pairs of CTLA4-CD86 and TIGIT-NECTIN2 in younger patients. CONCLUSION This study reveals the distinct immune profiles between younger and elder NSCLC patients, and the elder patients were likely to exhibit a more immunosuppressive TME and attenuated tumor-killing capability compared with younger patients.
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Affiliation(s)
- Huixing Dong
- Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Feng Hu
- Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Bo Hao
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan University, 238 Jiefang Road, Wuhan, 430060, China
| | - Xiaoyan Jin
- Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China
| | - Qi Zheng
- Department of Respiratory and Critical Care Medicine, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.58, Pu Yu Dong Road, Shanghai, 200011, China.
| | - Yiliang Su
- Department of Pulmonary and Critical Care Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 XianXia Road, Shanghai, 200336, China.
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Wang X, Zhang H, XinZhang, Liu Y. Abscopal effect: from a rare phenomenon to a new frontier in cancer therapy. Biomark Res 2024; 12:98. [PMID: 39228005 PMCID: PMC11373306 DOI: 10.1186/s40364-024-00628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/30/2024] [Indexed: 09/05/2024] Open
Abstract
Radiotherapy (RT) controls local lesions, meantime it has the capability to induce systemic response to inhibit distant, metastatic, non-radiated tumors, which is referred to as the "abscopal effect". It is widely recognized that radiotherapy can stimulate systemic immune response. This provides a compelling theoretical basis for the combination of immune therapy combined with radiotherapy(iRT). Indeed, this phenomenon has also been observed in clinical treatment, bringing significant clinical benefits to patients, and a series of basic studies are underway to amplify this effect. However, the molecular mechanisms of immune response induced by RT, determination of the optimal treatment regimen for iRT, and how to amplify the abscopal effect. In order to amplify and utilize this effect in clinical management, these key issues require to be well addressed; In this review, we comprehensively summarize the growing consensus and emphasize the emerging limitations of enhancing the abscopal effect with radiotherapy or immunotherapy. Finally, we discuss the prospects and barriers to the current clinical translational applications.
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Affiliation(s)
- Xueying Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, 410008, Hunan, China
| | - Haoyu Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, 410008, Hunan, China
| | - XinZhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, 410008, Hunan, China.
| | - Yong Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), Changsha, 410008, Hunan, China.
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20
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Wu X, Stabile LP, Burns TF. The Emerging Role of Immune Checkpoint Blockade for the Treatment of Lung Cancer Brain Metastases. Clin Lung Cancer 2024; 25:483-501. [PMID: 38991863 DOI: 10.1016/j.cllc.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/15/2024] [Accepted: 06/06/2024] [Indexed: 07/13/2024]
Abstract
Lung cancer has the highest incidence of brain metastases (BM) among solid organ cancers. Traditionally whole brain radiation therapy has been utilized for non-small-cell lung cancer (NSCLC) BM treatment, although stereotactic radiosurgery has emerged as the superior treatment modality for most patients. Highly penetrant central nervous system (CNS) tyrosine kinase inhibitors have also shown significant CNS activity in patients harboring select oncogenic drivers. There is emerging evidence that patients without oncogene-driven tumors derive benefit from the use of immune checkpoint inhibitors (ICIs). The CNS activity of ICIs have not been well studied given exclusion of patients with active BM from landmark trials, due to concerns of inadequate CNS penetration and activity. However, studies have challenged the idea of an immune-privileged CNS, given the presence of functional lymphatic drainage within the CNS and destruction of the blood brain barrier by BM. An emerging understanding of the interactions between tumor and CNS immune cells in the BM tumor microenvironment also support a role for immunotherapy in BM treatment. In addition, posthoc analyses of major trials have shown improved intracranial response and survival benefit of regimens with ICIs over chemotherapy (CT) alone for patients with BM. Two prospective phase 2 trials evaluating pembrolizumab monotherapy and atezolizumab plus CT in patients with untreated NSCLC BM also demonstrated significant intracranial responses. This review describes the interplay between CNS immune cells and tumor cells, discusses current evidence for ICI CNS activity from retrospective and prospective studies, and speculates on future directions of investigation.
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Affiliation(s)
- Xiancheng Wu
- Department of Medicine, Division of Internal Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Laura P Stabile
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Timothy F Burns
- UPMC Hillman Cancer Center, Pittsburgh, PA; Department of Medicine, Division of Hematology-Oncology, University of Pittsburgh, Pittsburgh, PA.
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21
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Désage AL, Duruisseaux M, Lafitte C, Bayle-Bleuez S, Chouaid C, Fournel P, Pierret T. Toxicities associated with sequential or combined use of immune checkpoint inhibitors and small targeted therapies in non-small cell lung cancer: A critical review of the literature. Cancer Treat Rev 2024; 129:102805. [PMID: 39111188 DOI: 10.1016/j.ctrv.2024.102805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/29/2024] [Accepted: 07/22/2024] [Indexed: 08/18/2024]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have become standard-of-care at different stage disease in non-small cell lung cancer (NSCLC). Based on the increasing characterization of molecular aberrations and oncogenic drivers in NSCLC, it is expected that more and more patients will benefit from orally small targeted therapies in NSCLC. However, their concomitant or sequential use is associated with an increased risk of a various toxicity pattern. METHODS Relevant publications were included if they reported data on the question of toxicities associated with sequential or combined use of ICIs and small targeted therapies used in NSCLC treatment. MEDLINE, Google Scholar, and the Cochrane Library were searched for the following request, from database inception until June 2023. RESULTS This review highlighted a various pattern of toxicities (i.e., interstitial lung disease, hepatitis, dermatoses) in the context of both sequential and concomitant administration of ICIs and small targeted therapies. Such toxicities seem rather a "drug-effect" than a "class-effect" and some of these toxicities are more specific of a small targeted therapy. This review highlights on the impact of treatment sequence administration and emphasis for physicians to be particularly careful whether small targeted therapy is administered within one to three months after last ICIs injection. CONCLUSION Physicians have to be aware of severe toxicities in case of both concomitant or sequential ICIs/small targeted therapies administration in NSCLC. Further studies are needed to better understand the mechanisms underlying these toxicities in order to prevent them and to refine ICIs and small targeted therapy sequencing strategy.
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Affiliation(s)
- Anne-Laure Désage
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France.
| | - Michael Duruisseaux
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France; Oncopharmacology Laboratory, Cancer Research Center of Lyon, UMR INSERM 1052 CNRS 5286, Lyon, France; Université Claude Bernard, Université de Lyon, Lyon, France
| | - Claire Lafitte
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France
| | - Sophie Bayle-Bleuez
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Christos Chouaid
- Pneumology Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Pierre Fournel
- Department of Pulmonology and Thoracic Oncology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Thomas Pierret
- Respiratory Department, Louis Pradel Hospital, Hospices Civils de Lyon Cancer Institute, Lyon, France
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22
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Jo NC, Shroff GS, Ahuja J, Agrawal R, Price MC, Wu CC. Radiation Recall Pneumonitis: Imaging Appearance and Differential Considerations. Korean J Radiol 2024; 25:843-850. [PMID: 39197829 PMCID: PMC11361796 DOI: 10.3348/kjr.2024.0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/22/2024] [Accepted: 07/24/2024] [Indexed: 09/01/2024] Open
Abstract
Radiation recall pneumonitis is an inflammatory reaction of previously radiated lung parenchyma triggered by systemic pharmacological agents (such as chemotherapy and immunotherapy) or vaccination. Patients present with non-specific symptoms such as cough, shortness of breath, or hypoxia soon after the initiation of medication or vaccination. Careful assessment of the patient's history, including the thoracic radiation treatment plan and timing of the initiation of the triggering agent, in conjunction with CT findings, contribute to the diagnosis. Once a diagnosis is established, treatment includes cessation of the causative medication and/or initiation of steroid therapy. Differentiating this relatively rare entity from other common post-therapeutic complications in oncology patients, such as recurrent malignancy, infection, or medication-induced pneumonitis, is essential for guiding downstream clinical management.
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Affiliation(s)
- Nahyun Celina Jo
- Department of Diagnostic Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rishi Agrawal
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa C Price
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Carol C Wu
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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23
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Mai VQ, Lindholm L, Van Minh H, Sun S, Giang KB, Sahlén KG. Cost-effectiveness of consolidation durvalumab for inoperable stage III non-small cell lung cancer in Vietnam. BMJ Open 2024; 14:e083895. [PMID: 39214656 PMCID: PMC11407225 DOI: 10.1136/bmjopen-2024-083895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study aimed to assess the cost-effectiveness of durvalumab as a treatment option for patients with inoperable stage III non-small cell lung cancer (NSCLC) from healthcare and partial societal perspectives in Vietnam. METHOD A lifetime partitioned survival model was used to evaluate the costs and quality-adjusted life years (QALYs) associated with consolidation durvalumab in comparison with the standard of care alone. Local costs and utilities were incorporated into the model. In the base-case analysis, no discount was applied to the acquisition cost of durvalumab. Scenario-based, one-way and probabilistic-sensitivity analyses were conducted. RESULTS The base-case analysis revealed that the intervention resulted in an increase of 1.38 life years or 1.08 QALYs for patients, but the intervention was not deemed cost-effective from either perspective in the base-case analysis. However, with a 70% reduction in the durvalumab acquisition cost, the intervention was observed to be cost-effective when evaluated from a healthcare perspective and when examining the undiscounted results from a partial societal standpoint. CONCLUSION This study provides evidence regarding the cost-effectiveness of durvalumab for the treatment of inoperable stage III NSCLC in Vietnam for various scenarios. The intervention was not cost-effective at full acquisition cost, but it is important to acknowledge that cost-effectiveness arguments alone cannot solely guide decision-makers in Vietnam; other criteria, such as budget impact and ethical concerns, are crucial factors to consider in decision-making processes.
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Affiliation(s)
- Vu Quynh Mai
- Epidemiology and Global Public Health, Umea Universitet, Umea, Sweden
- Hanoi University of Public Health, Hanoi, Viet Nam
| | | | | | - Sun Sun
- Department of Epidemiology and Global Health, Umeå University, Umea, Sweden
- Department of Learning, Informatics Management and Ethics Karolinska Institute, Sweden
| | - Kim Bao Giang
- Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
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24
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Sugimoto A, Kaneda H, Yoshimoto N, Nagata K, Fujii T, Michimoto K, Ueno S, Kamimori T, Ishii Y, Sakagami M, Inokuchi H, Shibuya K, Mizutani M, Nagamine H, Nakahama K, Matsumoto Y, Tani Y, Sawa K, Kawaguchi T. Derived neutrophil-to-lymphocyte ratio has the potential to predict safety and outcomes of durvalumab after chemoradiation in non-small cell lung cancer. Sci Rep 2024; 14:19596. [PMID: 39179598 PMCID: PMC11343745 DOI: 10.1038/s41598-024-70214-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024] Open
Abstract
The usefulness of the derived neutrophil-to-lymphocyte ratio (dNLR) and its dynamics before/after durvalumab consolidation therapy to predict safety or efficacy remains unclear. We retrospectively reviewed patients with locally advanced non-small cell lung cancer treated with durvalumab consolidation therapy after chemoradiotherapy (D group) or chemoradiotherapy alone (non-D group) at multiple institutions. We investigated the association between dNLR, or its dynamics, and pneumonitis, checkpoint inhibitor-related pneumonitis (CIP), irAEs, and efficacy. Ninety-eight and fifty-six patients were enrolled in the D and non-D groups, respectively. The dNLR at baseline was significantly lower in patients who experienced irAEs or CIP than in those who did not. The low dNLR group, 28 days following durvalumab consolidation therapy (dNLR28 ≤ 3), demonstrated longer progression-free survival (PFS) and overall survival (OS) than the high dNLR group (dNLR28 > 3) (PFS, hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.22-0.88, p = 0.020; OS, HR 0.39, 95% CI 0.16-0.94, p = 0.037). Among patients with high dNLR at baseline (dNLR > 3), the dNLR28 ≤ 3 group showed longer PFS than the dNLR28 > 3 group (p = 0.010). The dNLR is a predictive factor for irAEs and CIP in patients receiving durvalumab consolidation therapy. The dNLR at 28 days after durvalumab consolidation therapy and its dynamics predict favorable outcomes.
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Affiliation(s)
- Akira Sugimoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroyasu Kaneda
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Naoki Yoshimoto
- Department of Respiratory Medicine, Ishikiriseiki Hospital, 18-28 Yayoi-cho, Higashiosaka, Osaka, 579-8026, Japan
| | - Kenji Nagata
- Department of Radiation Oncology, Ishikiriseiki Hospital, 18-28 Yayoi-cho, Higashiosaka, Osaka, 579-8026, Japan
| | - Tatsuo Fujii
- Department of Respiratory Medicine, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzaki-cho, Abeno-ku, Osaka, 545-0053, Japan
| | - Koichi Michimoto
- Department of Radiation Therapy, Osaka General Hospital of West Japan Railway Company, 1-2-22 Matsuzaki-cho, Abeno-ku, Osaka, 545-0053, Japan
| | - Shunsuke Ueno
- Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan
| | - Takao Kamimori
- Department of Respiratory Medicine, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan
| | - Yoshie Ishii
- Department of Radiation Therapy, Yodogawa Christian Hospital, 1-7-50 Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan
| | - Mai Sakagami
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Haruo Inokuchi
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Keiko Shibuya
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Megumi Mizutani
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nagamine
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenji Nakahama
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
- Department of Respiratory Medicine, Ishikiriseiki Hospital, 18-28 Yayoi-cho, Higashiosaka, Osaka, 579-8026, Japan
| | - Yoshiya Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoko Tani
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenji Sawa
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Tomoya Kawaguchi
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
- Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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25
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Bansal A, Lavoie RR, Lucien F, Kethamreddy M, Wootla B, Dong H, Park SS, Pandey MK. Synthesis and evaluation of anti-PD-L1-B11 antibody fragments for PET imaging of PD-L1 in breast cancer and melanoma tumor models. Sci Rep 2024; 14:19561. [PMID: 39174596 PMCID: PMC11341854 DOI: 10.1038/s41598-024-70385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 08/16/2024] [Indexed: 08/24/2024] Open
Abstract
There is a critical need to non-invasively assess the PD-L1 expression in tumors as a predictive biomarker for determining the efficacy of anti-PD-1/PD-L1 immunotherapies. Non-invasive imaging modality like positron emission tomography (PET) can be a powerful tool to assess the PD-L1 expression in the whole body including multiple metastases as a patient selection criterion for the anti-PD-1/PD-L1 immunotherapy. In this study, we synthesized B11-nanobody, B11-scFv and B11-diabody fragments from the full-length anti-PD-L1 B11 IgG. Out of the three antibody fragments, B11-diabody showed higher nM affinity towards PD-L1 antigen as compared to B11-scFv and B11-nanobody. All three antibody fragments were successfully radiolabeled with 64Cu, a PET radioisotope. For radiolabeling, the antibody fragments were first conjugated with p-SCN-Bn-NOTA followed by chelation with 64Cu. All three radiolabeled antibody fragments were found to be stable in mouse and human sera for up to 24 h. Additionally, all three [64Cu]Cu-NOTA-B11-antibody fragments were evaluated in PD-L1 negative and human PD-L1 expressing cancer cells and subcutaneous tumor models. Based on the results, [64Cu]Cu-NOTA-B11-diabody has potential to be used as a PET imaging probe for assessing PD-L1 expression in tumors as early as 4 h post-injection, allowing faster assessment compared to the full length IgG based PET imaging probe.
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Affiliation(s)
- Aditya Bansal
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Roxane R Lavoie
- Department of Urology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Fabrice Lucien
- Department of Urology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Manasa Kethamreddy
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Bharath Wootla
- Office of Translation to Practice, Mayo Clinic, Rochester, MN, 55905, USA
| | - Haidong Dong
- Department of Urology, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Mukesh K Pandey
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA.
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Leighl NB. Osimertinib in Stage III EGFR-Mutated NSCLC - Game, Set, Match. N Engl J Med 2024; 391:652-654. [PMID: 39141858 DOI: 10.1056/nejme2406495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Affiliation(s)
- Natasha B Leighl
- From Princess Margaret Cancer Centre and the University of Toronto, Toronto
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27
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Han Z, Li T, Zhang H, Liang K, You M, Xu M, Bai F, Zhang T. A case of response to combination treatment with TSA-DC-CTL immunotherapy and osimertinib in EGFR mutated advanced lung adenocarcinoma. Mol Cancer 2024; 23:163. [PMID: 39123231 PMCID: PMC11313023 DOI: 10.1186/s12943-024-02070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND This study details a case of a patient with advanced lung adenocarcinoma harboring an exon 19 deletion in the EGFR gene. METHOD A 46-year-old female patient was diagnosed with stage IVb left lung adenocarcinoma, with multiple bone and lymph node metastases. Following the identification of tumor-specific antigen peptides, the patient received a combination treatment of immunotherapy (TSA-DC-CTL) and oral osimertinib. Peripheral blood circulating immune cells and circulating tumor cells (CTCs) were monitored before and after treatment. PET-CT and CT scans were used to assess the tumor response to treatment. RESULTS A significant increase in total lymphocyte percentage and decrease in the number of CTCs in the patient was observed. Imaging studies showed a notable reduction in tumor metastases. CONCLUSION This report demonstrates the safety and efficacy of TSA-DC-CTL cell immunotherapy combined with osimertinib in the treatment of a patient with advanced lung adenocarcinoma with an EGFR exon 19 deletions. This study describes a promising new treatment option for patients with advanced lung cancer with EGFR mutations.
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Affiliation(s)
- Zhiyi Han
- Department of Surgery, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Tao Li
- Department of Medical Oncology, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong, 226361, China
| | - Heng Zhang
- Healthy Cell Biotechnology LLC, Beijing, 100036, China
| | - Kai Liang
- Healthy Cell Biotechnology LLC, Beijing, 100036, China
| | - Mingcong You
- Healthy Cell Biotechnology LLC, Beijing, 100036, China
| | - Mengdi Xu
- Healthy Cell Biotechnology LLC, Beijing, 100036, China
| | - Fan Bai
- Healthy Cell Biotechnology LLC, Beijing, 100036, China
| | - Tongmei Zhang
- Department of Medical Oncology, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic & Laboratory for Clinical Medicine, Capital Medical University, Beijing, 101149, China.
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Schirru M, Charef H, Ismaili KE, Fenneteau F, Zugaj D, Tremblay PO, Nekka F. Predicting efficacy assessment of combined treatment of radiotherapy and nivolumab for NSCLC patients through virtual clinical trials using QSP modeling. J Pharmacokinet Pharmacodyn 2024; 51:319-333. [PMID: 38493439 DOI: 10.1007/s10928-024-09903-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/05/2024] [Indexed: 03/19/2024]
Abstract
Non-Small Cell Lung Cancer (NSCLC) remains one of the main causes of cancer death worldwide. In the urge of finding an effective approach to treat cancer, enormous therapeutic targets and treatment combinations are explored in clinical studies, which are not only costly, suffer from a shortage of participants, but also unable to explore all prospective therapeutic solutions. Within the evolving therapeutic landscape, the combined use of radiotherapy (RT) and checkpoint inhibitors (ICIs) emerged as a promising avenue. Exploiting the power of quantitative system pharmacology (QSP), we undertook a study to anticipate the therapeutic outcomes of these interventions, aiming to address the limitations of clinical trials. After enhancing a pre-existing QSP platform and accurately replicating clinical data outcomes, we conducted an in-depth study, examining different treatment protocols with nivolumab and RT, both as monotherapy and in combination, by assessing their efficacy through clinical endpoints, namely time to progression (TTP) and duration of response (DOR). As result, the synergy of combined protocols showcased enhanced TTP and extended DOR, suggesting dual advantages of extended response and slowed disease progression with certain combined regimens. Through the lens of QSP modeling, our findings highlight the potential to fine-tune combination therapies for NSCLC, thereby providing pivotal insights for tailoring patient-centric therapeutic interventions.
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Affiliation(s)
- Miriam Schirru
- Laboratoire de recherche en pharmacométrie, Faculté de pharmacie, Université de Montréal, Montreal, Canada.
| | - Hamza Charef
- Laboratoire de recherche en pharmacométrie, Faculté de pharmacie, Université de Montréal, Montreal, Canada
| | - Khalil-Elmehdi Ismaili
- Laboratoire de recherche en pharmacométrie, Faculté de pharmacie, Université de Montréal, Montreal, Canada
| | - Frédérique Fenneteau
- Laboratoire de recherche en pharmacométrie, Faculté de pharmacie, Université de Montréal, Montreal, Canada
| | - Didier Zugaj
- Clinical Pharmacology, Syneos Health, Quebec, Quebec G1P 0A2, Canada
| | | | - Fahima Nekka
- Laboratoire de recherche en pharmacométrie, Faculté de pharmacie, Université de Montréal, Montreal, Canada
- Centre de recherches mathématiques (CRM), Université de Montréal, Montreal, Canada
- Centre for Applied Mathematics in Bioscience and Medicine (CAMBAM), McGill University, Montreal, Canada
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Watts T, Roche D, Csontos J. Patients' experiences of cancer immunotherapy with immune checkpoint inhibitors: A systematic review and thematic synthesis. J Clin Nurs 2024; 33:2885-2904. [PMID: 38589992 DOI: 10.1111/jocn.17154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/19/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
AIM To obtain a deeper understanding of peoples' experiences of cancer treatments with immune checkpoint inhibitors (ICIs). BACKGROUND ICIs are transforming survival outcomes for many with certain advanced cancers. Given the possibility of unique immune-related adverse events (irAEs), understanding treatment experiences is crucial to identify support needs and provide safe and effective person-centred care. DESIGN A systematic review of qualitative research and thematic synthesis. To report this review, the Preferred Reporting Items for Systematic Analysis and Meta Analysis (PRISMA) checklist and Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidance have been used. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science databases were searched in January 2022 for eligible studies published in English from database inception. REVIEW METHODS Two reviewers independently screened records, identified papers for inclusion and appraised methodological quality using the Critical Appraisal Skills Programme checklist. Themes were developed using thematic synthesis. RESULTS Eighteen papers were included and three analytical themes developed: immune checkpoint inhibitor treatment decision-making; the experience and impact of immune checkpoint inhibitor treatments; and appraising and responding to irAEs. CONCLUSION The synthesis renders visible individuals' unmet information, psychological and practical support needs. It identifies shortcomings in immune checkpoint inhibitor treatment decision-making processes and highlights the need for healthcare professionals to recognise and sensitively handle individuals' treatment expectations. Individuals' understandings of and responses to irAEs are also illustrated, and attention drawn to patients' concerns about healthcare professionals' checkpoint inhibitor and irAEs knowledge. IMPLICATIONS FOR PATIENT CARE To sensitively manage treatment expectations and uncertainties, and optimise health outcomes, there are distinct points in treatment trajectories where care and support might require adapting and enhancing. IMPACT This review addresses people's experiences of immune checkpoint inhibitor treatments. The core findings reveal unmet information, psychological and practical support needs. Insights derived from this review will enhance individuals' experiences and outcomes and healthcare professionals' practice. PATIENT OR PUBLIC CONTRIBUTION No patient or public involvement.
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Affiliation(s)
- Tessa Watts
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Dominic Roche
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Judit Csontos
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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McGee HM, Williams TM, Lee P. Radiation With Immunotherapy May Be a Double-Edged Sword-How Can We Learn From Recent Negative Clinical Trials? JAMA Oncol 2024; 10:1019-1020. [PMID: 38842841 DOI: 10.1001/jamaoncol.2024.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
This Viewpoint explains differences between recent studies using radiotherapy with immunotherapy and possible reasons for their different outcomes.
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Affiliation(s)
- Heather M McGee
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
- Department of Immuno-Oncology, Beckman Research Institute of City of Hope, Duarte, California
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
- Department of Cancer Genetics & Epigenetics, Beckman Research Institute of City of Hope, Duarte, California
| | - Percy Lee
- Department of Radiation Oncology, City of Hope Orange County, Irvine, California
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Craig C, Johnston J, Goodley P, Bishop P, Al-Najjar H, Brown L, Gallagher J, Sundar R, Upperton S, Callister M, Meek D, Succony L, Parvez W, Tufail M, Jayasekera G, Maclay J, Livesey A, Woolhouse I, Smith N, Bibby A, Evison M. What Is the Accuracy of Clinical Staging for Stage III-Single-station N2 NSCLC? A Multi-Centre UK Study. JTO Clin Res Rep 2024; 5:100694. [PMID: 39161961 PMCID: PMC11332836 DOI: 10.1016/j.jtocrr.2024.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction Single-station N2 (ssN2) versus multi-station N2 has been used as a selection criterion for treatment recommendations between surgical versus non-surgical multimodality treatment in stage III-N2 NSCLC. We hypothesized that clinical staging would be susceptible to upstaging on pathologic staging and, therefore, challenge this practice. Methods A retrospective study of prospectively collected routine clinical data for patients with stage III-N2 NSCLC that had completed computed tomography (CT), positron emission tomography (PET), and staging endobronchial ultrasound (EBUS) and had been confirmed clinical stage III-ssN2 at multidisciplinary team discussion and went on to complete surgical resection as the first treatment to provide pathologic staging. The study was completed in two cohorts (A) across a single cancer alliance in England (Greater Manchester) January 1, 2015 to December 31, 2018 and (B) across five United Kingdom centers to validate the findings in part A January 1, 2016 to December 31, 2020. Results A total of 115 patients met the inclusion criteria across cohort A (56 patients) and cohort B (59 patients) across 15 United Kingdom hospitals. The proportion of cases in which clinical stage III-ssN2 was upstaged to pathologic stage III-multi-station N2 was 34% (19 of 56) in cohort A, 32% in cohort B (19 of 59), and 33% across the combined study cohort (38 of 115). Most patients had a single radiologically abnormal lymph node on CT and PET (88%, 105 of 115). In the majority, the reasons for missed N2 disease on staging EBUS were due to inaccessible (stations 5, 6, 8, 9) N2 nodes at EBUS (34%, 13 of 38) and accessible lymph nodes not sampled during staging EBUS as not meeting sampling threshold (40%, 15 of 38) rather than false-negative sampling during EBUS (26%, 10 of 38). Conclusions During multidisciplinary team discussions, clinicians must be aware that one-third of patients with stage III-ssN2 on the basis of CT, PET, and staging EBUS do not truly have ssN2 and this questions the use of this criterion to define treatment recommendations.
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Affiliation(s)
- Christopher Craig
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Janet Johnston
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Patrick Goodley
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Bishop
- Department of Thoracic Histopathology, Clinical Support Services, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Haider Al-Najjar
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Louise Brown
- North Manchester General Hospital, Manchester, United Kingdom
| | - Joanna Gallagher
- Macclesfield Hospital, East Cheshire NHS Trust, Macclesfield, United Kingdom
| | - Ramachandran Sundar
- Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, United Kingdom
| | - Sara Upperton
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - David Meek
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Laura Succony
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Wadood Parvez
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Muhammad Tufail
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Geeshath Jayasekera
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - John Maclay
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Alana Livesey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ian Woolhouse
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Anna Bibby
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Matthew Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
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Zhu H, Xu Y, Gao H, Fan X, Fan M, Zhao K, Yang H, Zhu Z, Wu K. Long-term outcome of definitive radiotherapy for locally advanced non-small cell lung cancer: A real-world single-center study in the pre-durvalumab era. Cancer Med 2024; 13:e70051. [PMID: 39082888 PMCID: PMC11289899 DOI: 10.1002/cam4.70051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND There was limited research data on large-scale locally advanced non-small cell lung cancer (LA-NSCLC) radical radiotherapy (RT) reported in China. This study examined overall survival (OS), progression-free survival (PFS), treatment effectiveness, and toxicity in patients with LA-NSCLC treated with definitive RT in the pre-durvalumab era. METHODS A retrospective analysis of demographic information, clinical characteristics, treatment patterns, and clinical outcomes of 789 patients with LA-NSCLC who underwent radical RT at our center between January 2005 and December 2015 was performed. The Kaplan-Meier method and log-rank test were used for survival comparisons, and Cox regression was used for multivariate analysis. RESULTS There were 328 patients with stage IIIA disease and 461 with stage IIIB disease. By the last follow-up, there were 365 overall deaths and 576 cases of recurrence, metastasis, or death. The median survival time was 31 months. The OS rates at 1, 2, 5, and 10 years were 83.7%, 59.5%, 28.8%, and 18.9%, respectively. PFS rates at 1, 2, 5, and 10 years were 48%, 24.5%, 11.9%, and 5.5%, respectively. Rates of ≥grade 3 acute radiation pneumonitis or esophagitis were 7.6% and 1.9%, respectively. Rates of ≥grade 3 chronic radiation pneumonitis and esophagitis were 11% and 0.4%, respectively. Multivariate analysis showed that the Karnofsky Performance Status (KPS) score, smoking status, and combined chemotherapy were prognostic factors for OS (p < 0.05). Multivariate analysis revealed that combined chemotherapy and radiation dose were prognostic factors for PFS (p < 0.05). CONCLUSIONS Our center's data showed that the survival prognosis of locally advanced patients receiving RT and chemotherapy in China was consistent with international levels during the same period. Patients with a KPS score of 80 or higher, who had never smoked or received combined RT, had a more favorable prognosis than those with a KPS of less than 80, who had smoked, or only received RT. The combination of RT and chemotherapy, with a reasonable radiation dose, was the key to improving the therapeutic effect.
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Affiliation(s)
- Hong Zhu
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Radiation Oncology, Tongji HospitalTongji University School of MedicineShanghaiChina
| | - Yi Xu
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Huiquan Gao
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
| | - Xingwen Fan
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Ming Fan
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Kuaile Zhao
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Huanjun Yang
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Zhengfei Zhu
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
| | - Kailiang Wu
- Department of Radiation OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
- Shanghai Clinical Research Center for Radiation OncologyShanghaiChina
- Shanghai Key Laboratory of Radiation OncologyShanghaiChina
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Li R, Xu Y, Zhao J, Zhang L, Zhong W, Gao X, Liu X, Chen M, Wang M. Comparison of radiotherapy versus surgical resection following neoadjuvant chemoimmunotherapy in potentially resectable stage III non-small-cell lung cancer: A propensity score matching analysis. Lung Cancer 2024; 194:107884. [PMID: 38991281 DOI: 10.1016/j.lungcan.2024.107884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Neoadjuvant chemoimmunotherapy followed by surgery is recommended for resectable non-small-cell lung cancer (NSCLC). However, a considerable proportion of patients do not undergo surgery and opt for alternative treatments such as radiotherapy. The efficacy of radiotherapy in this context remains unclear. METHODS This retrospective study analyzed data from patients with stage III NSCLC who received neoadjuvant chemoimmunotherapy followed by either surgery or radiotherapy. Propensity score matching (PSM) was used to balance the heterogeneity between the groups. Efficacy outcomes, safety profiles, and disease recurrence patterns were assessed. RESULTS In total, 175 patients were included; 50 underwent radiotherapy, and 125 underwent surgery. Prior to matching, radiotherapy was inferior to surgery in terms of progression-free survival (PFS; Hazard ratio [HR], 2.23; P = 0.008). Following a 1:1 PSM adjustment, each group consisted of 40 patients. The median PFS was 30.8 months in the radiotherapy group and not reached in the surgery group (HR, 1.46; P = 0.390). The 12- and 24-month PFS rates were 90.4 % and 69.0 % for the radiotherapy group compared to 94.1 % and 73.9 % for the surgery group, respectively. Subgroup analyses after PSM showed that patients with stage IIIA disease tend to benefit more from surgery than those with stage IIIB disease (HR, 3.00; P = 0.074). Grade 3-4 treatment-related adverse events (TRAEs) occurred in 62.5 % of patients in the radiotherapy group and 55.0 % in the surgery group, with no grade 5 TRAEs reported. The incidence of grade 3-4 treatment-related pneumonitis or pneumonia was 7.5 % and 2.5 % in the radiotherapy and surgery groups, respectively. CONCLUSION Radiotherapy may be a viable alternative to surgery in patients with resectable NSCLC who do not undergo surgical resection after initial neoadjuvant chemoimmunotherapy, offering comparable efficacy and a manageable safety profile. Larger prospective studies are needed to validate these findings and optimize the treatment strategies for this patient population.
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Affiliation(s)
- Rongzhen Li
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Xu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jing Zhao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Li Zhang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Zhong
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaoxing Gao
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaoyan Liu
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Minjiang Chen
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Chun SG, Hu C, Komaki RU, Timmerman RD, Schild SE, Bogart JA, Dobelbower MC, Bosch W, Kavadi VS, Narayan S, Iyengar P, Robinson C, Rothman J, Raben A, Augspurger ME, MacRae RM, Paulus R, Bradley JD. Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2024; 10:1111-1115. [PMID: 38935373 PMCID: PMC11211986 DOI: 10.1001/jamaoncol.2024.1841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/09/2024] [Indexed: 06/28/2024]
Abstract
Importance The optimal radiotherapy technique for unresectable locally advanced non-small cell lung cancer (NSCLC) is controversial, so evaluating long-term prospective outcomes of intensity-modulated radiotherapy (IMRT) is important. Objective To compare long-term prospective outcomes of patients receiving IMRT and 3-dimensional conformal radiotherapy (3D-CRT) with concurrent carboplatin/paclitaxel for locally advanced NSCLC. Design, Setting, and Participants A secondary analysis of a prospective phase 3 randomized clinical trial NRG Oncology-RTOG 0617 assessed 483 patients receiving chemoradiotherapy (3D-CRT vs IMRT) for locally advanced NSCLC based on stratification. Main Outcomes and Measures Long-term outcomes were analyzed, including overall survival (OS), progression-free survival (PFS), time to local failure, development of second cancers, and severe grade 3 or higher adverse events (AEs) per Common Terminology Criteria for Adverse Events, version 3. The percentage of an organ volume (V) receiving a specified amount of radiation in units of Gy is reported as V(radiation dose). Results Of 483 patients (median [IQR] age, 64 [57-70] years; 194 [40.2%] female), 228 (47.2%) received IMRT, and 255 (52.8%) received 3D-CRT (median [IQR] follow-up, 5.2 [4.8-6.0] years). IMRT was associated with a 2-fold reduction in grade 3 or higher pneumonitis AEs compared with 3D-CRT (8 [3.5%] vs 21 [8.2%]; P = .03). On univariate analysis, heart V20, V40, and V60 were associated with worse OS (hazard ratios, 1.06 [95% CI, 1.04-1.09]; 1.09 [95% CI, 1.05-1.13]; 1.16 [95% CI, 1.09-1.24], respectively; all P < .001). IMRT significantly reduced heart V40 compared to 3D-CRT (16.5% vs 20.5%; P < .001). Heart V40 (<20%) had better OS than V40 (≥20%) (median [IQR], 2.5 [2.1-3.1] years vs 1.7 [1.5-2.0] years; P < .001). On multivariable analysis, heart V40 (≥20%), was associated with worse OS (hazard ratio, 1.34 [95% CI, 1.06-1.70]; P = .01), whereas lung V5 and age had no association with OS. Patients receiving IMRT and 3D-CRT had similar rates of developing secondary cancers (15 [6.6%] vs 14 [5.5%]) with long-term follow-up. Conclusions and Relevance These findings support the standard use of IMRT for locally advanced NSCLC. IMRT should aim to minimize lung V20 and heart V20 to V60, rather than constraining low-dose radiation bath. Lung V5 and age were not associated with survival and should not be considered a contraindication for chemoradiotherapy. Trial Registration ClinicalTrials.gov Identifier: NCT00533949.
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Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
- American College of Radiology, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | - Samir Narayan
- Trinity Health Saint Joseph Mercy Hospital, Ann Arbor, Michigan
| | | | | | - Jan Rothman
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Adam Raben
- Christiana Care Health System, Christiana Hospital, Newark, Delaware
| | | | | | - Rebecca Paulus
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
- American College of Radiology, Philadelphia, Pennsylvania
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Luo Y, Lu J, Lei Z, Zhu H, Rao D, Wang T, Fu C, Zhang Z, Xia L, Huang W. Lysine methylation modifications in tumor immunomodulation and immunotherapy: regulatory mechanisms and perspectives. Biomark Res 2024; 12:74. [PMID: 39080807 PMCID: PMC11289998 DOI: 10.1186/s40364-024-00621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024] Open
Abstract
Lysine methylation is a crucial post-translational modification (PTM) that significantly impacts gene expression regulation. This modification not only influences cancer development directly but also has significant implications for the immune system. Lysine methylation modulates immune cell functions and shapes the anti-tumor immune response, highlighting its dual role in both tumor progression and immune regulation. In this review, we provide a comprehensive overview of the intrinsic role of lysine methylation in the activation and function of immune cells, detailing how these modifications affect cellular processes and signaling pathways. We delve into the mechanisms by which lysine methylation contributes to tumor immune evasion, allowing cancer cells to escape immune surveillance and thrive. Furthermore, we discuss the therapeutic potential of targeting lysine methylation in cancer immunotherapy. Emerging strategies, such as immune checkpoint inhibitors (ICIs) and chimeric antigen receptor T-cell (CAR-T) therapy, are being explored for their efficacy in modulating lysine methylation to enhance anti-tumor immune responses. By targeting these modifications, we can potentially improve the effectiveness of existing treatments and develop novel therapeutic approaches to combat cancer more effectively.
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Affiliation(s)
- Yiming Luo
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Junli Lu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zhen Lei
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - He Zhu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Dean Rao
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Tiantian Wang
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Chenan Fu
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Zhiwei Zhang
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
- Clinical Medicine Research Center for Hepatic Surgery of Hubei Province, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, 430030, Hubei, China
| | - Limin Xia
- Department of Gastroenterology, Institute of Liver and Gastrointestinal Diseases, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Wenjie Huang
- Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
- Clinical Medicine Research Center for Hepatic Surgery of Hubei Province, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, 430030, Hubei, China.
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Kawachi H, Tamiya M, Oya Y, Saito G, Taniguchi Y, Matsumoto H, Sato Y, Otsuki T, Suzuki H, Fukuda Y, Tanaka S, Tsukita Y, Uchida J, Sakata Y, Nakatani Y, Shibaki R, Arai D, Okada A, Hara S, Takayama K, Nishino K. Real-World Outcomes of Subsequent Chemotherapy after Progression Following Chemoradiation and Consolidative Durvalumab Therapy in Locally Advanced Non-small Cell Lung Cancer: An Exploratory Analysis from the CRIMSON Study (HOPE-005). Clin Lung Cancer 2024:S1525-7304(24)00152-9. [PMID: 39138106 DOI: 10.1016/j.cllc.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/11/2024] [Accepted: 07/21/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND The optimal subsequent treatment strategy for locally advanced non-small cell lung cancer (LA-NSCLC) after chemoradiotherapy (CRT) and consolidative durvalumab therapy remains unknown. We aimed to determine the optimal subsequent treatment strategy for this clinical population. MATERIALS AND METHODS We retrospectively enrolled 523 consecutive patients with LA-NSCLC treated with CRT and analyzed the treatment outcomes of subsequent therapy after progression following CRT and consolidative durvalumab therapy. Patients who received tyrosine kinase inhibitors as subsequent therapy were excluded. RESULTS Out of 122 patients who received subsequent chemotherapy, 55% underwent platinum-based, 25% non-platinum-based, and 20% immune checkpoint inhibitor (ICI)-containing therapies. In the platinum-based group, patients with a durvalumab-progression-free survival (Dur-PFS) ≥ 1 year had a significantly longer median subsequent therapy-PFS (SubTx-PFS) than those with Dur-PFS < 1 year (13.2 months vs. 4.7 months; hazard ratio, 0.45; 95% confidence interval, 0.21-0.97; P = .04). Furthermore, among patients receiving non-platinum-based chemotherapy, the median SubTx-PFS was longer in the combined with angiogenesis inhibitor group than in the without group, although the difference was not statistically significant. No significant difference of SubTx-PFS was observed between the reason for durvalumab discontinuation and the outcomes of ICI-containing therapy. CONCLUSION In clinical practice, platinum-based chemotherapy rechallenge is frequently employed following progression subsequent to CRT and consolidative durvalumab therapy for LA-NSCLC. Optimal treatment strategies may consider Dur-PFS and angiogenesis inhibitor feasibility. Further research is warranted to identify clinical biomarkers that can help identify patients who would benefit from ICI rechallenge.
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Affiliation(s)
- Hayato Kawachi
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan; Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan.
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan; Department of Respiratory Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Go Saito
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan
| | - Yoshihiko Taniguchi
- Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Taiichiro Otsuki
- Department of Respiratory Medicine and Hematology, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Habikino, Osaka, Japan
| | - Yasushi Fukuda
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Satoshi Tanaka
- Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Junji Uchida
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Osaka, Japan
| | - Yoshihiko Sakata
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, Japan
| | - Yuki Nakatani
- Department of Medical Oncology, Osaka City General Hospital, Osaka, Osaka, Japan
| | - Ryota Shibaki
- Internal Medicine III, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Daisuke Arai
- Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Asuka Okada
- Department of Respiratory Medicine, Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Satoshi Hara
- Department of Respiratory Medicine, Itami City Hospital, Itami, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Kazumi Nishino
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Osaka, Japan
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Damhuis R, Bahce I, Senan S. Association Between PD-L1 Score and the Outcomes of Consolidation Durvalumab in a Large Nationwide Series of Patients With Stage III NSCLC Treated With Chemoradiotherapy. Clin Lung Cancer 2024:S1525-7304(24)00150-5. [PMID: 39153866 DOI: 10.1016/j.cllc.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/18/2024] [Accepted: 07/20/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The Pacific trial reported improved outcomes when durvalumab was administered following concurrent chemoradiotherapy (CRT) for stage III NSCLC. Post-hoc subgroup analysis did not show favorable results for PD-L1 negative cases. We compared nationwide survival data with the trial outcomes, and evaluated the influence of PD-L1. PATIENTS AND METHODS Data from the Netherlands Cancer Registry were queried regarding patients with clinical stage III who underwent CRT, either by concurrent or sequential administration. Predictors for the use of consolidation treatment with durvalumab were evaluated by tabulations and logistic regression analysis. Overall survival (OS) was calculated from start of radiation or start of durvalumab and was stratified by PD-L1 score. RESULTS Between 2017 and 2021, application of consolidation durvalumab increased from 2% to 21%, 40%, 57%, 62%, respectively. In the period 2020-2021, durvalumab use was more frequent among patients with younger age, concurrent CRT, better performance score and proton radiation, but was irrespective of PD-L1 score. For patients receiving durvalumab (n = 1639), the 4-year OS was 53% overall (95%CI 50-57), and it was 56% (95%CI 52-60) after concurrent CRT. Four-year OS was considerably better for the PD-L1 subgroup ≧50% at 67% (95%CI 59-73), and it was similar for PD-L1 subgroups 0 and 1-49, at 51% (95%CI 42-58) and 46% (95%CI 39-54), respectively. CONCLUSION In real-world clinical practice, survival outcomes were equivalent to results from trial series. Overall survival in patients with negative PD-L1 was similar to the survival in patients with PD-L1 1-49, questioning the restrictions imposed by the European Medicines Agency.
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Affiliation(s)
- Ronald Damhuis
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht, The Netherlands.
| | - Idris Bahce
- Department of Pulmonary Medicine, Amsterdam University Medical Center location VUmc, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Center location VUmc, Amsterdam, The Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Su Q, Pan J, Wang C, Zhang M, Cui H, Zhao X. Curcumin and Baicalin Co-Loaded Nanoliposomes for Synergistic Treatment of Non-Small Cell Lung Cancer. Pharmaceutics 2024; 16:973. [PMID: 39204318 PMCID: PMC11359521 DOI: 10.3390/pharmaceutics16080973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
Currently, the treatment of patients with advanced non-small cell lung cancer (NSCLC) mainly relies on traditional chemotherapeutic drugs; however, most of them have limited therapeutic effects and high toxicity. Some natural products with good therapeutic efficacy and low toxicity and side effects are limited in clinical application due to their low solubility and bioavailability. In this study, a nanoliposome drug-carrying system (Lip-Cur/Ba) was developed for the co-delivery of curcumin (Cur) and baicalin (Ba) using the thin-film hydration method. In vitro experiments demonstrated that Lip-Cur/Ba had a strong killing effect on A549 cells, and the inhibitory effect of Lip-Cur/Ba on A549 cells was enhanced by 67.8% and 51.9% relative to that of the single-carrier system, which could reduce the use of a single-drug dose (Lip-Cur and Lip-Ba), delay the release rate of the drug and improve the bioavailability. In vivo experiments demonstrated the antitumor activity of Lip-Cur/Ba by intravitreal injection in BALB/c mice, and there were no obvious toxic side effects. This study provides a new idea for curcumin and baicalin to be used in the co-treatment of NSCLC by constructing a new vector.
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Affiliation(s)
| | | | | | | | | | - Xiang Zhao
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing 100081, China; (Q.S.); (J.P.); (C.W.); (M.Z.); (H.C.)
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39
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Guo H, Zhang C, Shen YK, Zhang JD, Yang FY, Liang F, Wang W, Liu YT, Wang GZ, Zhou GB. PD-L2 mediates tobacco smoking-induced recruitment of regulatory T cells via the RGMB/NFκB/CCL20 cascade. Cell Biol Toxicol 2024; 40:56. [PMID: 39042313 PMCID: PMC11266262 DOI: 10.1007/s10565-024-09892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/18/2024] [Indexed: 07/24/2024]
Abstract
Programmed cell death ligand 2 (PD-L2), a ligand for the receptor programmed cell death 1 (PD-1), has an identity of 34% with its twin ligand PD-L1 and exhibits higher binding affinity with PD-1 than PD-L1. However, the role of PD-L2 in non-small cell lung cancer (NSCLC) progression, especially tobacco-induced cancer progression, has not been fully understood. Here, we found that PD-L2 promoted tumor growth in murine models with recruitment of regulatory T cells (Tregs). In patients with NSCLC, PD-L2 expression level in tumor samples was higher than in counterpart normal controls and was positively associated with patients' response to anti-PD-1 treatment. Mechanismly, PD-L2 bound its receptor Repulsive guidance molecule B (RGMB) on cancer cells and activated extracellular signal-regulated kinase (Erk) and nuclear factor κB (NFκB), leading to increased production of chemokine CCL20, which recruited Tregs and contributed to NSCLC progression. Consistently, knockdown of RGMB or NFκB p65 inhibited PD-L2-induced CCL20 production, and silencing of PD-L2 repressed Treg recruitment by NSCLC cells. Furthermore, cigarette smoke and carcinogen benzo(a)pyrene (BaP) upregulated PD-L2 in lung epithelial cells via aryl hydrocarbon receptor (AhR)-mediated transcription activation, whose deficiency markedly suppressed BaP-induced PD-L2 upregulation. These results suggest that PD-L2 mediates tobacco-induced recruitment of Tregs via the RGMB/NFκB/CCL20 cascade, and targeting this pathway might have therapeutic potentials in NSCLC.
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Affiliation(s)
- Hua Guo
- State Key Laboratory of Molecular Oncology & Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chen Zhang
- School of Life Sciences and Engineering, Handan University, Handan, Hebei Province, 056005, China
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Yu-Ke Shen
- State Key Laboratory of Molecular Oncology & Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jian-Dong Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
- Shanxi Bethune Hospital Affiliated with Shanxi Academy of Medical Sciences, Taiyuan, Shanxi Province, 030032, China
| | - Fu-Ying Yang
- State Key Laboratory of Molecular Oncology & Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fan Liang
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
- School of Basic Medicine, Weifang Medical University, Shandong, 261000, China
| | - Wei Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yu-Tao Liu
- State Key Laboratory of Molecular Oncology & Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Gui-Zhen Wang
- State Key Laboratory of Molecular Oncology & Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Guang-Biao Zhou
- State Key Laboratory of Molecular Oncology & Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Coussement M, Fazio R, Audisio A, El Khoury R, Abbassi FZ, Assaf I, Conti C, Gallio C, Benhima N, Bregni G, Gkolfakis P, Spagnolo V, Anthoine G, Liberale G, Moretti L, Martinive P, Hendlisz A, Demetter P, Sclafani F. PD-L1 Expression in Paired Samples of Rectal Cancer. Cancers (Basel) 2024; 16:2606. [PMID: 39061244 PMCID: PMC11275196 DOI: 10.3390/cancers16142606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Immune checkpoint inhibitors and immune-related biomarkers are increasingly investigated in rectal cancer (RC). We retrospectively analysed PD-L1 expression in diagnostic biopsy and resection samples from RC patients treated at our centre between 2000 and 2020. PD-L1 immunostaining (22C3 clone) was evaluated according to tumour proportion (TPS), immune cell (ICS), and the combined positive score (CPS). Eighty-three patients were included. At diagnosis, PD-L1 expression ≥1%/≥5% was observed in 15.4%/0%, 80.7%/37.4%, and 69.2%/25.6% of patients based on TPS, ICS, and CPS, respectively. At surgery, the respective figures were 4.6%/1.5%, 60.2%/32.5%, and 50.7%/26.2%. Using the 1% cut-off and regardless of the scoring system, PD-L1 was less expressed in surgery than biopsy samples (p ≤ 0.04). In paired specimens, PD-L1-ICS reduction was especially observed following neoadjuvant long-course (chemo)radiotherapy (p = 0.03). PD-L1-ICS of ≥5% in surgical samples (HR: 0.17; p = 0.02), and a biopsy-to-surgery increase in PD-L1-ICS (HR: 0.19; p = 0.04) was predictive for longer disease-free survival, while the PD-L1-ICS of either ≥1% (HR 0.28; p = 0.04) or ≥5% (HR 0.19; p = 0.03) in surgical samples and the biopsy-to-surgery increase in PD-L1-ICS (HR: 0.20; p = 0.04) were associated with better overall survival. Our study suggests that PD-L1 expression in RC is largely reflective of immune cell infiltration, and its presence/increase in surgical samples predicts better outcomes.
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Affiliation(s)
- Mina Coussement
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Roberta Fazio
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Alessandro Audisio
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Reem El Khoury
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Fatima-Zahra Abbassi
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Irene Assaf
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Chiara Conti
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Chiara Gallio
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Nada Benhima
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Giacomo Bregni
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Paraskevas Gkolfakis
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Valentina Spagnolo
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Geraldine Anthoine
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Gabriel Liberale
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Luigi Moretti
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Philippe Martinive
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Alain Hendlisz
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
| | - Pieter Demetter
- Cerba Path, Division CMP, 1070 Brussels, Belgium
- Laboratory for Experimental Gastroenterology, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Francesco Sclafani
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), 1070 Brussels, Belgium; (M.C.); (R.F.); (V.S.)
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Barlesi F, Cho BC, Goldberg SB, Yoh K, Zimmer Gelatti AC, Mann H, Gopinathan A, Bielecka ZF, Newton M, Aggarwal C. PACIFIC-9: Phase III trial of durvalumab + oleclumab or monalizumab in unresectable stage III non-small-cell lung cancer. Future Oncol 2024:1-11. [PMID: 39023287 DOI: 10.1080/14796694.2024.2354160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/08/2024] [Indexed: 07/20/2024] Open
Abstract
Evidence from the Phase III PACIFIC trial established durvalumab, a monoclonal antibody (mAb) targeting PD-L1, following concurrent chemoradiotherapy (cCRT) as a global standard of care for patients with unresectable, stage III non-small-cell lung cancer (NSCLC). There remains an unmet need to improve upon the outcomes achieved with the PACIFIC regimen. Combining durvalumab with other immunotherapies may improve outcomes further. Two such immunotherapies include oleclumab, an mAb targeting CD73, and monalizumab, an mAb targeting NKG2A. Both agents demonstrated antitumor activity in early-phase trials. PACIFIC-9 (NCT05221840) is an international, double-blind, randomized, placebo-controlled, Phase III trial comparing durvalumab plus either oleclumab or monalizumab with durvalumab plus placebo in patients with unresectable, stage III NSCLC and no disease progression following cCRT.Clinical Trial Registration: NCT05221840 (ClinicalTrials.gov).
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Affiliation(s)
- Fabrice Barlesi
- Gustave Roussy, Medical Oncology Department, Villejuif, France
- Paris Saclay University, Faculty of Medicine, Kremlin-Bicêtre, France
| | - Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Sarah B Goldberg
- Yale School of Medicine & Yale Cancer Center, New Haven, CT, USA
| | - Kiyotaka Yoh
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Ana Caroline Zimmer Gelatti
- Grupo Oncoclínicas, Porto Alegre, Brazil
- Grupo Brasileiro de Oncologia Torácica, Porto Alegre, Brazil
- Hospital São Lucas PUC/RS, Brazil
| | | | | | | | | | - Charu Aggarwal
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA USA
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Dunne VL, Ghita-Pettigrew M, Redmond KM, Small DM, Weldon S, Taggart CC, Prise KM, Hanna GG, Butterworth KT. PTEN Depletion Increases Radiosensitivity in Response to Ataxia Telangiectasia-Related-3 (ATR) Inhibition in Non-Small Cell Lung Cancer (NSCLC). Int J Mol Sci 2024; 25:7817. [PMID: 39063060 PMCID: PMC11277409 DOI: 10.3390/ijms25147817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Radiotherapy (RT) treatment is an important strategy for the management of non-small cell lung cancer (NSCLC). Local recurrence amongst patients with late-stage NSCLC remains a challenge. The loss of PTEN has been associated with radio-resistance. This study aimed to examine the efficacy of RT combined with ataxia telangiectasia-mutated Rad3-related (ATR) inhibition using Ceralasertib in phosphatase and tensin homolog (PTEN)-depleted NSCLC cells and to assess early inflammatory responses indicative of radiation pneumonitis (RP) after combined-modality treatment. Small hairpin RNA (shRNA) transfections were used to generate H460 and A549 PTEN-depleted models. Ceralasertib was evaluated as a single agent and in combination with RT in vitro and in vivo. Histological staining was used to assess immune cell infiltration in pneumonitis-prone C3H/NeJ mice. Here, we report that the inhibition of ATR in combination with RT caused a significant reduction in PTEN-depleted NSCLC cells, with delayed DNA repair and reduced cell viability, as shown by an increase in cells in Sub G1. Combination treatment in vivo significantly inhibited H460 PTEN-depleted tumour growth in comparison to H460 non-targeting PTEN-expressing (NT) cell-line-derived xenografts (CDXs). Additionally, there was no significant increase in infiltrating macrophages or neutrophils except at 4 weeks, whereby combination treatment significantly increased macrophage levels relative to RT alone. Overall, our study demonstrates that ceralasertib and RT combined preferentially sensitises PTEN-depleted NSCLC models in vitro and in vivo, with no impact on early inflammatory response indicative of RP. These findings provide a rationale for evaluating ATR inhibition in combination with RT in NSCLC patients with PTEN mutations.
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Affiliation(s)
- Victoria L. Dunne
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK; (M.G.-P.); (K.M.R.); (D.M.S.); (K.M.P.); (K.T.B.)
| | - Mihaela Ghita-Pettigrew
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK; (M.G.-P.); (K.M.R.); (D.M.S.); (K.M.P.); (K.T.B.)
| | - Kelly M. Redmond
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK; (M.G.-P.); (K.M.R.); (D.M.S.); (K.M.P.); (K.T.B.)
| | - Donna M. Small
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK; (M.G.-P.); (K.M.R.); (D.M.S.); (K.M.P.); (K.T.B.)
| | - Sinéad Weldon
- Airway Innate Immunity Research Group (AiiR), Wellcome Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7AE, UK; (S.W.); (C.C.T.)
| | - Clifford C. Taggart
- Airway Innate Immunity Research Group (AiiR), Wellcome Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7AE, UK; (S.W.); (C.C.T.)
| | - Kevin M. Prise
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK; (M.G.-P.); (K.M.R.); (D.M.S.); (K.M.P.); (K.T.B.)
| | - Gerard G. Hanna
- Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK;
| | - Karl T. Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, UK; (M.G.-P.); (K.M.R.); (D.M.S.); (K.M.P.); (K.T.B.)
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Yamaguchi H, Hsu JM, Sun L, Wang SC, Hung MC. Advances and prospects of biomarkers for immune checkpoint inhibitors. Cell Rep Med 2024; 5:101621. [PMID: 38906149 PMCID: PMC11293349 DOI: 10.1016/j.xcrm.2024.101621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/22/2024] [Accepted: 05/29/2024] [Indexed: 06/23/2024]
Abstract
Immune checkpoint inhibitors (ICIs) activate anti-cancer immunity by blocking T cell checkpoint molecules such as programmed death 1 (PD-1) and cytotoxic T lymphocyte-associated protein 4 (CTLA-4). Although ICIs induce some durable responses in various cancer patients, they also have disadvantages, including low response rates, the potential for severe side effects, and high treatment costs. Therefore, selection of patients who can benefit from ICI treatment is critical, and identification of biomarkers is essential to improve the efficiency of ICIs. In this review, we provide updated information on established predictive biomarkers (tumor programmed death-ligand 1 [PD-L1] expression, DNA mismatch repair deficiency, microsatellite instability high, and tumor mutational burden) and potential biomarkers currently under investigation such as tumor-infiltrated and peripheral lymphocytes, gut microbiome, and signaling pathways related to DNA damage and antigen presentation. In particular, this review aims to summarize the current knowledge of biomarkers, discuss issues, and further explore future biomarkers.
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Affiliation(s)
- Hirohito Yamaguchi
- Graduate Institute of Cell Biology, China Medical University, Taichung City 406040, Taiwan; Graduate Institute of Biomedical Sciences and Institute of Biochemistry and Molecular Biology, China Medical University, Taichung City 406040, Taiwan; Cancer Biology and Precision Therapeutics Center and Research Center for Cancer Biology, China Medical University, Taichung City 40402, Taiwan
| | - Jung-Mao Hsu
- Graduate Institute of Biomedical Sciences and Institute of Biochemistry and Molecular Biology, China Medical University, Taichung City 406040, Taiwan; Cancer Biology and Precision Therapeutics Center and Research Center for Cancer Biology, China Medical University, Taichung City 40402, Taiwan
| | - Linlin Sun
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shao-Chun Wang
- Graduate Institute of Biomedical Sciences and Institute of Biochemistry and Molecular Biology, China Medical University, Taichung City 406040, Taiwan; Cancer Biology and Precision Therapeutics Center and Research Center for Cancer Biology, China Medical University, Taichung City 40402, Taiwan; Center for Molecular Medicine, China Medical University Hospital, Taichung City 40402, Taiwan
| | - Mien-Chie Hung
- Graduate Institute of Biomedical Sciences and Institute of Biochemistry and Molecular Biology, China Medical University, Taichung City 406040, Taiwan; Cancer Biology and Precision Therapeutics Center and Research Center for Cancer Biology, China Medical University, Taichung City 40402, Taiwan; Center for Molecular Medicine, China Medical University Hospital, Taichung City 40402, Taiwan.
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Harris JP, Samson P, Owen D, Siva S, Daly ME, Giuliani M. Adapt or Perish: Adaptive RT for NSCLC. Int J Radiat Oncol Biol Phys 2024; 119:1047-1051. [PMID: 38925759 DOI: 10.1016/j.ijrobp.2024.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine, Orange, California.
| | - Pamela Samson
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Center, Victoria, Australia
| | - Megan E Daly
- Department of Radiation Oncology, University of California, Davis, California
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Jacob M, Fournel P, Tissot C, Cadranel J, Bylicki O, Monnet I, Justeau G, Ricordel C, Thomas P, Falchero L, Locher C, Wislez M, Vergnenegre A, Abdiche S, Guisier F, Bizieux A, Lamy R, François G, De Chabot G, Pierret T, Sabatini M, Abeillera M, Vieillot S, Martinez S, Morel H, Doubre H, Madroszyk A, Geier M, LucLabourey J, Chouaïd C, Greillier L. A prospective analysis of the management practices for patients with Stage-III-N2Non-Small-Cell lung cancer (OBSERVE IIIA-B GFPC 04-2020Study). Lung Cancer 2024; 194:107868. [PMID: 39003937 DOI: 10.1016/j.lungcan.2024.107868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/31/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Management of stage-III-N2 non-small-cell lung cancer (NSCLC) based on a multimodal strategy (surgery or radiotherapycombined with systemic drugs) remains controversial. Patients are treated with a curative intent, and available data suggestprolonged survival after complete resection. However, no consensual definition of "tumor resectability" exists. This study aimed to analyze the concordanceamong French tumor board meeting (TBM)-emittedtherapeutic decisions forstage-III-N2 NSCLC. METHODS Six patients with stage-III-N2 NSCLC discussed at Saint-Etienne University Hospital'sthoracic TBMs were selected, anonymouslyreported, and submitted to the participating TBMs. The primary goal of this multicenter, prospective, observational study was to assess the consistency of TBMpanel decisions for each case. The secondary endpointwas identifying the demographic or technical factors that potentiallyaffected decision-making. RESULTS Twenty-seven TBMs from university hospitals, a cancer center, general hospitals, and a private hospitalparticipated in this study. None of their decisions for the six cases were unanimous.The decisions were homogenous for three cases (78%, 85%, and 88% TBMs opted for medical treatment, respectively),andmore ambivalent for the other three (medical versus surgical strategies were favored by 44%/56%, 46%/54%, and 58%/42% TBMs, respectively). Interestingly, decisions regarding chemoradiationand perioperative chemotherapyinthe medical and surgical strategies, respectively, were also discordant. Hospital type, specialist participation in TBMs, and activity volumes were not significantly associated with therapeutic decisions. CONCLUSION The results of this study highlight substantial disparities amongFrench TBMs regarding therapeutic management of stage-III-N2 NSCLC. The decisions were not associated with local conditions.
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Affiliation(s)
- Mathilde Jacob
- Department of Pneumonology and Thoracic Oncology, CHU, Saint-Etienne, France
| | - Pierre Fournel
- Department of Pneumonology and Thoracic Oncology, CHU, Saint-Etienne, France
| | - Claire Tissot
- Oncology Department, Loire Private Hospital (HPL), Saint-Etienne, France
| | | | | | | | | | | | | | - Lionel Falchero
- Pneumology Department, CH Villefranche sur Soane,Villefranche sur Soane, France
| | | | - Marie Wislez
- Pneumology Department, Hôpital Cochin, APHP, France
| | | | - Samir Abdiche
- Pneumology Department, CH Libourne, Libourne, France
| | | | - Acya Bizieux
- Pneumology Department, CH, La Roche sur Yon, France
| | - Regine Lamy
- Pneumology Department, CH Lorient, Lorient, France
| | | | | | - Thomas Pierret
- Pneumology Department, Hospices civiles de Lyon, Lyon France
| | | | | | - Sabine Vieillot
- Service d'Oncologie, Centre Catalan oncologie Perpignan, Perpignan, France
| | | | - Hugues Morel
- Pneumology Department, CH d'Orleans, Orleans, France
| | | | - Anne Madroszyk
- Service d'Oncologie, Institut paolo Calmette, Marseille, France
| | | | | | | | - Laurent Greillier
- Aix-Marseille University, APHM, INSERM, CNRS, CRCM, Hospital Nord, MultidisciplinaryOncology and Therapeutic Innovations Department, Marseille, France
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Yoshida K, Asanuma K, Matsuyama Y, Okamoto T, Hagi T, Nakamura T, Sudo A. Release of Exosomal PD-L1 in Bone and Soft Tissue Sarcomas and Its Relationship to Radiotherapy. Cancers (Basel) 2024; 16:2489. [PMID: 39001550 PMCID: PMC11240571 DOI: 10.3390/cancers16132489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 06/26/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
(1) Background: Exosomal PD-L1 has garnered attention owing to its role in instigating systemic immune suppression. The objective of this study is to elucidate whether bone and soft tissue sarcoma cells possess the capacity to secrete functionally active exosomal PD-L1 and whether radiotherapy (RT) induces the exosomal PD-L1 release. (2) Methods: Human osteosarcoma cell line 143B and human fibrosarcoma cell line HT1080 were utilized. Exosomes were isolated from the culture medium and blood via ultracentrifugation. The expression of PD-L1 on both tumor cells and exosomes was evaluated. The inhibitory effect on PBMC was employed to assess the activity of exosomal PD-L1. Post radiotherapy, changes in PD-L1 expression were compared. (3) Results: Exosomal PD-L1 was detected in the culture medium of tumor cells but was absent in the culture medium of PD-L1 knockout cells. Exosomal PD-L1 exhibited an inhibitory effect on PBMC activation. In tumor-bearing mice, human-derived exosomal PD-L1 was detected in the bloodstream. Following radiotherapy, tumor cells upregulated PD-L1, and human-derived exosomal PD-L1 were detected in the bloodstream. (4) Conclusions: Exosomal PD-L1 emanates from bone and soft tissue sarcoma cells and is disseminated into the circulatory system. The levels of PD-L1 in tumor cells and the release of exosomal PD-L1 were augmented after irradiation with RT.
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Affiliation(s)
- Keisuke Yoshida
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Yumi Matsuyama
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Takayuki Okamoto
- Department of Pharmacology, Faculty of Medicine, Shimane University, Izumo 693-0021, Shimane, Japan
| | - Tomohito Hagi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Mie, Japan
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Kakiuchi Y, Saruwatari K, Murotani K, Tokito T, Iriki T, Iwakawa J, Sakata Y, Shingu N, Saeki S, Inaba M, Takaki A, Misono S, Suetsugu T, Azuma K, Mizuno K, Sakagami T. Real-World Efficacy and Safety of Durvalumab Administration Following Chemoradiotherapy in Elderly Patients With Unresectable Locally Advanced Nonsmall Cell Lung Cancer: A Multicenter, Retrospective Study. Clin Lung Cancer 2024:S1525-7304(24)00139-6. [PMID: 39095234 DOI: 10.1016/j.cllc.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/07/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The PACIFIC trial established durvalumab administration after chemoradiotherapy as the standard of care for unresectable locally advanced nonsmall cell lung cancer (LA-NSCLC). However, the efficacy and safety of durvalumab in elderly patients aged 75 years or above remains unclear. This study aimed to investigate the real-world efficacy and safety of durvalumab for LA-NSCLC, with a specific focus on elderly patients. PATIENTS AND METHODS We reviewed 214 patients who received durvalumab out of 278 patients with unresectable LA-NSCLC who underwent chemoradiotherapy at 7 institutions between July 2018 and March 2022. Propensity score matching (PSM) analysis was performed to evaluate the efficacy of durvalumab in elderly patients. RESULTS The 2-year progression-free survival (PFS) and 2-year overall survival (OS) rates were 42.2% (95% confidence interval [CI], 34.7%-49.5%) and 77.1% (95% CI, 70.1-82.7%), respectively. Grade ≥ 3 immune-related adverse events (irAEs) occurred in 8.2% of patients. PSM analysis revealed that OS was significantly shorter in elderly patients (≥ 75 years) than in younger patients (< 75 years) (hazard ratio [HR]; 95% CI, 1.39-8.99; P = .008), whereas PFS did not differ significantly between the 2 groups (HR: 1.50, 95% CI, 0.84-2.68, P = .169). The frequency of irAEs did not differ between these groups. CONCLUSIONS The real-world efficacy and safety of durvalumab administration following chemoradiotherapy for LA-NSCLC coincided with the PACIFIC trial's findings. Disease control achieved with this protocol did not differ significantly between elderly and younger patients but had acceptable tolerability, demonstrating its benefit even in elderly LA-NSCLC patients aged 75 years or above.
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Affiliation(s)
- Yosuke Kakiuchi
- Department of Respiratory Medicine, Japan Community Health Care Organization Hitoyoshi Medical Center, Hitoyoshi City, Kumamoto, Japan
| | - Koichi Saruwatari
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan.
| | - Kenta Murotani
- School of Medical Technology, Kurume University, Kurume City, Fukuoka, Japan; Biostatistics Center, Kurume University, Kurume City, Fukuoka, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Toyohisa Iriki
- Department of Respiratory Medicine, Imakiire General Hospital, Kagoshima City, Kagoshima, Japan
| | - Jun Iwakawa
- Department of Respiratory Medicine, Imakiire General Hospital, Kagoshima City, Kagoshima, Japan
| | - Yoshihiko Sakata
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Naoki Shingu
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto City, Kumamoto, Japan
| | - Sho Saeki
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto City, Kumamoto, Japan
| | - Megumi Inaba
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto City, Kumamoto, Japan
| | - Akira Takaki
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
| | - Shunsuke Misono
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Kagoshima, Japan
| | - Takayuki Suetsugu
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Kagoshima, Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume City, Fukuoka, Japan
| | - Keiko Mizuno
- Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima City, Kagoshima, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
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Chang AEB, Piper-Vallillo AJ, Mak RH, Lanuti M, Muzikansky A, Rotow J, Jänne PA, Mino-Kenudson M, Swanson S, Wright CD, Kozono D, Marcoux P, Piotrowska Z, Sequist LV, Willers H. The ASCENT Trial: a phase 2 study of induction and consolidation afatinib and chemoradiation with or without surgery in stage III EGFR-mutant NSCLC. Oncologist 2024; 29:609-618. [PMID: 38761385 PMCID: PMC11224994 DOI: 10.1093/oncolo/oyae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/04/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The role of tyrosine kinase inhibitors (TKIs) in early-stage and metastatic oncogene-driven non-small cell lung cancer (NSCLC) is established, but it remains unknown how best to integrate TKIs with concurrent chemoradiotherapy (cCRT) in locally advanced disease. The phase 2 ASCENT trial assessed the efficacy and safety of afatinib and cCRT with or without surgery in locally advanced epidermal growth factor receptor (EGFR)-mutant NSCLC. PATIENTS AND METHODS Adults ≥18 years with histologically confirmed stage III (AJCC 7th edition) NSCLC with activating EGFR mutations were enrolled at Mass General and Dana-Farber/Brigham Cancer Centers, Boston, Massachusetts. Patients received induction afatinib 40 mg daily for 2 months, then cisplatin 75 mg/m2 and pemetrexed 500 mg/m2 IV every 3 weeks during RT (definitive or neoadjuvant dosing). Patients with resectable disease underwent surgery. All patients were offered consolidation afatinib for 2 years. The primary endpoint was the objective response rate (ORR) to induction TKI. Secondary endpoints were safety, conversion to operability, progression-free survival (PFS), and overall survival (OS). Analyses were performed on the intention-to-treat population. RESULTS Nineteen patients (median age 56 years; 74% female) were enrolled. ORR to induction afatinib was 63%. Seventeen patients received cCRT; 2/9 previously unresectable became resectable. Ten underwent surgery; 6 had a major or complete pathological response. Thirteen received consolidation afatinib. With a median follow-up of 5.0 years, median PFS and OS were 2.6 (95% CI, 1.4-3.1) and 5.8 years (2.9-NR), respectively. Sixteen recurred or died; 6 recurrences were isolated to CNS. The median time to progression after stopping consolidation TKI was 2.9 months (95% CI, 1.1-7.2). Four developed grade 2 pneumonitis. There were no treatment-related deaths. CONCLUSION We explored the efficacy of combining TKI with cCRT in oncogene-driven NSCLC. Induction TKI did not compromise subsequent receipt of multimodality therapy. PFS was promising, but the prevalence of CNS-only recurrences and rapid progression after TKI discontinuation speak to unmet needs in measuring and eradicating micrometastatic disease.
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Affiliation(s)
- Allison E B Chang
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Andrew J Piper-Vallillo
- Department of Medicine, Division of Hematology/Oncology, Lahey Hospital and Medical Center, Burlington, MA 01805, United States
| | - Raymond H Mak
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Michael Lanuti
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Alona Muzikansky
- Massachusetts General Hospital Biostatistics Center, Boston, MA 02114, United States
| | - Julia Rotow
- Lowe Center for Thoracic Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Pasi A Jänne
- Lowe Center for Thoracic Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Scott Swanson
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Cameron D Wright
- Department of Surgery, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - David Kozono
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA 02215, United States
| | - Paul Marcoux
- Lowe Center for Thoracic Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02115, United States
| | - Zofia Piotrowska
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Lecia V Sequist
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
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Jun S, Shukla NA, Durm G, Hui AB, Cao S, Ganti AK, Jabbour SK, Kunder C, Alizadeh AA, Hanna NH, Diehn M. Analysis of Circulating Tumor DNA Predicts Outcomes of Short-Course Consolidation Immunotherapy in Unresectable Stage III NSCLC. J Thorac Oncol 2024:S1556-0864(24)00664-6. [PMID: 38971369 DOI: 10.1016/j.jtho.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/13/2024] [Accepted: 06/30/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION The current standard of care for patients with inoperable stage III non-small cell lung cancer includes chemoradiotherapy (CRT) followed by 1 year of checkpoint inhibitor (CPI) therapy. Nevertheless, the optimal duration of consolidation CPI remains unknown. Here, we characterized the relationship between circulating tumor DNA (ctDNA) minimal residual disease (MRD) and clinical outcomes of patients with unresectable locally advanced non-small cell lung cancer treated on a phase 2 trial of short-course consolidation immunotherapy after CRT, with the goal of testing whether ctDNA may be able to identify patients who do not require a full year of treatment. METHODS Plasma samples for ctDNA analysis were collected from patients on the Big Ten Cancer Research Consortium LUN 16-081 trial after completion of CRT, before day 1 of cycle 2 (C2D1) of CPI (i.e., 1 mo after treatment start), and at the end of up to 6 months of treatment. Tumor-informed ctDNA MRD analysis was performed using cancer personalized profiling by deep sequencing. Levels of ctDNA at each time point were correlated with clinical outcomes. RESULTS Detection of ctDNA predicted significantly inferior progression-free survival after completion of CRT (24-mo 29% versus 65%, p = 0.0048), before C2D1 of CPI (24-mo 0% versus 72%, p < 0.0001) and at the end of CPI (24-mo 15% versus 67%, p = 0.0011). In addition, patients with decreasing or undetectable ctDNA levels after 1 cycle of CPI had improved outcomes compared with patients with increasing ctDNA levels (24-mo progression-free survival 72% versus 0%, p < 0.0001). Progression of disease occurred within less than 12 months of starting CPI in all patients with increasing ctDNA levels at C2D1. CONCLUSIONS Detection of ctDNA before, during, or after 6 months of consolidation CPI is strongly associated with inferior outcomes. Our findings suggest that analysis of ctDNA MRD may enable personalizing the duration of consolidation immunotherapy treatment.
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Affiliation(s)
- Soyeong Jun
- Department of Radiation Oncology, Stanford University, Stanford, California; Stanford Cancer Institute, Stanford University, Stanford, California
| | - Nikhil A Shukla
- Community Hospital Oncology Physicians, Community Health Network MD Anderson Comprehensive Cancer Center, Indianapolis, Indiana
| | - Greg Durm
- Division of Hematology/Oncology, IU Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Angela B Hui
- Department of Radiation Oncology, Stanford University, Stanford, California; Stanford Cancer Institute, Stanford University, Stanford, California
| | - Sha Cao
- Division of Hematology/Oncology, IU Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Apar Kishor Ganti
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Christian Kunder
- Department of Pathology, Stanford University, Stanford, California
| | - Ash A Alizadeh
- Stanford Cancer Institute, Stanford University, Stanford, California; Division of Oncology, Department of Medicine, Stanford University, Stanford, California; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California
| | - Nasser H Hanna
- Division of Hematology/Oncology, IU Simon Comprehensive Cancer Center, Indianapolis, Indiana
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, California; Stanford Cancer Institute, Stanford University, Stanford, California; Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California.
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50
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Wang C, Fu H, Wang F. Durvalumab supplementation for non-small-cell lung cancer: a meta-analysis study. J Cardiothorac Surg 2024; 19:421. [PMID: 38965530 PMCID: PMC11223428 DOI: 10.1186/s13019-024-02940-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 06/17/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Durvalumab supplementation may have some potential in improving the efficacy in patients with non-small-cell lung cancer (NSCLC), and this meta-analysis aims to explore the impact of durvalumab supplementation on efficacy for NSCLC. METHODS PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials (RCTs) assessing the effect of durvalumab supplementation on efficacy in patients with NSCLC. Overall survival and progression-free survival were included for this meta-analysis. RESULTS Four RCTs were finally included in the meta-analysis. Overall, compared with control group for NSCLC, durvalumab supplementation showed significantly improved survival rate (odd ratio [OR] = 1.64; 95% confidence interval [CI] = 1.31 to 2.06; P < 0.0001), overall survival ( hazard ratio [HR] = 0.73; 95% CI = 0.61 to 0.87; P = 0.0003), progression-free survival rate (OR = 2.31; 95% CI = 1.78 to 3.01; P < 0.00001) and progression-free survival (HR = 0.71; 95% CI = 0.54 to 0.95; P = 0.02), and had the capability to reduce the incidence of grade ≥ 3 adverse events (OR = 0.26; 95% CI = 0.16 to 0.42; P < 0.00001). CONCLUSIONS Durvalumab supplementation is effective to improve the efficacy for NSCLC.
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Affiliation(s)
- Chengchen Wang
- Department of Oncology Radiotherapy Center, Chongqing University Cancer Hospital, Chongqing, 400030, China.
- Chongqing University Cancer Hospital, No. 181 Hanyu Road, Chongqing, 400030, China.
| | - Hongyi Fu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China
| | - Feng Wang
- Department of Oncology Radiotherapy Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
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